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- Volume 23, Issue sup-2, 2010
South African Journal of Clinical Nutrition - Supplement 2, January 2010
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Supplement 2, January 2010
Alcohol consumption, nutrition, cardiovascular disease and iron status in South Africa : implications for South Africa's drinking guidelines : editorialAuthor N. MorojeleSource: South African Journal of Clinical Nutrition 23, pp 2 –3 (2010)More Less
This series of articles deals with alcohol abuse in South Africa, one of the main economic, social and health problems contributing greatly to the burden of disease in South Africa. The article by Setlalentoa et al provides a useful backdrop to the historical and social aspects of the causes and consequences of alcohol use and abuse in South Africa. The narrative article by Pisa et al is a useful overview of the biological hazards associated with alcohol use and its metabolic products, and the teratogenic effects of alcohol consumption. The authors argue that, while abstinence for all may be a preferable "solution" to promoting continued abstinence for non-drinkers and moderate drinking for those who drink, a move to banning alcohol, rather than reducing drinking, could be both impractical and have deleterious societal consequences.
Alcohol metabolism and health hazards associated with alcohol abuse in a South African context : a review : review articleSource: South African Journal of Clinical Nutrition 23, pp 4 –10 (2010)More Less
The World Health Organization recently stated that alcohol consumption is the fifth leading cause of death worldwide and that intakes are increasing, especially in developing countries. Alcohol-related effects are major threats to global public health. There is growing recognition of an association between alcohol abuse and a host of health and social problems in many parts of the world. In South Africa, a developing country with a rapidly growing economy, available evidence shows that alcohol is a leading risk factor for mortality and morbidity, and hence a significant contributor to the burden of disease. The observed pattern of binge drinking of about a third of South African drinkers is of concern. In addition to physical dependence on alcohol, other psychological, genetic and social factors may contribute to the development of alcohol-related diseases. To develop a relevant, integrated and coherent strategy to address alcohol use, misuse and abuse in South Africa, we need a much better understanding of the metabolism of alcohol, and how the metabolic products and changes associated with alcohol abuse ultimately lead to biological health hazards. This review offers a broad understanding of the metabolism of alcohol and the biological health hazards associated with its abuse. Levels of foetal alcohol syndrome in South Africa are the highest ever recorded, and hence this review will separately address teratogenic effects associated with abuse.
Source: South African Journal of Clinical Nutrition 23, pp 11 –15 (2010)More Less
Use of alcohol in Africa, particularly in South Africa, has a long history and is a way of life for many people, regardless of their socio-economic background. Alcohol abuse has many negative economic, social and health consequences. The objective of this review is to present in brief the history of alcohol use and the social and economic causes and consequences of alcohol abuse in South Africa. Research has shown that the socio-economic effects associated with alcohol abuse include unemployment, violence, crime, sexual risk behaviour and disruptions to family life and work performance. These effects are discussed by emphasising that social and economic changes stemming from urbanisation account for new patterns of drinking among most Africans. South African legislation pertaining to alcohol is also discussed in order to highlight the need for changing or amending certain acts if alcohol abuse is to be reduced.
Relationships of alcohol intake with biological health outcomes in an African population in transition : the Transition and Health during Urbanisation in South Africa (THUSA) study : original researchSource: South African Journal of Clinical Nutrition 23, pp 16 –21 (2010)More Less
Objective : Because present recommendations on alcohol intake are based mainly on evidence of beneficial effects in populations of developed countries, this study examines biological effects of alcohol consumption in an African population in transition to assess whether these recommendations are also valid for Africans.
Design : A cross-sectional, comparative, population-based study.
Setting : Thirty-seven randomly selected sites in the North West province of South Africa, representing both rural and urban areas.
Subjects : A total of 1 854 apparently healthy men and women older than 15 years volunteered to participate. Complete data of 1 757 participants were available for analysis. Pregnant and lactating women as well as subjects taking any form of chronic medication, those with oral temperatures above 37 °C and those who were inebriated were excluded.
Outcome measures : A validated, quantitative food frequency questionnaire was used to measure dietary intake, including alcoholic beverages, expressed as absolute alcohol in grams per day. Anthropometric measurements and blood pressure were taken in triplicate using standardised equipment and procedures. Fasting blood samples were used to determine biochemical variables related to nutritional status and health. Serum gamma glutamyl transferase was used to examine the reliability of reported alcohol intake. The SPSS package was used to relate alcohol intake to blood pressure and biochemical variables, controlling for age, body mass index and blood glucose. Data from men and women, as well as drinkers and non-drinkers, were analysed separately and compared.
Results : In total, 61.5% of the men and 25.2% of the women reported that they consumed alcoholic beverages. The mean alcohol intake of men (30.2 ± 47.8 g/day) exceeded the recommend value of 21 g/day. The women had a mean intake of 11.4 ± 18.8 g/day, falling within the 12 to 15 g/day recommendation. Older drinkers (> 40 years) and those infected with HIV drank more. The level of urbanisation had little effect on amounts consumed. Drinkers had significantly higher HDL cholesterol (HDL-C), serum triglycerides, blood pressure and iron status variables than non-drinkers. These effects represent some beneficial but mostly detrimental consequences of alcohol consumption. When serum ferritin was used to classify subjects into those in negative iron balance (< 12 µg/L), 'normal' iron balance (12-150 µg/L) and positive iron balance (> 150 µg/L), it became evident that alcohol intake almost doubled the proportion of subjects in positive iron balance (in men from 25 to 46%; in women from 11 to 23%).
