Pain management & opioid dose reduction with topical sevoflurane instillations in intractable venous ulcers: a case report

Abstract Vascular ulcers (VU) constitute a major cause of pain and disability, and significantly compromise quality of life. VU have a natural tendency to become chronic and in many cases exhibit anunsatisfactoryresponse to many of the standard therapeutic options.The case of a 73 year-old Caucasian female with severe pain and poorly-controlled pain (Visual Analogic Scale-VAS- of 8-9) due to three lower leg long-standing VUs is reported and discussed herein. The patient was treated with topical instillations of undiluted sevoflurane as per institutional off-label protocol (starting doses of 1mL/cm2 twice a day, and up-titrated according to response to a maximum of 7 mL twice daily). The VAS score dropped to 0-1 shortly after initiation of therapy and remained stable throughout treatment up until the closure of the observations. Subsequently, opioid therapy was gradually tapered down and ultimately abandoned.Sevoflurane application resulted on adequate and sustained pain management of refractory VU, with no significant side effects. On account of its beneficial effectivity and safety profiles, topical sevoflurane emerges as an add-on alternative for the long-term management of VU, and potentially other painful conditions.

Efficacy and Safety of a Novel Submucosal Injection Solution for Resection of Gastrointestinal Lesions.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive and efficient techniques for the removal of gastrointestinal (GI) mucosal polyps. In both techniques, submucosal injection solutions are necessary for complete effectiveness and safety during the intervention to be obtained. The main objective of this study was to evaluate the efficacy and safety of a new sterile submucosal injection solution for EMR/ESD used within a clinical protocol in patients with intestinal polyps. We carried out a prospective study between 2016 and 2017 with patients who attended the Endoscopy Consultation-Digestive Department of Primary Hospital. Patients were selected for EMR/ESD after the application of clinical protocols. Thirty-six patients were selected (≥ 66 years with comorbidities and risk factors). Lesions were located mainly in the colon. Our solution presented an intestinal lift ≥ 60 min in EMR/ESD and a high expansion of tissue, optimum viscosity, and subsequent complete resorption. The genes S100A9 and TP53 presented an expression increase in the distal regions. TP53 and PCNA were the only genes whose expression was increased in polyp specimens vs. the surrounding tissue at the mRNA level. In EMR/ESD, our solution presented a prolonged effect at the intestinal level during all times of the intervention. Thus, our solution seems be an effective and safe alternative in cases of flat lesions in both techniques.

Palliative analgesia with topical sevoflurane in cancer-related skin ulcers: a case report.

A Caucasian 39-year-old male patient with a poorly-differentiated infiltrating epidermoid penile carcinoma with urethral invasion was diagnosed. The patient received concomitant adjuvant chemotherapy with radiotherapy in the palliative setting, which produced painful ulceration of tumour lesions at loco-regional level (Numerical Rate Scale, NRS=9). The patient consented for treatment with direct topical sevoflurane instillations, at initial doses of 1 mL/cm2 of ulcerated area, as per unit protocol. The local use of undiluted sevoflurane achieved a marked reduction of the pain score in both nociceptive and irruptive pains (average NRS=3 immediately post-application). This improvement was corroborated by a decline in total morphine needs, any adverse events associated with major opiates. PGI-I and CGI-I scales were used before and after treatment with topical sevoflurane to assess patient and clinician perceptions of improvement in the quality of life. The pharmacy of our hospital had the responsibility to elaborate pre-loaded syringes with sevoflurane so that the patient was instilled simply and comfortably.

Polyols: Is their use safe in enteral nutrition? / Polioles: ¿es seguro su uso en nutrición enteral?

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Identification and prioritisation of risks in a hospital pharmacy using healthcare failure mode and effect analysis.

