Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults

Naimi, Timothy S.; Brown, David W.; Brewer, Robert D.; Giles, Wayne H.; Mensah, George A.; Serdula, Mary K.; Mokdad, Ali H.; Hungerford, Daniel W.; Lando, James; Naimi, Shapur; Stroup, Donna F.

doi:10.1016/j.amepre.2005.01.011

Cited by 276 publications

(243 citation statements)

References 22 publications

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“…The most plausible alternative explanation to there being a causal association between moderate drinking and reduced risk of some diseases is the failure to control for confounding life-style risk factors. In a classic study, Naimi et al [8] found that out of 30 potential risk factors for heart disease unrelated to drinking, abstainers were at significantly higher risk than were light or moderate drinkers on 27 risk factors. The plausibility of this alternative explanation is also made starkly apparent (although rarely remarked upon) by numerous studies reporting biologically implausible health benefits associated with moderate drinking [9].…”

mentioning

confidence: 99%

Commentary on Roerecke & Rehm (2012): The state of the science on moderate drinking and health—a case of heterogeneity in and heterogeneity out?

Stockwell¹

2012

Addiction

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confidence: 99%

Commentary on Roerecke & Rehm (2012): The state of the science on moderate drinking and health—a case of heterogeneity in and heterogeneity out?

Stockwell¹

2012

Addiction

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“…This decline has been shown to occur among those individuals most vulnerable to morbidity and mortality [8][9][10]. People most likely to be stable in their drinking-the light or moderate drinkers-tend to have the most favourable health characteristics [11,12]. Britton et al acknowledge these findings by stating that it is well established that the nondrinking group often includes former drinkers who terminated consumption due to ill health.…”

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confidence: 88%

“…This study reminds us all that a number of confounders, including the onset of ill health, may explain these findings [11,17], and until these are properly accounted for our efforts will remain tentative and incomplete. Britton et al may still redeem their own efforts by performing additional analyses on their data to address the critical question of whether illness drove alcohol consumption down among the high variability group or vice versa.…”

Section: Commentary On Britton Et Al (2010):the Dangers Of Decliningmentioning

confidence: 99%

“…Secondly, civil servants are not well suited to study variation because they do not represent the general population and sample loss (37%) may have been due to vulnerable subjects dropping out of the study. Undoubtedly, respondents retained in this nonrepresentative sample are biased in favour of those with continuing good health.This study reminds us all that a number of confounders, including the onset of ill health, may explain these findings [11,17], and until these are properly accounted for our efforts will remain tentative and incomplete. Britton et al may still redeem their own efforts by performing additional analyses on their data to address the critical question of whether illness drove alcohol consumption down among the high variability group or vice versa.…”

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Commentary on Britton et al. (2010): The dangers of declining drink

Fillmore

Chikritzhs²

2010

Addiction

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Commentary on Britton et al. (2010):The dangers of declining drink add_2895 646..648 The real significance of the Britton et al. [1] paper is overlooked by the authors themselves. Alcohol intake varies in the same individuals over time, declining with increasing age in many countries [2][3][4][5][6][7]. This decline has been shown to occur among those individuals most vulnerable to morbidity and mortality [8][9][10]. People most likely to be stable in their drinking-the light or moderate drinkers-tend to have the most favourable health characteristics [11,12]. Britton et al. acknowledge these findings by stating that it is well established that the nondrinking group often includes former drinkers who terminated consumption due to ill health.The Britton et al. results are not surprising, in that they show a 'drift' down in consumption after the middle years of life among those who have been 'heavier' drinkers at one time or another. An understanding of this 'drift' requires multiple measurements associated with health changes over time. The authors might have contributed substantially to understanding whether it is the declining drink, the illness/medication or the interactions of these that predict premature mortality/morbidity.Britton et al. provide but four characteristics of group variability (smoking, age, employment grade and alcohol consumption in the last week). Unfortunately, the authors do not supply the characteristics relating to health status, serious disease and medication use that might account not only for the decline in the drinking, but also for mortality/morbidity. If these characteristics are not factored into the analysis, we have no understanding of what is actually driving the elevated riskthe drinking, the onset of illness or both.Despite this major limitation, this paper should be welcomed because cohort studies associating alcohol use with disease outcomes have lagged far behind the remainder of the alcohol field, the latter taking into account variation in drinking behaviour. In recent years greater attention has been paid to these matters by cohort studies, but they are few (e.g. [13][14][15]). They illustrate that drinking behaviour is complex and may be implicated with respect to disease incidence and, in fact, may be critical-but only in part-to understanding how drinking might affect outcome.Previously, alcohol studies have put great emphasis on differentiating between these patterns, recognizing that they had profound implications for social problems, accidents and injuries. Knupfer's 1989 [16] attempt to classify drinkers into, among other groups, a variety of 'heavy' drinkers found that when the bar was set low, the association between 'heavy' drinking and frequent drunkenness and serious problems was missed. This required the combination of 10 general population crosssectional data sets. Like most studies, Britton et al. lack an adequate sample size. As anyone performing these studies will testify, the choice of analytical strategy is difficult, the analysts fast run out of...

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“…We use the term 'moderate use' here to refer to a level of psychoactive substance use that is associated with no harm. Indeed, some research suggests that moderate use of alcohol not only may cause no harm, it may be beneficial [5,6]. It is more difficult to think of moderate or non-problem levels of use of other substances (e.g.…”

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confidence: 99%

Matching clients' treatment goals with treatment oriented towards abstinence, moderation or harm reduction

Finney

Moos

2006

Addiction

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Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults

Cited by 276 publications

References 22 publications

Commentary on Roerecke & Rehm (2012): The state of the science on moderate drinking and health—a case of heterogeneity in and heterogeneity out?

Commentary on Roerecke & Rehm (2012): The state of the science on moderate drinking and health—a case of heterogeneity in and heterogeneity out?

Commentary on Britton et al. (2010): The dangers of declining drink

Matching clients' treatment goals with treatment oriented towards abstinence, moderation or harm reduction

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