Heavy drinking into older age adds 4 cm to waistline

More than half of drinkers aged 59 and over have been heavy drinkers and this is linked to a significantly larger waistline and increased stroke risk, according to a new UCL study.

The study, published in the journal Addiction, examined the association between heavy drinking over a lifetime and a range of health indicators including cardiovascular disease.

The researchers used data from the Whitehall II cohort, which collected information from UK civil servants, aged 34-56 years at study outset, since 1985-88. The final sample for this study was made up of 4,820 older adults, aged between 59 and 83 years. The mean (average) age was 69, and 75% were male.

It found that heavy alcohol consumption over a lifetime is associated with higher blood pressure, poorer liver function, increased stroke risk, larger waist circumferences and body mass index (BMI) in later life, even if you stop drinking heavily before age 50. However, stopping heavy drinking at any point in life is likely to be beneficial for overall health.

Dr Linda Ng Fat (UCL Institute of Epidemiology & Health Care), first author on the study, said: “Alcohol misuse, despite the common perception of young people binge drinking, is common among older adults, with alcohol related hospital admissions in England being the highest among adults aged over 50.

“Previous studies have focused on single snapshots of consumption, which has the potential to mask the cumulative effects of drinking. This study raises awareness of the effect of alcohol consumption over the life-course.”

A heavy drinker was identified using the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), a standard screening tool for GPs. The screening tool consists of just three questions, and assesses how often you drink, how much you drink, and how often you binge (have six or more drinks). To provide an example a person who has three or four drinks, four or more times a week, would score positive as a hazardous drinker on the AUDIT-C.

Participants were asked on a single occasion to complete the AUDIT-C retrospectively for each decade of their life, from 16-19 to 80 and over. This information was used to categorise their life-time drinking pattern: never hazardous drinker, former early hazardous drinker (stopped before age 50), former later hazardous drinker (stopped at age 50 or after), current hazardous drinker, and consistent hazardous drinker (during every decade of their life).

More than half of drinkers (56%) had been hazardous drinkers at some point in their life, with 21% being current hazardous drinkers and 5% being consistent hazardous drinkers.

Current and consistent heavy drinkers were mainly male (80% and 82%, respectively), predominately white, and likely to be in senior level jobs (61% compared with 52% in the total sample).

Former later, current and consistent hazardous drinkers had significantly higher systolic blood pressure and poorer liver function, than never hazardous drinkers, after adjusting for lifestyle factors. Among current hazardous drinkers, systolic blood pressure was 2.44 mmHG higher and gamma-glutamyl transferase (GGT), a marker of liver disease, was elevated by 22.64 IU/l, compared with never hazardous drinkers.

Current hazardous drinkers had three times greater risk of stroke and former later hazardous drinkers had approximately two times higher risk of non-cardiovascular disease mortality compared with never hazardous drinkers.

Lifetime hazardous drinkers had significantly larger waist circumferences and BMI than never hazardous drinkers, with the magnitude increasing with more current and consistent hazardous drinking.

Former early hazardous drinkers on average had a 1.17 cm larger waist than never hazardous drinkers, whereas former later hazardous drinkers, current hazardous drinkers and consistent hazardous drinkers had a waist circumference that was 1.88 cm, 2.44 cm and 3.85cm larger respectively.

Dr Ng Fat added: “This suggests that the longer adults engage in heavy drinking the larger their waistline in older age. That is why it is beneficial, along with other health benefits, that adults reduce heavy drinking earlier rather than later.”

Professor Annie Britton (UCL Institute of Epidemiology & Health Care), senior author on the study, said: “Despite high prevalence of stroke and liver disease steadily increasing in the United Kingdom, heavy drinking remains common among older adults.

“Early intervention and screening for alcohol consumption, as part of regular check-ups, could help reduce hazardous drinking among this demographic.”


How we perceive close relationships with others determines our willingness to share food

In the midst of a global pandemic, a lot of people rightly will be reluctant to offer food from their plate to another person, or accept such an offer due to the fear of contamination.

