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OBJECTIVES:: To study the association between alcohol drinking pattern and obesity. DESIGN:: Cross-sectional population study with assessment of quantity and frequency of alcohol intake, waist and hip circumference, height, weight, and lifestyle factors including diet. SUBJECTS:: In all, 25?325 men and 24?552 women aged 50-65?y from the Diet, Cancer and Health Study, Denmark, 1993-1997 participated in the study. MEASUREMENTS:: Drinking frequency, total alcohol intake, body mass index (BMI), and waist and hip circumference. RESULTS:: Among men, total alcohol intake was positively associated with high BMI (=30?kg/m2), large waist circumference (=102?cm) and inversely associated with small hip circumference (<100?cm). Among women, the total alcohol was associated with high BMI, large waist (=88?cm), and small hips only for the highest intake (28+drinks/week). The most frequent drinkers had the lowest odds ratios (OR) for being obese. Among men, OR for having a high BMI were 1.39 (95%confidence interval: 1.36-1.64), 1.17 (1.02-1.34), 1.00 (reference), 0.87 (0.77-0.98), and 0.73 (0.65-0.82) for drinking 1-3 days/month, 1 day/week, 2-4 days/week, 5-6 days/week, and 7 days/week, respectively. Similar estimates were found for waist circumference. Corresponding results were found for women. CONCLUSION:: For a given level of total alcohol intake, obesity was inversely associated with drinking frequency, whereas the amount of alcohol intake was positively associated with obesity. These results indicate that frequent drinking of small amounts of alcohol is the optimal drinking pattern in this relation.International Journal of Obesity (2005) 29, 490-497. doi:10.1038/sj.ijo.0802874 Published online 11 January 2005 [ABSTRACT FROM AUTHOR]

The association between alcohol dependence and suicidal behaviour is well established and patients with suicidal behaviour in treatment for alcohol dependence present a considerable challenge for clinical services. The aim of this study is to identify risk factors for suicide attempts and to evaluate the outcome of treatment in patients in treatment for alcohol dependence. Semi-structured, detailed interviews were administered at baseline and at three sequential follow-up interviews with a large sample of 1692 patients at an outpatient treatment centre in the county of Funen in Denmark. Characteristics of, predictors for and outcome among suicidal patients were studied. Alcohol-dependent patients with a history of suicide attempts were found to constitute a highly selected group in alcohol abuse treatment as they often had a more severe course of alcohol dependence, were unemployed, younger, were more often lowly educated, and had more physical and psychiatric problems. Traumatic childhood experience related to physical or sexual abuse was found as a major predictor for suicidal behaviour among alcohol-dependent patients. We found no significant difference in the effect of treatment in patients with and without suicidal behaviour. These results support the hypothesis that alcohol-dependent patients with a history of suicide attempts are a selected group in respect to a number of demographical and psychosocial factors, but we found no difference in the outcome of treatment. This may imply that suicidal patients in treatment for alcohol abuse are treated effectively within the present treatment settings.

Background: Cross-sectional studies have reported a lower prevalence of abdominal obese persons among frequent drinkers than among nonfrequent drinkers., Objective: We tested the hypothesis that drinking frequency is associated with subsequent changes in waist circumference., Design: Data come from a prospective cohort study conducted in 1993-1997 (baseline) and 1999-2002 (follow-up) and included 43 543 men and women. Baseline information on alcohol drinking frequency was related to 1) change in waist circumference by linear regression and 2) major gain and major loss in waist circumference (defined as waist change in the lowest or highest quintile of waist changes) by polytomous logistic regression, also taking into account amount of alcohol intake., Results: Drinking frequency was inversely associated with changes in waist circumference in women and was unassociated with changes in waist circumference in men. Drinking frequency was unassociated with major waist loss but was inversely associated with major waist gain: odds ratios among men were 0.97 (95% CI: 0.73, 1.28), 0.95 (95% CI: 0.81, 1.12), 0.88 (95% CI: 0.77, 0.99), 0.82 (95% CI: 0.71, -0.95), and 0.79 (95% CI: 0.69, 0.9) for never drinking, drinking on 1, 2-4, 5-6, and 7 d/wk, respectively, compared with men who drank alcohol on <1 d/wk (P for trend < 0.0001). Results for women were similar. Adjustment for the amount of alcohol intake or total energy intake did not affect results considerably., Conclusions: Drinking pattern may be associated with development of abdominal obesity; in this prospective study, drinking frequency was inversely associated with major waist gain and was unassociated with major waist loss.

