AIM: To examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems.

METHOD: Register-linked population-based longitudinal study using data from a natural experiment setting, including 363 286 children born 1965-71. An experimental alcohol policy change was piloted in two regions of Sweden in 1967-68, where access to strong beer increased for 16-20 year old. Children exposed in utero to the policy change were compared to children born elsewhere in Sweden (excluding a border area), and to children born before and after the policy change. The outcome was obtained from the National Hospital Discharge Register using the Swedish index of alcohol-related inpatient care. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression analysis.

RESULTS: The results suggest that children conceived by young mothers prior to the policy change but exposed to it in utero had a slightly increased risk of alcohol-related health problems later in life (HR 1.26, 95% CI 0.94-1.68). A tendency towards an inverse association was found among children conceived by older mothers (HR 0.88, 95% CI 0.74-1.06).

CONCLUSION: Results obtained from a natural experiment setting found no consistent evidence of long-term health consequences among children exposed in utero to an alcohol policy change. Some evidence however suggested an increased risk of alcohol-related health problems among the exposed children of young mothers.

Published in General Health

BACKGROUND: A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.

METHODS: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.

RESULTS: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.

CONCLUSION: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

Published in General Health

AIMS: The aim of this study was to clarify the relationship between drinking and metabolically healthy status in men with normal weight, overweight and obesity.

METHODS: The subjects were Japanese men aged from 35 to 60 years (n=31781) and they were divided by daily amount of drinking (g ethanol) into light (< 22), moderate (>/=22 and <44), heavy (>/=44 and <66) and very heavy (>/=66) drinkers. Metabolically healthy subjects were defined as those without hypertension, dyslipidemia and diabetes.

RESULTS: The percentage of metabolically healthy subjects was much lower in the overweight (BMI>/=25 and <30) and obese (BMI>/=30) groups than in the normal weight group (BMI>/=18.5 and <25) and was much lower in the obese group than in the overweight group. In each of the normal weight and overweight groups, percentages of metabolically healthy subjects were significantly lower in heavy and very heavy drinkers than in nondrinkers and were marginally significantly higher in light drinkers than in nondrinkers. The above associations between drinking and metabolically healthy status were confirmed by logistic regression analysis. In the obese group, the percentage of metabolically healthy subjects was significantly lower in regular drinkers (including all drinker categories) than in nondrinkers, and metabolically healthy subjects were rare (0.56%) among regular drinkers.

CONCLUSIONS: Regardless of absence and presence of overweight or obesity, excessive alcohol drinking is inversely associated with metabolically healthy status and should be avoided for prevention of cardiovascular disease.

Published in Cardiovascular System

OBJECTIVE: To examine outcomes among boys and girls that are associated with prenatal alcohol exposure.

METHODS: Boys and girls with fetal alcohol spectrum disorders (FASD) and randomly-selected controls were compared on a variety of physical and neurobehavioral traits.

RESULTS: Sex ratios indicated that heavy maternal binge drinking may have significantly diminished viability to birth and survival of boys postpartum more than girls by age seven. Case control comparisons of a variety of physical and neurobehavioral traits at age seven indicate that both sexes were affected similarly for a majority of variables. However, alcohol-exposed girls had significantly more dysmorphology overall than boys and performed significantly worse on non-verbal IQ tests than males. A three-step sequential regression analysis, controlling for multiple covariates, further indicated that dysmorphology among girls was significantly more associated with five maternal drinking variables and three distal maternal risk factors. However, the overall model, which included five associated neurobehavioral measures at step three, was not significant (p=0.09, two-tailed test). A separate sequential logistic regression analysis of predictors of a FASD diagnosis, however, indicated significantly more negative outcomes overall for girls than boys (Nagelkerke R2=0.42 for boys and 0.54 for girls, z=-2.9, p=0.004).

CONCLUSION: Boys and girls had mostly similar outcomes when prenatal alcohol exposure was linked to poor physical and neurocognitive development. Nevertheless, sex ratios implicate lower viability and survival of males by first grade, and girls have more dysmorphology and neurocognitive impairment than boys resulting in a higher probability of a FASD diagnosis.

Published in Pregnant Women
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