Greater risk of ascitic cirrhosis in females in relation to alcohol consumption.

The risk of ascitic cirrhosis increases with average daily consumption of alcoholic beverages, both in males and in females. For the latter, however, the curve is much steeper, indicating a greater risk for the female liver, with the disease occurring earlier in life. Health implications are discussed.

Ascitic cirrhosis in relation to alcohol consumption.

The average daily alcohol consumption of 184 male patients with ascitic cirrhosis and a random population sample of 778 males was ascertained by interview. Relative risks of ascitic cirrhosis are calculated for different levels of daily alcohol consumption: the logarithm of risk is shown to be a linear function of consumption. The proportion of cases attributable to alcohol is calculated and shown to be over 90%. The potential saving of ascitic cirrhosis if individual consumption of alcohol does not exceed 40g. per day is estimated at 80%.

Varicose veins: a risk factor for atherosclerotic disease in middle-aged men?

The prevalence of varicose veins was higher among lower social subjects and was positively associated with a body-mass index, cigarette consumption and diastolic blood pressure. A detailed dietary survey in a subsample of the population showed a significantly higher total calory intake in men with varicose veins but no difference in the distribution of the various nutrients. During follow up for subsequent atherosclerotic disease (average 6.6 yrs), men with varicose veins were at a significantly higher risk for intermittent claudication and, at least in the lower social class, for hard coronary heart disease. No association was found with angina pectoris incidence.

Relationship between adiposity and food intake: an example of pseudo-contradictory results obtained in case-control versus between-populations studies.

Seemingly contradictory data support controversies concerning the relationships between food intake and illnesses. The present study of 1035 adults, aged 30-39 years, shows that (1) daily energy intake is not higher in obese than in non-obese people, (2) obesity is more prevalent in social groups where energy intake is higher. These pseudo-contradictory results can be reconciled on the basis of a constitution/environment interaction. A comparison of groups based on presence or absence of illness (obesity, hypertension, coronary heart disease (CHD), cancer, etc) shows that some people can develop risk factors, even though their feeding behaviour is normal. This result (no direct relationship) underlines differences in individual susceptibility. When comparisons are made between populations with different diets the results (direct relationship) express environmental factors. The hypotheses on behavioural contribution to the aetiology of certain diseases appears more clearly in between-population comparisons than in case-control studies. Results of comparisons between populations (if the hypotheses they suggest are confirmed by intervention studies) warrant prevention at the level of populations, while results of case-control studies justify particular prevention in subjects at risk.

Blood cells and alcohol consumption with special reference to smoking habits.

In the course of the Paris study on risk factors of cardiovascular disease in a large professional group, 7710 active and apparently healthy men aged between 48 and 54 were examined. This study measured the relationship between clinical abnormalities suggesting alcoholic liver disease (ALD) and the following blood parameters: white (WBC) and red (RBC) blood cell counts, haematocrit (H), and mean corpuscular volume (MCV), the former computed as H/RBC ratio. A subsequent analysis was performed on a random sample of 485 subjects without ALD who were questioned on their daily average alcohol consumption. Each subject was classified as ;smoker' or ;non-smoker' according to his daily tobacco consumption for the last five years. Analysis of the data confirmed that smoking and alcohol were related to the blood parameters; but, according to smoking habit, different relationships between alcohol consumption (or ALD) and MCV, RBC, or WBC counts were found: for smokers, RBC count significantly decreased and MCV increased with alcohol consumption (or ALD); for non-smokers, WBC count significantly increased with alcohol consumption (or ALD). So, it would be of interest to consider the relation between alcohol and tobacco in interpreting possible changes in blood parameters and in formulating hypotheses on the mechanisms of their specific action.

Usefulness of population controls in retrospective studies of alcohol consumption. Experience from a case--control study of esophageal cancer in Ille-et-Vilaine, France.

Men from the general population of an area, interviewed in their homes, and men from the same area who were hospitalized (without alochol-related diseases) and interviewed in the hospital had similar distributions according to alcohol use.