Based on ethnographic research with 13-16-year-olds in a rural Danish community the article reports on strategies of harm minimization employed by teenage drinkers. Participating teenagers were more concerned about social than health risks. They preferred drinking in the company of peers whom they knew and trusted, and they helped each other to minimize harm. Hence, teenage peer groups may be considered a resource for health promotion.

The Danish Fitness and Nutrition Council evaluated the impact of moderate alcohol intake depending on drinking pattern, age, sex, and the type of beverage. A daily intake of approximately 1-3 units for men and approximately 1 unit for women is associated with the lowest risk of type 2-diabetes and cardiovascular diseases. Binge drinking is more detrimental than a more steady alcohol intake. No clear association is found between alcohol and obesity. In contrast, alcohol intake is associated with increased risk of various cancers, e.g. a linear increased risk of breast cancer with every unit of alcohol is present.

In a cross sectional study based on information on the number, type of item and total charge of 3(1/2) million transactions over a period of 6 months in various supermarkets in Denmark we examined whether people who buy wine also buy healthier food items than those who buy beer. We found that wine buyers bought more olives, fruit and vegetables, poultry, cocking oil and low fat cheese, milk and meat than beer buyers who bought more ready cooked meals, sugar, cold cuts, chips, pork, butter or margarine, sausages, lamb and soft drinks than wine buyers.

Introduction: The trend in alcohol consumption by middle-aged and elderly Danes has received little attention, but earlier studies indicated increased consumption. Social factors may influence the trend. Our objective was to investigate the trend in alcohol consumption by the middle-aged and elderly and inquire about significant trends among specific social subgroups., Materials and Methods: In the Danish Health and Morbidity Survey carried out in 1987, 1994, 2000 and 2003, a total of 11,754 people aged 50 and older were asked about their alcohol consumption. The mean alcohol intake and the number of heavy drinkers were compared from year to year., Results: The mean intake per day increased from 1.5 drinks in 1987 to 2.1 drinks in 2003 for men and from 0.5 drink in 1987 to 1.0 drink in 2003 for women. The percentage of elderly drinking above the sensible drinking limits increased from 15.2% to 20.4% for men and from 10.7% to 13.6% for women. The strongest increasing trend in the number of heavy drinkers was in the lowest socio-economic groups and among those married or cohabiting., Conclusion: The increased number of heavy drinkers among the middle-aged and elderly is of great importance to their general state of health. The increase has possibly been caused by a social and cultural development which has led to a generation of elderly who used to drink alcohol earlier in their lives and continue drinking in old age. More focus on alcohol consumption among the middle-aged and elderly in health policy initiatives is needed.

The sensible drinking limits may be too high depending on sex, age, genetic variation and other factors. Recent research on the alcohol-related risk of breast cancer and the impact of drinking patterns on health calls for an update of the literature. We focus on studies of the effect of alcohol on morbidity and mortality and conclude that the maximum of 21 drinks per week for men and 14 for women may be maintained. We emphasize that episodic intake of alcohol increases the risk of death and that the beneficial effect of alcohol is reached at an intake of one drink per day. We also specify groups for whom the drinking limits are not valid.