OBJECTIVES: The goals of this project included identifying the processes and subprocesses performed in hospital pharmacies, identifying potential adverse events, detecting failure modes and the causes of errors, prioritising the risks identified and designing a map of risks for hospital pharmacies. METHODS: A task force composed of hospital pharmacy staff was committed to update the diagram of processes and design a map of processes performed in hospital pharmacies. Risks were identified by failure mode and effect analysis annd prioritised according to their risk priority index (RPI) and criticality. A risk map of adverse events was designed based on the diagram of processes and/or primary activities where the prioritised failure modes were most frequent. RESULTS: In total, 99 failure modes associated with 80 adverse events and 129 causes were identified in eight hospital pharmacy areas/subprocesses. The three areas with the highest percentages of failure modes were inpatient pharmaceutical care, pharmacy laboratory and pharmaceutical technology, and medication management. The 25 failure modes (first quartile) with the highest RPI scores (RPI≥20) and the 25 failure modes with the highest frequency and criticality scores were classified as priority. CONCLUSIONS: According to their RPI, priority failure modes mostly occurred in the area of inpatient pharmaceutical care (92%). However, according to their criticality, priority failure modes were found to homogeneously occur across all pharmaceutical care areas. As general recommendations pharmacists should assume responsibility and leadership in the implementation of safe medication use practices in healthcare centres.

Pancitopenia retardada secundaria a tratamiento con levofloxacino: a propósito de un caso / Delayed pancytopenia due to treatment with levofloxacin: A case report

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Sevoflurano tópico: una nueva opción terapéutica paliativa en las úlceras cutáneas / Topical sevoflurane: A new palliative therapeutic option for skin ulcers

La presencia de úlceras cutáneas, con tendencia a la cronicidad y con mala respuesta al arsenal terapéutico-analgésico clásico, conllevan un alto grado de dolor, discapacidad y merma en la calidad de vida. Presentamos el caso de una paciente terminal con un cuadro álgico debido a la presencia de múltiples úlceras vasculares en miembros inferiores de 3 meses de evolución y de difícil manejo por mala tolerancia a anticomiciales y opioides mayores. Las instilaciones tópicas de forma periódica del anestésico halogenado sevoflurano sobre el lecho ulceroso lograron un excelente control del dolor basal e irruptivo a los pocos minutos de su administración, y una progresiva mejoría en la cicatrización de las úlceras sin evidenciar efectos secundarios asociados

The presence of cutaneous ulcers, with a tendency to become chronic and without a response to the therapeutic-analgesic arsenal available, carry a heightened degree of pain and disability and significantly compromise patient quality of life. A case is reported of a terminally ill woman with a painful condition due to the presence of multiple vascular ulcers of 3 months onset in lower right limb, and difficult to manage because of poor tolerance to anticonvulsants and major opioids. Periodically administered topical applications of halogenated anaesthetic sevoflurane on the ulcer bed achieved good results in baseline and breakthrough pain management within a few minutes after application and a progressive improvement in the healing of ulcers without associated adverse effects

Efficacy and safety of topical sevoflurane in the treatment of chronic skin ulcers.

PURPOSE: Results of efficacy and safety assessments of topical sevoflurane use in patients with long-term treatment-refractory vascular ulcers are reported. METHODS: Patients were randomly assigned to receive sevoflurane instillations (1 mL per cm2 of ulcer area 1-4 times daily) plus standard wound care (ulcer cleaning, debridement, and dressing changes) or standard care only. Topical sevoflurane was initiated during hospitalization, with self- or nurse-administered instillations continued after discharge. Study participants were evaluated at least once weekly for 1 month and then every 2 weeks for up to 90 days. The primary efficacy measures were debridement-related and overall pain (assessed using a 10-point visual analog scale), daily opioid use, and ulcer size; secondary measures were patient and clinician impressions of improvement and ulcer-related admissions during treatment. The primary safety endpoint was intolerable sevoflurane-related adverse effects. RESULTS: Compared with the group receiving standard care alone (n = 5), the sevoflurane group (n = 10) had significant (p = 0.001) reductions in mean ± S.D. scores for debridement-related pain on day 1 of treatment and at subsequent time points; the sevoflurane group also had significant reductions in overall pain, daily opioid use, and ulcer size. Outcomes in terms of patient- and clinician-rated improvement and emergency admissions also favored the sevoflurane group. Mild localized reddening in the area surrounding ulcers occurred in 4 sevoflurane-treated patients. CONCLUSION: Direct application of sevoflurane onto vascular ulcers resulted in an intense and long-lasting analgesia and was associated with a progressive reduction of ulcer size.

