Academic journal article Alcohol Research: Current Reviews

Measuring the Burden-Current and Future Research Trends: Results from the NIAAA Expert Panel on Alcohol and Chronic Disease Epidemiology

Academic journal article Alcohol Research: Current Reviews

Measuring the Burden-Current and Future Research Trends: Results from the NIAAA Expert Panel on Alcohol and Chronic Disease Epidemiology

Article excerpt

Research is continuing to investigate how alcohol impacts chronic disease. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) hosted a 2-day Expert Panel on Alcohol and Chronic Disease Epidemiology in August 2011 to review the state of the field on alcohol and chronic disease. The panel was chaired by Kenneth J. Mukamal, M.D., and Rosalind A. Breslow, Ph.D., M.PH., R.D., and was convened by NIAAAs Division of Epidemiology and Prevention Research.

Panel members (see textbox) represented a wide range of backgrounds and expertise, ranging from alcohol-related chronic diseases and risk factors to methods and technology. Among the chronic diseases addressed were diabetes, cardiovascular disease, cancer, stroke, and liver disease. The broader aspects of the design and implementation of clinical trials and the implication of technological advances for research also were considered. Other topics included the links between genetics and other lifestyle factors, such as eating behavior, and the relationship between drinking and various chronic diseases. Taken together, these summaries provide unique insight into the current state of research on alcohol's role in chronic disease and the direction these investigations may take in the future. (For more information on the epidemiological challenges of elucidating the effects of alcohol consumption and drinking as they relate to the initiation/ exacerbation and treatment of chronic diseases, see the article by Shield and colleagues [pp. 155-173]). Panel members also were asked what research they would most strongly support if funds were unlimited and how they might scale back that research if funding were limited (see Future Ideas textbox). Highlights from this panel are presented below and specific recommendations are listed in the accompanying sidebar.

Clinical trials

Clinical studies include clinical nutrition studies, controlled feeding studies, and metabolic studies. This type of research has numerous strengths for studying alcohol and chronic disease, including the ability to control alcohol dose and diet, collect abundant biologic samples from a variety of tissues, assess cause and effect, and examine mechanisms-all with a relatively small number of participants enrolled for a short period of time.

Clinical study end points typically are surrogate markers for chronic diseases because the disease itself may take years or even decades to develop. For example, lipoproteins and markers of inflammation have been used as surrogates for cardiovascular disease, insulin sensitivity for diabetes, and DNA damage for cancer.

According to Dr. David J. Baer, considerable need for controlled clinical studies on alcohol and chronic disease still exists. There have been few clinical studies, even on cardiovascular disease (Brien et al. 2011), which is the focus of most alcohol-related chronic disease research. He also noted the relatively few controlled clinical studies of alcohol and obesity (Sayon-Orea et al. 2011) that were advocated by the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans (U.S. Department of Agriculture 2010).

Dr. Baer suggested the following future opportunities for alcohol and chronic disease research:

* Drinking patterns;

* Effects on metabolism and disease risk;

* Non-ethanol components of alcoholic beverages;

* Possible effects on cardiovascular disease, diabetes (insulin sensitivity), cancer, and bone metabolism;

* Gender and age differences (pre- and postmenopausal women, men);

* Genetic basis for response of chronic disease surrogate markers to alcohol;

* Energy metabolism, body weight regulation, and insulin sensitivity;

* Interaction of alcohol with lower-fat or higher-protein diets; and

* Bone metabolism.

Cardiovascular Disease

Studies on alcohol and cardiovascular disease have yielded important findings with regard to public health. …

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