Introduction: In Great Britain and in Denmark, strong efforts have been made to influence knowledge on the upper threshold of hazardous drinking. In Denmark, a campaign has been repeated every week 40 from 1990 to 2001 with information on the sensible drinking limits of 21 drinks per week for men and 14 drinks per week for women. The aim of this study was to examine the effect of this ongoing campaign on the level of knowledge of sensible drinking limits for men and women., Material and Methods: Every year from 1994 to 1999, random representative samples of 1,030 adult Danes were interviewed on the telephone., Results: Our main finding was that the level of knowledge of sensible drinking limits for own sex increased in all subsets of the population throughout the period. However, at the end of the study period (1999), a total of 80% of highly educated young (18-25 years of age) men knew sensible drinking limits for own sex, while only 35% of uneducated older (more than 65 years old) men had knowledge on sensible drinking limits. The proportions were similar among women: Subjects admitting an intake higher than sensible for own sex, i.e. 21 and 14 drinks per week, respectively, had the highest knowledge of these drinking limits., Discussion: We conclude that public health campaigns, such as the sensible drinking limit campaign, certainly has an impact on the level of awareness in the general population. Furthermore, those drinking more than 21 and 14 drinks per week, respectively, are reached by these campaigns.

Introduction: The aim of the present study was to assess the relation between these life-style factors and suboptimal self-reported health., Methods: A cross-sectional study was carried out on a random sample of 12,040 men and women from Copenhagen, who had answered a questionnaire regarding smoking, alcohol intake, physical activity, socio-economic status, social network, and self-perceived health., Results: Smoking, high alcohol intake, and physical inactivity are strongly associated with a suboptimal self-reported health., Discussion: The assumption of a correlation between a high quality of life and a shorter life cannot be confirmed by this study.

Introduction: In the present population-based cohort study, we prospectively determined the influence of current, previous, and cumulative smoking history on the risk of hip fracture in men and women and addressed the issue of possible gender difference in susceptibility to tobacco smoking., Material: A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed up until 1997 for their first admission because of hip fracture., Results: During follow-up, a total of 1169 hip fractures were identified. After adjustment for potential confounders, female current smokers had a relative risk of hip fracture of 1.36 (1.12-1.65) and male smoked 1.59 (1.04-2.43) relative to those who have never smoked. In both sexes, the relative risk of hip fracture gradually increased with current and accumulated tobacco consumption. A test for interaction between gender and smoking habits was insignificant. Men who stopped smoking for more than five years had a lower risk of hip fracture than men who currently smoked, whereas no such risk reduction was seen in female ex-smokers., Conclusion: Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in the smoking-related risk. Men who stopped smoking for more than five years had lower risk of hip fracture than men who currently smoked, whereas no such risk reduction was seen in female ex-smokers.

Both the incidence of and mortality from bleeding and perforated peptic ulcers are growing. We assessed the association between smoking, ingestion of alcohol (including the type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated the relative risks (RRs) of incident bleeding and perforated peptic ulcers with the Poisson regression analysis. Smoking more than 15 cigarettes a day compared with never smoking increased the risk of a perforated ulcer more than threefold (RR = 3.5; 95% confidence interval [CI] = 1.7-7.1). Ingestion of more than 42 drinks a week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with ingestion of less than one drink a week. Comparison of the same group, showed that subjects who ingested more than 21 drinks a week, but no wine, were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).

A population based cohort study investigates the association between alcohol intake and mortality from all causes, coronary heart disease and cancer. The design is prospective with baseline assessment of intake of beer, wine and spirits, smoking habits, educational level, physical activity, and body mass index and a total of 257,859 person-years follow-up on mortality. A total of 4,833 participants died, of these 1,075 from coronary heart disease and 1,552 of cancer. Compared with non-drinkers, light drinkers who avoided wine, had a relative risk of death from all causes of 0.90 (0.82-0.99) and those who drank wine had a relative risk of 0.66 (0.55-0.77). Heavy drinkers who avoided wine were at higher risk of death from all causes than were heavy drinkers who included wine in their alcohol intake. Wine drinkers had significantly lower mortality from both coronary heart disease and cancer than did non-wine drinkers (p = 0.007 and p = 0.004, respectively). In conclusion, wine intake may have a beneficial effect on all cause mortality that is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