But for people with “attachment avoidance,” a psychological term for reluctance to form close personal relationships, this was true long before anybody had heard the term “COVID-19.”

“When we share food, it shows trust — it shows we’re willing to give up some of our resources, and it shows we want to get close with someone,” said Omri Gillath, professor of psychology at the University of Kansas. “Think about the psychological aspect of comfort food. When people are feeling down, when they’re upset, when they’re stressed, food is a source of comfort. We think in part this is because of the connection between food and love. If you think about breastfeeding, babies are getting both the food and the nutrition they need, and the warmth and love from their mom, this creates a strong connection between food and love.”

Gillath is a co-author of a new paper, led by KU doctoral student Sabrina Gregersen, that examines the links between food-sharing and styles of attachment. It was just published in the peer-reviewed journal Appetite.

“‘Attachment’ is a theory that explains how people bond to each other and how they regulate their emotions,” Gillath said. “People have an attachment style based on early interactions with their primary caregivers — parents usually. The three main styles are secure, anxious and avoidant. If you have parents that were supportive and sensitive and find a good balance between helping you on the one hand and providing autonomy on the other, you’re more likely to be secure. If you had parents that were insensitive and intrusive and weren’t consistent about the help they provided, you’re more likely to be anxious. And then if you had parents that were cold and rejecting, you are more likely to develop an avoidant attachment style. These differences that people develop pretty early predict a lot of relational behaviors and outcomes.”

To see how these attachment styles affected people’s food-sharing behaviors, the KU researchers conducted several studies. In one study, participants answered a battery of questions, many of which touched on how food preferences might be tied to romantic or dating behavior for people with various attachment styles. In a different study, participants were placed in a situation where they interacted with another person while one of them had a pack of fruit snacks.

“We brought people to the lab and had them fill out a few questionnaires, then we exposed them to either attachment-security-related cues or control cues,” Gillath said. “For example, we asked them to think about a secure relationship, which activated their security-related models. Then we asked them to wait outside in a waiting area. In both studies they happened to meet another ‘participant’ in that area. In one study, we gave the participant a bag of treats and wanted to see if they would share it, and in the other study, we gave our confederate, who was supposedly another participant, a bag of treats and they offered to share. We wanted to see whether participants would accept the food offering. Many participants were reluctant to take food or give it. However, some people — those who were exposed to security-related cues — were more likely to share their treat with a stranger.”

From the first study, the researchers found people high on attachment avoidance were less likely to share food or date a potential partner who had dissimilar food preferences. In the second study, they found enhancing attachment security increased the tendency to offer one’s food to a fellow participant. In the final study, the team found the tendency to accept food from a fellow participant was positively associated with attachment anxiety, but security priming did not affect this tendency.

Gillath said a better understanding of the links between attachment and food could potentially help inform efforts to extend help to people during the current coronavirus pandemic — particularly among people with high attachment avoidance, who, the authors wrote, “were less likely to engage in food sharing behaviors with current romantic partners and less likely to cook and eat meals with their partners.”

“We could also use the findings to better understand people’s tendencies when it comes to prosocial behavior,” he said. “Right now, with the coronavirus crisis, trust — or the lack of — is a major obstacle. On the one hand, some people don’t have food, they don’t have a job, they don’t have the means to support themselves. On the other hand, there are people who want to help others by giving them food or other resources but are afraid of the consequences. Fear and confusion — of contamination or starvation — may lead people to hoard, preventing them from sharing resources — not giving to those who need them, or buying too much and not leaving to people who also might need — see the rush to buy toilet paper. How can we fix that? If people aren’t taking food because of trust issues, we should ask, ‘Are you guys willing to starve (or not getting the right treatment because of your fears)?’ I’m not saying we want to make people trust anyone and everyone; however, we do want to reduce anxiety, increase security and facilitate food — and resource sharing — in a safe way.”

According to Gillath, in a crisis situation sharing and accepting food and other resources could have psychological benefits beyond just making sure people have enough to eat.