Alcohol consumption in healthy women: relationship to gamma-glutamyl transferase activity, mean corpuscular volume and hormonal status.

PIP: 362 nonpregnant women aged 18-76 years participated in a study to determine the relationship between gamma-glutamyl-transferase (GGT), mean corpuscular volume (MCV), and alcohol consumption in women. The women provided information on their tobacco consumption over the past 5 years, their dietary habits, their mean daily intake of pure alcohol, and their hormonal status, including use of oral contrceptives (OCs). The women were classified into 3 groups: 176 nonusers of OCs (NOC), 85 users of OCs, mainly prepartions with 50 mcg estrogen (OC), and 101 postmenopausal women (PM). 29 additional women were excluded from the analysis because of missing data or because they used estrogens for medical reasons independent of contraception. Average age was 34.9 years for the NOC group, 31.4 for the OC, and 55.6 for the PM group. Tobacco consumption did not differ and alcohol consumption was quite similar in the 3 groups. MCV in cu mcm was 89.7 +or- 1.4 for NOC, 89.9 +or- 1.6 for OC, and 90.5 +or- 1.9 for PM. GGT in U/1 was 14.3 +or- 1.4 for NOC, 13.7 +or- 1.2 for OC, and 22.4 +or- 5.0 for PM. The results indicated that the effect of alcohol might be different in the 3 groups. In the NOC group, MCV was slightly different between teetotalers and drinkers (88.2 +or- 0.5 and 90.2 +or- 0.2 cu mcm respectively), while the GGT level was 9.3 +or- 0.4 in teetotalers and 15.7 +or- 2.2 in drinkers. In the OC group, the only significant difference was observed in GGT levels with a lower degree of significance than for the NOC group. OC teetotalers had GGT levels of 11.5 +or- 6.0 U/1 compared to 14.4 +or- 1.5 for drinkers. No difference was observed for any parameter in the PM group but there was a tendency toward higher MCV and GGT values among the teetolalers. A multiple regression analysis in each group indicated that in the NOC group, GGT and MCV are the 2 main relevant parameters in predication of alcohol consumption, with age a 3rd factor. The multiple regression coefficient is much higher in the NOC group than in the total female group and is quite similar to that of the male group. In the OC group, age is the 1st relevant factor in prediction of alcohol consumption, followed by GGT. No significant correlation with any variable was found in the PM group.^ieng

[Nutrition, alcohol and oesophageal cancer (author's transl)]. / Nutrition, alcool et cancer de l'oesophage.

Nutritional factors are suspected to cause oesophageal cancer as well as other cancers of the digestive tract. Sideropenia, lack of molybdenum, tannins have been reported to be associated with the disease. Polycyclic hydrocarbons and nitrosamines have been found in alcoholic beverages from high incidence regions; the significance of the small amounts detected remains to be assessed. A recent survey in Iran points out the role of poor and monotonous diet. In Brittany, no major deficiencies were found, neither in quantity or quality, in the diet of 200 male cases of oesophageal cancer when compared with a population control group. Differences in consumption were detected for a few items; the most obvious discrepancies concerned the various alcoholic beverages for which the proportion of heavy consumers was systematically greater among cases. Alcohol and tobacco are both independently associated with the disease; there is a dose-response relationship for both and their effects are multiplicative. The mechanism of the action of alcohol in oesophageal cancer is briefly discussed.

[Esophageal cancer in Ille-et-Vilaine in relation to levels of alcohol and tobacco consumption. Risks are multiplying]. / Le cancer de l'oesophage en Ille-et-Vilaine en fonction des niveaux de consommation d'alcool et de tabac. Des risques qui se multiplient

A retrospective case-control study of 200 male cases of oesophageal cancer and 778 population controls has been carried out in Ille-et-Vilanine (France). The logarithms of the relative risks of developing the disease increase linearly with daily consumption of alcohol and tobacco independently. The combined effect of both fit with a multiplicative model which is proposed. This model could be applicable to other situations. It explains the sex ratio and the urban/rural differences observed in Ille-er-Vilaine. The practical implications for public health purposes are briefly discussed.