Introduction: The aim of the present population-based cohort study was to examine the association between alcohol intake and mortality from all causes, coronary heart disease, and cancer., Methods: A prospective population study with baseline assessment of beer, wine and spirit consumption, smoking habits, educational level, physical activity, and body mass index in a total of 257,859 person-years follow-up on mortality., Results: A total of 4833 participants died, 1075 of these from coronary heart disease and 1552 of cancer. Compared with non-drinkers, light drinkers, who avoided wine, had a relative risk of death from all causes of 0.90 (0.82-0.99) and those who drank wine had a relative risk of 0.66 (0.55-0.77). Heavy drinkers, who avoided wine, were at higher risk of death from all causes than were heavy drinkers, who included wine in their alcohol consumption. Wine drinkers had a significantly lower mortality from both coronary heart disease and cancer than had non-wine drinkers (p = 0.007 and p = 0.004, respectively)., Conclusion: A moderate consumption of wine may have a beneficial effect on all causes of mortality, which is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

Background: In March 1999, the National Board of Health changed its recommendations about alcohol drinking in pregnancy. A "No drinking" policy was changed to three recommendations: 1. Avoid, as far as possible, alcohol in pregnancy; 2. Never take more than one drink a day; and 3. Do not drink alcohol every day., Aim: By means of data from the Danish National Birth Cohort, to monitor changes in pregnant women's reporting of alcohol drinking before and after the change in policy., Methods: From October 1, 1997, to September 30, 1999, a total of 30,899 pregnant women were interviewed by the end of first trimester. Information on alcohol intake reported among women interviewed from July 1, to September 30, 1998 was compared with the same information obtained from interviews completed in the same months in 1999., Results: Overall, there were no changes in mean alcohol intake in the two periods. Hence, the mean intake was 0.6 drinks per week in the period before and 0.7 drinks per week in the period after introduction of the recommendations. The proportion of women drinking more than two drinks per week was 6.4% before vs 7.4% after the new and less restrictive recommendations (p = 0.12). The proportion of women having one or more binge episode (e.g. drinking five or more drink at one occasion) was 26.7 vs 27.4 (p = 0.65)., Conclusion: The study showed no significant changes in drinking habits among Danish pregnant women after relaxation of the guidelines for sensible drinking during pregnancy.

Introduction: The aim of the present study was to quantify the impact of different dietary factors on the mortality from ischaemic heart disease in Denmark., Methods: Relative risks and knowledge on the distribution of different dietary factors were used to estimate etiological fractions., Results: It is estimated that an intake of fruit and vegetables and saturated fat as recommended would prevent 12 and 22%, respectively, of deaths from ischaemic heart disease in Denmark. An intake of fish among those at high risk for ischaemic heart disease, would lead to a 26% lower mortality, while alcohol intake among abstainers would have no significant quantitative effect., Discussion: These results suggest that changes in dietary habits according to current recommendations would have an impact on public health in Denmark.

Variation in diet associated with drinking patterns may partly explain why wine seems to reduce ischaemic heart disease mortality. In a cross-sectional study conducted in Copenhagen and Aarhus from 1995 to 1997 including 23,284 men and 25,479 women aged 50-64 years, the relation between intake of different alcoholic beverages and selected indicators of a healthy diet was investigated. In multivariate analyses, wine, as compared with other alcoholic drinks, was associated with a higher intake of fruit, fish, cooked vegetables, salad, the use of olive oil for cooking and not using fat spread on rye bread. In conclusion, the association between wine drinking and an intake of a healthy diet may have implications for the interpretation of previous reports of the relation between type of alcoholic beverage and ischaemic heart disease mortality.

A questionnaire-based interview on alcohol drinking pattern in a random sample of 4,016 men and 4,179 women in 1992 was compared to an identical interview from 1979. In coherence with alcohol sale statistics, the average alcohol intake was unchanged in the population. Nevertheless, during the period drinking patterns have changed among Danes. Thus, 20 to 39 year-olds drank less, 40 to 59 years-olds drank more, fewer Danes drank during daytime, and fewer drank on weekdays at the second survey.