Biosimilares, el camino ha comenzado / Biosimilars, the journey has begun

Según la Agencia Europea del Medicamento, un medicamento biosimilar es aquel obtenido por biotecnología que contiene una versión de la sustancia activa del medicamento biológico original (de referencia o innovador), previamente autorizado en el Espacio Económico Europeo. La similitud entre medicamento de referencia y biosimilar en términos de calidad, actividad biológica, seguridad y eficacia debe ser establecida según criterios de comparabilidad integral. El enfoque estándar para un medicamento genérico (demostración de bioequivalencia por estudios de biodisponibilidad) es aplicable a medicamentos derivados de síntesis química y no es suficiente para productos obtenidos por biotecnología, debido a su mayor complejidad estructural. Además estos productos biofarmacéuticos, en contraste con los convencionales, demuestran una mayor capacidad para activar la respuesta inmunitaria. La intercambiabilidad y sustitución en el acto de la prescripción y dispensación, respectivamente, es un aspecto que se plantea de forma continuada y deberá ser tratado por cada Estado Miembro de la Unión Europea, según comunica la Agencia Europea del Medicamento. Con el fin de apoyar la farmacovigilancia y trazabilidad se deberán tomar medidas oportunas para la identificación, atendiendo al nombre del producto, número de lote y fecha de caducidad. La situación en el entorno de la Comunidad Europea así como el marco regulatorio en términos de autorización y comercialización han evolucionado desde las primeras solicitudes (hormona del crecimiento), hace casi una década, hasta la reciente aparición de medicamentos biosimilares molecularmente complejos (anticuerpos monoclonales). Actualmente, la introducción en el mercado de estos medicamentos favorece la competencia mejorando el acceso a nuevas terapias biológicas (AU)

According to the European Medicine Agency, a 'biosimilar' is a biological medicinal product that contains a version of the active substance of an original biological medicinal product (reference or innovative medicinal product) that has been authorized in the European Economic Area. The similarity to the reference medicinal product in terms of quality, biological activity, safety and efficacy needs to be set on a comprehensive comparability basis. The generic standard approach (demonstration of bioequivalence with a reference medicinal product by appropriate bioavailability studies), which is applicable to a wide range of chemically derived medicinal products, is not sufficient to prove the similarity of biotechnology derived products due to their structural complexity. Furthermore, these biopharmaceuticals products, in comparison with the conventional ones, show a greater ability to activate the immune response. The evaluation of biosimilar medicines for authorisation purposes by the European Medicine Agency does not include recommendations on whether a biosimilar should be used interchangeably with its reference medicine. Substitution policies are, therefore, within the remit of the EU member states. In order to support pharmacovigilance monitoring, all appropriate measures should be taken to clearly identify any biological medicinal product with due regard to its brand name and batch number. The situation of the European Community and the regulatory framework have been developed since the first applications (growth hormone), almost a decade ago, until the recent advent (monoclonal antibodies). The introduction to the market of biosimilars have positive effects on competition by improving access to biological therapies (AU)

[Biosimilars, the journey has begun]. / Biosimilares, el camino ha comenzado.

According to the European Medicine Agency, a "biosimilar" is a biological medicinal product that contains a version of the active substance of an original biological medicinal product (reference or innovative medicinal product) that has been authorized in the European Economic Area. The similarity to the reference medicinal product in terms of quality, biological activity, safety and efficacy needs to be set on a comprehensive comparability basis. The generic standard approach (demonstration of bioequivalence with a reference medicinal product by appropriate bioavailability studies), which is applicable to a wide range of chemically derived medicinal products, is not sufficient to prove the similarity of biotechnology derived products due to their structural complexity. Furthermore, these biopharmaceuticals products, in comparison with the conventional ones, show a greater ability to activate the immune response. The evaluation of biosimilar medicines for authorisation purposes by the European Medicine Agency does not include recommendations on whether a biosimilar should be used interchangeably with its reference medicine. Substitution policies are, therefore, within the remit of the EU member states. In order to support pharmacovigilance monitoring, all appropriate measures should be taken to clearly identify any biological medicinal product with due regard to its brand name and batch number. The situation of the European Community and the regulatory framework have been developed since the first applications (growth hormone), almost a decade ago, until the recent advent (monoclonal antibodies). The introduction to the market of biosimilars have positive effects on competition by improving access to biological therapies.