[Results of a dietary survey in the Calvados. Dietary intake, tobacco and alcohol consumption]. / Résultats d'une enquête alimentaire dans le Calvados. Ration alimentaire, consommation de tabac et d'alcool.

A survey on individual nutritional intake was conducted in a representative sample of 1,975 people in the French province of Calvados using a dietary history method. The energy ration (2,964 kcal/d in males, 2,148 kcal/d in females) was found to exceed the recommended allowances by 150 kcal/d in women and by 300 kcal/d in men, corresponding to alcohol consumption. The trends observed were similar to those seen elsewhere in France and other developed countries: a diet with a high proportion (41-43 p. 100) of lipids and saturated fatty acids (16-18 p. 100) mainly due to reduced consumption of vegetable foods; a high intake of cholesterol (513-422 mg) and a low ration of polyunsaturated fatty acids (3.9-4.5 p. 100) leading to a high risk of vascular diseases, particularly of the coronary arteries. The high intake of alcohol may be responsible for the high incidence of alcohol-related diseases, possibly in association with tobacco. The intake of vitamins and minerals was adequate, with the exception of iron, which was below the recommended allowance for females. In contrast with common belief, the dietary energy intake increased when alcohol consumption increased in both sexes. For tobacco, the energy ration decreased moderately in females only with increasing consumption; no relationship was observed in males.

[Diet and rectocolonic cancers. Results of a case-control study]. / Alimentation et cancers recto-coliques. Résultats d'une étude "cas-témoin".

In a case-control study performed in an hospital of the North-Eastern Paris area, nutritional intakes of 94 patients with colorectal carcinoma were compared with those of 94 control patients, matched for age and sex. Results were expressed as mean daily nutrients and energy intakes. This dietary survey covered the "present period" (i.e. prior to the hospitalisation) and the "past-period" in case of striking and prolonged changes in dietary habits. Whatever the site of carcinoma (the rectum and sigmoid or the remaining colon) there was no statistically significant difference between patients and controls (in both sexes) for the following parameters: a) total energy intake, b) proportions of lipids, proteins and fat expressed as percentages of total energy intake, c) minerals, d) vitamins and e) dietary fibers. In women with colorectal carcinoma, a decrease in alcohol and lipid consumptions was observed. In patients with rectal or sigmoid carcinoma past alcoholic intakes were higher in both sexes. These results do not allow any clear epidemiological conclusion. In spite of their cost and length prospective studies are probably the only way to answer the difficult question of which dietary factors may be found in colorectal carcinoma.

[The quantitative alimentary questionnaire technique used by the I.N.S.E.R.M. nutrition department (author's transl)]. / La technique du questionnaire alimentaire quantitatif utilisé par la section nutrition de l'I.N.S.E.R.M.

The utilization, during a certain number of years, of quantitative alimentary questionnaire in epidemiologic studies, has allowed: to model a print allowing the interviewer to transcribe the food ingested into an average for each day by a single person, to reflect on the different methods capable of being adaptable to reach this aim and to index the rocks to keep out of, so that this method would be used with chances of reliability.

[The difficulty of choosing a good control group in a retrospective study (author's transl)]. / Le choix difficile d'un bon groupe de témoins dans une enquête rétrospective.

The choice of either hospital or population controls in retrospective studies is guided by rules implying underlying hypotheses. In a study on aesophageal cancer in relation to alcohol and tobacco consumption, two such control groups were available and were compared. It was found that some of the currently accepted assumptions relating to representativeness of cases or controls were verified but many others were not, particularly in hospital controls. These were found to give less correct estimates of drinking and smoking habits than those obtained from population controls. The limitations in the use of either type of controls is discussed, in relation to the purpose of the study concerned.

Alcohol consumption patterns in the department of Calvados (France).