A large number of prospective population studies from many countries have described a J- or U-shaped relation between alcohol intake and mortality. Both heavy drinkers and abstainers are at a higher risk of dying from all causes than individuals with light to moderate alcohol intake. This makes information to the public about sensible drinking limits more complex than, eg, that concerning smoking. The present paper aims at identifying upper thresholds for harmless alcohol intake. The review is mainly based on epidemiological evidence concerning somatic morbidity and mortality. It is concluded that the present Danish recommendations--14 drinks per week for women and 21 drinks per week for men--should be maintained. It is emphasized that these limits apply to adults who are at no risk of dependency and that they do not apply to pregnant women. Information about a potentially beneficial effect of a moderate alcohol intake should be reserved for individuals already at risk of coronary events.

The association between self-reported alcohol intake and the risk of future liver disease was studied in a population-based prospective cohort of 13,285 men and women aged 30-79 years. Diagnoses indicating alcoholic liver disease (n = 261) or cirrhosis (n = 124) were obtained from the Danish National Health Registers. The cumulated observation time was 130,558 person-years. A dose-dependent increase in risk of developing liver disease was observed with increasing alcohol intake, with the steepest increase among women. At an alcohol intake of 7-13 beverages per week for women and 14-27 beverages per week for men the relative risk was significantly greater than 1. Women had a significantly higher relative risk of developing alcohol related liver disease than men for any given level of alcohol intake. In the general population, self-reported current alcohol intake is a good predictor of the future risk of alcoholic liver disease.

In order to compare data on intake of wine, beer and spirits from a frequency questionnaire with intake of each type of alcoholic beverage estimated from a dietary interview, a randomly selected sub-sample of 244 women and 249 men aged 35-65 years was cross-sectionally studied. The sample was a sub-sample of the Danish MONICA study. Mean outcome measure in the study was the differences in intake of beer, wine and spirits as reported by the frequency questionnaire and the diet history interview. We found an overall agreement between the two methods, with very little or no systematic variation for all three alcoholic beverages. We conclude that compared to a more time and money consuming thorough dietary interview, the traditional frequency questionnaires seem to sufficiently capture intakes of different types of alcohol. Bias in alcohol reporting by the frequency questionnaire does not seem responsible for the recently found decreased mortality among subjects with a daily intake of wine, nor the increased mortality from drinking of spirits.

In a prospective population study of 7,234 women and 6,051 men aged 30-79 years, information on beer, wine, spirits and tobacco consumption, and on education, income and body mass index were assessed in the period 1976-1978, and the population was followed until 1.1.1988 for mortality. With increasing intake, the wine-mortality risk function steadily decreased from a relative risk of 1.00 for those who never drank wine through 0.51 (95% confidence limits; 0.32-0.81) among those who drank three to five glasses per day. In contrast, neither beer nor spirits consumption was associated with reduced risk. For spirits consumption the relative risk of dying increased from 1.00 among those who never drank to 1.34 (1.05-1.71) among those with an intake of 3-5 drinks per day. Wine drinking showed the same relation to risk of death from cardio- and cerebrovascular disease as to mortality from all causes.

The aim of the study was to examine the association between self-reported alcohol intake and subsequent mortality from all causes, and to examine if the effect of alcohol intake on the risk of death was modified by sex, age, body mass index, and smoking habits. In a prospective population study of 7,234 women and 6,051 men aged 30-79 years alcohol- and tobacco consumption and body mass index were assessed in the period 1976-1978, and the population was followed until 1.1.1988 for mortality. A U-shaped curve described the relation between alcohol intake and mortality. The nadir of the risk function was observed at one to six beverages per week (relative risk set at 1.00). Abstainers had a relative risk of 1.37 (95% confidence intervals: 1.20-1.56), whereas those drinking more than 70 beverages per week had a relative risk of 2.29 (1.75-3.00). Among the drinkers, the risk was significantly higher than 1 only among those drinking more than 42 beverages per week. Neither sex, age, body mass index, nor smoking significantly modified the risk function. Our findings suggest that simple messages about the benefits of total abstinence may not be appropriate.