Según la Agencia Europea del Medicamento, un medicamento biosimilar es aquel obtenido por biotecnología que contiene una versión de la sustancia activa del medicamento biológico original (de referencia o innovador), previamente autorizado en el Espacio Económico Europeo. La similitud entre medicamento de referencia y biosimilar en términos de calidad, actividad biológica, seguridad y eficacia debe ser establecida según criterios de comparabilidad integral. El enfoque estándar para un medicamento genérico (demostración de bioequivalencia por estudios de biodisponibilidad) es aplicable a medicamentos derivados de síntesis química y no es suficiente para productos obtenidos por biotecnología, debido a su mayor complejidad estructural. Además estos productos biofarmacéuticos, en contraste con los convencionales, demuestran una mayor capacidad para activar la respuesta inmunitaria. La intercambiabilidad y sustitución en el acto de la prescripción y dispensación, respectivamente, es un aspecto que se plantea de forma continuada y deberá ser tratado por cada Estado Miembro de la Unión Europea, según comunica la Agencia Europea del Medicamento. Con el fin de apoyar la farmacovigilancia y trazabilidad se deberán tomar medidas oportunas para la identificación, atendiendo al nombre del producto, número de lote y fecha de caducidad. La situación en el entorno de la Comunidad Europea así como el marco regulatorio en términos de autorización y comercialización han evolucionado desde las primeras solicitudes (hormona del crecimiento), hace casi una década, hasta la reciente aparición de medicamentos biosimilares molecularmente complejos (anticuerpos monoclonales). Actualmente, la introducción en el mercado de estos medicamentos favorece la competencia mejorando el acceso a nuevas terapias biológicas.

Bosentan and oral anticoagulants in HIV patients: what we can learn of cases reported so far.

Pulmonary arterial hypertension is an infrequent but nevertheless serious life-threatening severe complication of HIV infection. It can be treated with bosentan and oral anticoagulants. Bosentan could induce the acenocoumarol metabolism and it increases the INR values. Until now, no study of interaction between bosentan and oral anticoagulants in HIV patients has reported. So we present a case of this interaction between these drugs and we reviewed MEDLINE to identify all the papers published so far. In our case, several weeks after increasing dose of bosentan acenocoumarol dose had to be progressively increased to 70 mg/week (+33%) without obtaining an adequate INR level (2.0-3.0). Forty-nine days later, we achieved a therapeutic INR with 90 mg/week of warfarin. The use of bosentan and oral anticoagulants together in these patients require a closer monitoring during first weeks of treatment, after increasing the bosentan dose and even during longer periods of time.

Características clínicas diferenciales entre las bacteriemias por Enterococcus faecalis y Enterococcus faecium / Differentiating clinical characteristics in bacteriemia caused by Enterococcus faecalis or Enterococcus faecium

Introducción Los enterococos son causantes de infecciones graves, como endocarditis y bacteriemias. Durante las últimas décadas, las infecciones enterocócicas han ganado importancia debido al aumento del número de casos. El conocimiento de los factores predisponentes al aislamiento de Enterococcus faecalis o Enterococcus faecium puede ser útil para mejorar el tratamiento empírico de las bacteriemias. Métodos Estudio retrospectivo de los pacientes hospitalizados diagnosticados de bacteriemia enterocócica (enero 2000–diciembre 2006). Se analizaron datos demográficos, clínicos, microbiológicos, exposición antibiótica, tratamientos y pronóstico. Para identificar los factores predisponentes al aislamiento de E. faecalis o E. faecium se llevó a cabo un análisis comparativo univariado y después un análisis multivariado. Resultados Se estudiaron 228 episodios de bacteriemia: 168 de E. faecalis y 60 de E. faecium. Todos los aislamientos de E. faecalis fueron sensibles a ampicilina, aunque sólo el 25% lo fue en el grupo de E. faecium. Hubo un caso de resistencia a vancomicina. Las variables que se asociaron independientemente a la adquisición de bacteriemia por E. faecium cuando se compararon con las bacteriemias producidas por E. faecalis fueron el ingreso en una unidad quirúrgica (OR: 4,223; p=0,001), más de 5 días de tratamiento previo con cefalosporinas o carbapenémicos (OR: 2,564; p=0,013 y OR: 2,652; p=0,027, respectivamente), la administración previa de penicilinas (OR: 2,008; p=0,044), Simplified Acute Physiology Score superior a 30 al ingreso (OR: 3,530; p=0,001) y enfermedad hepática de base (OR: 3,754; p<0,001).Conclusiones Debido al diferente patrón de resistencia de ambas especies enterocócicas, es esencial el conocimiento de los factores predisponentes a la adquisición de bacteriemia por una u otra especie a fin de establecer un tratamiento empírico antibiótico adecuado (AU)