“Not having food and feeling insecure about the whole situation is definitely going to increase mental health issues — whereas having food and having people looking out for you can not only keep people from starving but also potentially help with their mental health and anxieties,” he said. “It is in times like these when we need to find a way to come together, reduce anxiety and help each other out. Making people feel secure can help with that.”


Relationship between different levels of the Mexican food environment and dietary intake: a qualitative systematic review

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Higher daily step count linked with lower all-cause mortality

In a new study, higher daily step counts were associated with lower mortality risk from all causes. The research team, which included investigators from the National Cancer Institute (NCI) and the National Institute on Aging (NIA), both parts of the National Institutes of Health, as well as from the Centers for Disease Control and Prevention (CDC), also found that the number of steps a person takes each day, but not the intensity of stepping, had a strong association with mortality.

The findings were published March 24, 2020, in the Journal of the American Medical Association.

“While we knew physical activity is good for you, we didn’t know how many steps per day you need to take to lower your mortality risk or whether stepping at a higher intensity makes a difference,” said Pedro Saint-Maurice, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics, first author of the study. “We wanted to investigate this question to provide new insights that could help people better understand the health implications of the step counts they get from fitness trackers and phone apps.”

Previous studies have been done on step counts and mortality. However, they were conducted primarily with older adults or among people with debilitating chronic conditions. This study tracked a representative sample of U.S. adults aged 40 and over; approximately 4,800 participants wore accelerometers for up to seven days between 2003 and 2006. The participants were then followed for mortality through 2015 via the National Death Index. The researchers calculated associations between mortality and step number and intensity after adjustment for demographic and behavioral risk factors, body mass index, and health status at the start of the study.

They found that, compared with taking 4,000 steps per day, a number considered to be low for adults, taking 8,000 steps per day was associated with a 51% lower risk for all-cause mortality (or death from all causes). Taking 12,000 steps per day was associated with a 65% lower risk compared with taking 4,000 steps. In contrast, the authors saw no association between step intensity and risk of death after accounting for the total number of steps taken per day.

“At NIA, we’ve long studied how exercise is important for older adults, and it’s good to see further evidence from a large study with a broad sample that the main thing is to get moving for better overall health as we age,” said Eric Shiroma, Ph.D., a co-author and NIA Intramural Research Program scientist.

In analyses by subgroups of participants, the authors found that higher step counts were associated with lower all-cause death rates among both men and women; among both younger and older adults; and among white, black, and Mexican-American adults. In secondary outcomes of the study, higher step counts were also associated with lower rates of death from cardiovascular disease and cancer.

Data collection was conducted through the CDC’s National Health and Nutrition Examination Survey (NHANES), a program of studies designed to assess a nationally representative sample of the health and nutritional status of adults and children in the United States.

The researchers were surprised they didn’t find an association between higher stepping intensity and all-cause mortality after adjusting for the total number of steps per day. Because few studies have investigated an association between mortality and intensity among adults going about their daily lives, the study authors wrote that future studies of walking intensity and mortality are warranted.

Although the study authors controlled for factors that could have affected the results, the study is observational and cannot prove causality. Nevertheless, their findings are consistent with current recommendations that adults should move more and sit less throughout the day. Adults who do any amount of physical activity gain some health benefits. For even greater health benefits, adults are recommended to get at least 150 minutes of moderate-intensity physical activity per week.

“Being physically active has many benefits, including reducing a person’s risk of obesity, heart disease, type 2 diabetes, and some cancers. And on a daily basis, it can help people feel better and sleep better,” said Janet Fulton, Ph.D., of CDC’s Division of Nutrition, Physical Activity, and Obesity. “CDC is working with communities and partners across the country, as part of the Active People, Healthy Nation initiative, to make it easier, safer, and more convenient for people to be active in their own communities.”


Orthorexia nervosa: examining the Eating Habits Questionnaire’s reliability and validity, and its links to dietary adequacy among adult women

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