Academic journal article Alcohol Research

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

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

Article excerpt

Alcohol has a significant impact on health and well-being, from the beneficial aspects of moderate drinking to the detrimental effects of alcoholism. the broad implications of alcohol use on public health have been addressed through a wide range of epidemiological and clinical studies, many of which are described in this issue of Alcohol Research: Current Reviews. Where chronic disease is involved, alcohol use can be a risk factor that not only affects the onset of various chronic diseases but also exacerbates the ongoing extent and severity of those diseases. lifestyle choices and genetic influences also contribute to, or help to alleviate, that risk. KEY WORDS: NIAAA Expert Panel on Alcohol and Chronic Disease Epidemiology; alcohol consumption; alcohol burden; chronic disease; risk factors; epidemiology; research; diabetes; cardiovascular disease; cancer; stroke; liver disease; genetic factors; eating behaviors; clinical trials

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.P.H., R.D., and was convened by NIAAA's 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 dis- ease and the direction these investigations may take in the future. (For more information on the epidemiological chal- lenges 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 recommen- dations 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 tis- sues, 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 cardio- vascular 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. …

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