Introduction Enterococci are responsible for severe infections, such as endocarditis and bacteremia. During recent decades, enterococcal infections have grown in importance because of the increasing number of cases. Knowledge of the factors predisposing to acquisition of infection by E. faecalis or E. faecium may be useful to improve the empirical treatment. Methods Retrospective study of patients diagnosed with enterococcal bacteremia and hospitalized over a 7-year period (January 2000–December 2006), analyzing demographic data, clinical and microbiological characteristics, antibiotic exposure, treatment, and outcome. To identify the predisposing factors for isolation of E. faecalis or E. faecium in a clinical specimen, we performed univariate comparisons between the 2 groups, and subsequently, multivariate logistic regression analysis.ResultsA total of 228 episodes of bacteremia were recorded, 168 caused by E. faecalis and 60 by E. faecium. All E. faecalis isolates were susceptible to ampicillin, but only 25% of E. faecium were ampicillin-susceptible. There was only 1 vancomycin-resistant isolate. The variables independently associated with acquisition of E. faecium bacteriemia were surgical ward admission (odds ratio [OR], 4.223; P=.001), >5 days of previous treatment with cephalosporins (OR, 2.564; P=.013), >5 days of carbapenems (OR, 2.652; P=.027), previous administration of penicillins (OR, 2.008; P=0.044), SAPS score >30 at admission (OR, 3.530; P=0.001), and hepatobiliary disease as a comorbid condition (OR, 3.754; P<0.001), Conclusion Because of the differing susceptibility patterns of the enterococcal species studied, it is essential to know the factors predisposing to acquisition of infection by one or the other species to initiate adequate empirical treatment (AU)

La estabilidad como factor para considerar en las soluciones de sellado antibiótico / Stability: A factor to consider in antibiotic-lock solutions

El sellado antibiótico de catéteres (SAC) se ha relacionado con una reducción de la necesidad de retirar el catéter en infecciones relacionadas con éstos. La estabilidad de las soluciones antimicrobianas utilizadas en el SAC no se ha estudiado suficientemente. Resumen Se realizó una revisión sistemática de la literatura médica para identificar los artículos en inglés que incluían estudios de estabilidad de estas soluciones. Nueve estudios cumplieron los criterios de inclusión al aplicar técnicas específicas de determinación de sustancias sin alteración aparente del fármaco. Los modelos incluyeron principalmente Staphylococcus spp., Pseudomonas aeruginosa y Klebsiella pneumoniae. Se analizaron cefazolina, ceftazidima, ciprofloxacino, colistina, gentamicina, ticarcilina/ácido clavulánico y vancomicina solos o en combinación con otros antibióticos y en soluciones con o sin heparina. Todas las soluciones fueron estables, excepto ciprofloxacino a concentraciones de 10mg/ml. Resumen Finalmente, pocos estudios aplican criterios estrictos para valorar la estabilidad de las soluciones utilizadas en el SAC. Por esto, parece aconsejable realizar estudios estrictos de estabilidad en futuras investigaciones de soluciones antimicrobianas para su empleo en el SAC(AU)

Antibiotic-lock therapy (ALT) has been related to a reduction in the need for catheter withdrawal in patients with catheter-related infection. The stability of the antimicrobial solutions used in ALT has not been sufficiently investigated. A systematic literature review was performed to identify articles including studies on the stability of ALT solutions. Nine studies fulfilled the inclusion criteria requiring specific drug determination techniques, and no apparent drug alterations were observed. The main microorganisms studied were Staphylococcus spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae. The antibiotics included cefazolin, ceftazidime, ciprofloxacin, colistin, gentamicin, ticarcillin/clavulanate, and vancomycin in solution, administered alone or in combinations, with or without heparin. All solutions were fairly stable except for ciprofloxacin at a concentration of 10mg/mL. Few studies applied strict criteria to assess the stability of antibiotic solutions used in ALT; hence, the currently available data are limited. Therefore, it seems advisable to include appropriate stability studies in further research on the use of ALT (AU)

[Differentiating clinical characteristics in bacteriemia caused by Enterococcus faecalis or Enterococcus faecium]. / Características clínicas diferenciales entre las bacteriemias por Enterococcus faecalis y Enterococcus faecium.

