BACKGROUND: Changes in per capita alcohol consumption are temporally linked to changes in rates of alcohol-related harm. Methodological approaches for analysing this relationship have been suggested, however, the problem of time lags is not well-addressed. This study provides a review of time lag specifications, looking at (a) time to first effect on harm, (b) time to full effect and (c) the functional form of the effect accumulation from first to full effect to inform modelling of the relationship between changes in aggregate alcohol consumption and changes in rates of harm.

METHODS: Bibliographic databases were searched and citation and reference checking was used to identify studies. Included studies were time series analyses of the relationship between aggregated population alcohol consumption and rates of alcohol-related harms where time lag specifications had been derived or tested.

RESULTS: 36 studies were included with liver cirrhosis, heart disease and suicide dominating the evidence base. For a large number of alcohol-related harms, no literature was identified. There was strong evidence of an immediate first effect following a change in consumption for most harms. Recommended lag specifications are proposed for a set of alcohol-attributable harms.

CONCLUSIONS: Research on time lag specifications is under-developed for most harms although we provide suggested specifications based on the findings of the review. Greater methodological attention needs to be given to the rationale for choosing or applying lag specifications and the inherent complexity of the time lag process. More consistent and transparent reporting of methodological decisions would aide progress in the field.

Introduction and Aims: The majority view among alcohol epidemiologists is that the lower coronary heart disease mortality observed in moderate drinkers is probably evidence for a protective effect of moderate drinking. In this paper I critically discuss the debate about what type of information, if any, should be provided to the public about the putative coronary heart disease benefits of moderate alcohol use.

Results: Most opposition to informing the public about these putative benefits is based on the fear that such advice will increase per capita alcohol consumption and therefore alcohol-related harm. It is unclear how well-based these concerns are. In the interim, the alcohol industry has communicated these putative benefits to the public.

Conclusions: There is a case for including some information on these putative benefits in specific safer drinking guidelines for middle-aged and older drinkers that: clearly conveys the remaining uncertainty about the benefits of moderate drinking, emphasises the conditional nature of any such benefits, and stresses the need to balance the potential benefits against the increased sensitivity of older adults to other adverse effects of alcohol, and the increased risk of interactions between alcohol and other medications used by older adults.

Aims: To review the concept of binge drinking as a measure of risky single occasion drinking (RSOD), to illustrate its differential impact on selected health outcomes and to identify research gaps.

Methods: Narrative literature review with focus on conceptual and methodological differences, trajectories of RSOD and effects of RSOD on fetal outcomes, coronary heart disease (CHD) and injuries.

Results: Effects ascribed commonly to RSOD may often be the effects of an undifferentiated mixture of risky single occasions and regular heavy volume drinking, constituted by frequent, successive RSOD. This leads to the problem that additional risks due to RSOD are mis-specified and remain unidentified or underestimated in some cases, such as for injuries or CHD, but are probably overstated for some chronic consequences or for effects of maternal drinking on newborns.

Conclusion: A stronger focus should be placed upon methods that can differentiate the effects of RSOD from those due to frequent occasions of heavy drinking that result in heavy volume drinking.

BACKGROUND AND AIMS: To estimate the association between patterns of alcohol consumption and biomarkers of coronary heart disease (CHD) risk.

METHODS AND RESULTS: Cross-sectional study among 10,793 individuals representative of the Spanish population aged >/=18 years. The threshold between moderate and heavy drinking was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of >/=80 g of alcohol in men and >/=60 g in women at any drinking occasion in the preceding 30 days. Analyses were performed with generalized linear models with adjustment for the main confounders, and results were expressed as the percentage change in the geometric mean (PCGM). Compared to non-drinkers, moderate and heavy drinkers had progressively higher serum HDL-cholesterol, with a PCGM ranging from 4.8% (95% CI: 3.7-6.0%) in moderate drinkers without binge drinking (MNB) to 9.6% (5.1-14.2%) in heavy drinkers with binge drinking (HB). Fibrinogen decreased progressively with alcohol intake, from -2.2% (-3.1 to -1.3%) in MNB to -5.8% (-9.4 to -2.0%) in HB. Leptin, glycated hemoglobin and the HOMA-index also decreased with increasing alcohol intake, and particularly with binge drinking.

CONCLUSIONS: Moderate alcohol intake is associated with improved HDL-cholesterol, fibrinogen and markers of glucose metabolism, which is consistent with the reduced CHD risk of moderate drinkers in many studies. Heavy and binge drinking were also associated with favorable levels of CHD biomarkers; since these drinking patterns produce substantial health harms, our results should not be used to promote alcohol consumption.

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