Conclusion : Although the beneficial effect of alcohol consumption on HDL-C was seen in this population, the effects on iron status and balance are of concern and should be researched in more detail.
Alcohol intake and micronutrient density in a population in transition : the transition and health during urbanisation in South Africa (THUSA) study : original researchSource: South African Journal of Clinical Nutrition 23, pp 22 –28 (2010)More Less
Objective : To investigate the possibility of micronutrient dilution by alcohol in the diets of an adult population in nutrition transition.
Design : A cross-sectional, comparative, population-based study.
Setting : The African population of the North West Province, South Africa.
Subjects : One thousand seven hundred and fifty-seven participants (742 men, 1 015 women) aged 15 years and older from 37 randomly selected sites from rural and urban areas.
Outcome measures : Outcome measures included alcohol consumption at different levels of urbanisation. Nutrient intakes in different alcohol intake categories (abstainers, light-to-moderate, and heavy drinkers) and body mass indices of men and women, separately.
Results : Sixty-one per cent of men and twenty-five per cent of women reported alcohol consumption. Mean daily alcohol consumption of light-to-moderate drinking men (< 30 g per day) and women (< 15 g per day) were 8.3 g and 3.7 g respectively and 80.4 g and 36.6 g for "heavy drinkers", defined as men consuming more than 30 g alcohol/day (18% of the study population) and women who drank more than 15 g alcohol/day (6% of the study population). Sorghum and commercial beer were the most popular alcoholic beverages. Alcohol intake increased from rural to urban middle class, with a shift from sorghum to commercial beer with urbanisation. Men consuming the most alcohol had significantly higher mean intakes of most macro- and micronutrients. For both men and women only the percentage of energy from fat decreased significantly as the alcohol intake increased. The intake of some micronutrients did not meet the Dietary Reference Intake (DRI, Estimated Average Requirement, EAR) at all levels of alcohol consumption. However, the DRIs for pantothenic acid, biotin, magnesium and zinc were met only in men consuming the most alcohol. There was no significant difference in BMI across the different alcohol consumption categories although the total energy intake increased with an increase in alcohol consumption.
Conclusion : In this population in transition, urbanisation increased the consumption of alcoholic beverages. Mean energy intake from alcohol of heavy-drinking men (18.1% of total energy, TE) and women (11.7% of TE) was significantly higher than in the other groups but this did not cause an overall micronutrient dilution effect. It seems that respondents who have the money to buy alcoholic drinks can possibly also afford more healthy and nutritious food.
Alcohol consumption and cardiovascular disease risk in an African population in transition : the Prospective Urban and Rural Epidemiology (PURE) study : original researchSource: South African Journal of Clinical Nutrition 23, pp 29 –37 (2010)More Less
Objective : There is evidence showing a cardioprotective effect of light to moderate alcohol consumption in many populations. Whether alcohol consumption reduces cardiovascular disease (CVD) risk in an African population remains unclear. This study therefore assessed the associations between alcohol consumption (using reported alcohol intake and biological alcohol consumption markers) and CVD risk factors in an African population in transition.
Design : This cross-sectional epidemiological survey is part of the South African segment of the international 12-year Prospective Urban and Rural Epidemiology (PURE) study in which the health transition in urban and rural subjects is investigated.
Setting : A rural and urban site in the North West Province of South Africa.
Subjects : A total of 2 010 apparently healthy African volunteers (35 years and older) were recruited from a sample of 6 000 randomly selected households.
Methods : Alcohol consumption was assessed by a validated quantitative food frequency questionnaire (QFFQ) and two biological markers, percentage serum carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl transferase (GGT). The cardiovascular risk factors included in this analysis were serum lipids and blood pressure. Complete data of 1 763 and 1 878 participants were available for %CDT and GGT respectively. The subjects were divided into quartiles on the basis of their reported alcohol consumption (QFFQ), %CDT and GGT values. Additionally, subjects were divided into self-reported drinkers and non-drinkers. Men and women were analysed separately.
Results : The two alcohol biomarkers %CDT and GGT had different associations with CVD risk factors in this population. The risk of CVD decreased with increasing %CDT level, in that high-density lipoprotein cholesterol (HDL-C) increased significantly with increasing %CDT concentrations for both men and women. There was no significant increase in blood pressure, triglycerides and total cholesterol with increasing %CDT concentrations, except for women, where blood pressure increased significantly with %CDT. Blood pressure, triglycerides and total cholesterol increased significantly with increasing GGT concentrations for both men and women. GGT was also positively associated with HDL-C for both men and women. Self-reported drinkers had a significantly higher HDL-C, blood pressure, %CDT, GGT and lower body mass index (BMI) values than self-reported non-drinkers for both men and women. No significant differences between self-reported drinkers and non-drinkers were seen for triglycerides and total serum cholesterol (even after adjusting for BMI and smoking) for both men and women.
Conclusions : In this population-based study, increased alcohol consumption was associated with higher HDL-C levels but also with increased blood pressure values, indicating that the cardioprotective effect of alcohol possibly may disappear because the increase in blood pressure offsets the benefits of the increase in HDL-C.