INTRODUCTION: Enterococci are responsible for severe infections, such as endocarditis and bacteremia. During recent decades, enterococcal infections have grown in importance because of the increasing number of cases. Knowledge of the factors predisposing to acquisition of infection by E. faecalis or E. faecium may be useful to improve the empirical treatment. METHODS: Retrospective study of patients diagnosed with enterococcal bacteremia and hospitalized over a 7-year period (January 2000-December 2006), analyzing demographic data, clinical and microbiological characteristics, antibiotic exposure, treatment, and outcome. To identify the predisposing factors for isolation of E. faecalis or E. faecium in a clinical specimen, we performed univariate comparisons between the 2 groups, and subsequently, multivariate logistic regression analysis. RESULTS: A total of 228 episodes of bacteremia were recorded, 168 caused by E. faecalis and 60 by E. faecium. All E. faecalis isolates were susceptible to ampicillin, but only 25% of E. faecium were ampicillin-susceptible. There was only 1 vancomycin-resistant isolate. The variables independently associated with acquisition of E. faecium bacteriemia were surgical ward admission (odds ratio [OR], 4.223; P=.001), >5 days of previous treatment with cephalosporins (OR, 2.564; P=.013), >5 days of carbapenems (OR, 2.652; P=.027), previous administration of penicillins (OR, 2.008; P=0.044), SAPS score >30 at admission (OR, 3.530; P=0.001), and hepatobiliary disease as a comorbid condition (OR, 3.754; P<0.001), CONCLUSION: Because of the differing susceptibility patterns of the enterococcal species studied, it is essential to know the factors predisposing to acquisition of infection by one or the other species to initiate adequate empirical treatment.

[Stability: a factor to consider in antibiotic-lock solutions]. / La estabilidad como factor para considerar en las soluciones de sellado antibiótico.

Antibiotic-lock therapy (ALT) has been related to a reduction in the need for catheter withdrawal in patients with catheter-related infection. The stability of the antimicrobial solutions used in ALT has not been sufficiently investigated. A systematic literature review was performed to identify articles including studies on the stability of ALT solutions. Nine studies fulfilled the inclusion criteria requiring specific drug determination techniques, and no apparent drug alterations were observed. The main microorganisms studied were Staphylococcus spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae. The antibiotics included cefazolin, ceftazidime, ciprofloxacin, colistin, gentamicin, ticarcillin/clavulanate, and vancomycin in solution, administered alone or in combinations, with or without heparin. All solutions were fairly stable except for ciprofloxacin at a concentration of 10mg/mL. Few studies applied strict criteria to assess the stability of antibiotic solutions used in ALT; hence, the currently available data are limited. Therefore, it seems advisable to include appropriate stability studies in further research on the use of ALT.

Relationship of abdominal obesity with alcohol consumption at population scale.

BACKGROUND: The high energy content of alcohol makes its consumption a potential contributor to the obesity epidemic. AIM OF THE STUDY: To determine whether alcohol consumption is a risk factor for abdominal obesity, taking into account energy underreporting. METHODS: The subjects were Spanish men (n = 1491) and women (n = 1563) aged 25-74 years who were examined in 1999-2000, in a population-based cross-sectional survey in northeastern Spain (Girona). Dietary intake, including alcohol consumption, was assessed using a food frequency questionnaire. Anthropometric variables were measured. RESULTS: The mean consumption of alcohol was 18.1 +/- 20.7 g/d in men and 5.3 +/- 10.4 g/d in women. 19.3% of men and 2.3% of women reported alcohol consumption of more than 3 drinks per day. The consumption of alcohol was directly associated with total energy intake in men (P < 0.001) and women (P = 0.001). The proportion of energy underreporting significantly (P < 0.001) decreased with higher amounts of alcohol drinking in both genders. Multiple logistic regression analysis, controlled for energy underreporting, smoking, educational level, leisure-time physical activity, energy, and diet quality, revealed that consuming more than 3 drinks of alcohol (>30 g ethanol) was significantly associated with the risk of abdominal obesity (Odds ratio 1.80; 1.05, 3.09) and exceeding recommended energy consumption (Odds ratio 1.97; 1.32, 2.93) in men. A very small number (2.13%) of women in this population reported high levels of alcohol consumption. CONCLUSIONS: Alcohol consumption in elevated amounts was associated with risk of abdominal obesity in men, independent of energy underreporting.