The individual consumption of alcoholic beverages was determined by interviewing 1.976 people, a representative sample of the population. 92% of males and 74% of females drink alcohol but no more than 4% of females consume over 40 g per day, against 39% males. The average intake is greater in rural than in urban areas. Wine is the most popular beverage but the consumption of cider remains important in rural areas. Apple brandy is also consumed in sizeable quantities by rural males. There are few beer drinkers, except in the younger age groups. The implications of these results are discussed. They probably reflect changes in drinking patterns over time; the traditional locally produced cider and apple brandy are progressively abandoned by the young, who turn to beer and aperitifs. Consequent changes in alcohol related pathology are expected.

[Dietary behavior during pregnancy (author's transl)]. / Comportement alimentaire au cours de la grossesse.

A study on dietary behavior during pregnancy was performed between June and December 1975 at the Saint Antoine Maternity Hospital in Paris. In addition to the routine clinical examinations at the 3rd, 6th, 8th and 9th month of pregnancy, the women were systematically questioned on their dietary and tobacco habits. Results show that: (1) the mean caloric intake is constant during the first trimester and then significantly decreases in the last two trimesters (2) the fatter the woman before pregnancy, the lower the caloric intake at the successive examinations (3) the total weight gain is positively related to the caloric intake during the first trimester, but not related to the dietary data observed at the 6th, 8th or 9th examinations (4) birth weight seems to be more related to body size before pregnancy than to weight gain.

[Food consumption in relation to size of collectivity. Parallel time trends (author's transl)]. / La consommation alimentaire des Français en fonction de la taille des agglomérations, reflet de l'évolution longitudinale.

The consumption of the French with respect to the size of parishes and its evolution from 1965 to 1974 can be investigated, thanks to the survey of Institut National de la Statistique et des Etudes Economiques on food consumption of a representative sample of households. During this period, with regard to the growing size of parishes and with respect to time, the percentage of lipidic calories has been raising, chiefly from the decrease in the consumption of vegetable foods which carries with it, at the same time, a decrease of the intake of glucids, dietary fibers and of the total energy intake. The shortcomings of data collecting explain only a small part of the discrepancies observed.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. I. Study design and dietary habits.

Diet, tobacco and alcohol consumption, and occupational histories have been investigated in stratified random samples of the adult population in 6 areas in France (departement of Calvados), Italy (province of Varese and city of Torino), Spain (provinces of Navarra and Zaragoza) and Switzerland (canton of Geneva), to be used as a reference group in a case-control study on cancer of the larynx and hypopharynx. Out of a total of 8,074 sampled subjects, 5,564 could be interviewed. Sampling procedures are described, and reasons for non-response are analysed. Everywhere the intake of the 4 energy providing nutrients (particularly alcohol) was much greater in men than in women. In both sexes, total caloric intake was higher in Calvados and in Italy than elsewhere. There were wide inter-area variations in the consumption of butter + milk products and oils, resulting in a polyunsaturated/saturated fatty acid ratio ranging from 0.27 in Calvados to 0.54-0.65 in Spain. Among nutrients suggested to be involved in cancer aetiology, inter-area differences in daily intake were up to 3-fold for carotene and smaller for vitamin C and fibre. The proportion of lipids, fibres, vitamin C and carotene provided by different foods varied widely between areas, thus suggesting that in etiological cancer studies consideration should be given not only to nutrients but also to foods providing them.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. III. Consumption of alcohol.

Individual present and life time intake of aethanol has been studied in population samples of six areas of Italy (Torino, Varese), Spain (Navarra, Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%); 49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g. (36% in Navarra). Women drank much less and were more often abstinent: 50 to 94% of them did not drink or drank less than 20 g. a day. Wine was the most commonly consumed beverage (over 60% of total alcohol intake), except in Calvados where cider was still largely consumed (over 30%). Such differences in drinking habits by sex and region are of major public health importance. They do not appear in national sales statistics which must be complemented by surveys on individuals.