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Sahle BW, Owen AJ, Wing LMH, Beilin LJ, Nelson MR, Jennings GLR, Reid CM; Second Australian National Blood Pressure Study Management Committee. Relation of Alcohol Consumption to Risk of Heart Failure in Patients Aged 65 to 84 Years With Hypertension. Am J Cardiol. 2018 Oct 15;122(8):1352-1358. doi: 10.1016/j.amjcard.2018.06.046. Epub 2018 Aug 11. PMID: 30107904.

This study examined the association between heavy alcohol consumption and risk for heart failure in older adults diagnosed with hypertension. Long-term alcohol consumption has been associated with structural and functional myocardial impairment that can lead to heart failure symptoms. Since only 6% of the research participants were binge drinkers, the research study found that there was no evidence for benefit or harm in light alcohol consumption in relation to heart failure incidence. This is only considered for light drinkers since there is supporting evidence that heavy alcohol consumption provides much greater risk of heart failure. The key findings in this study are shocking at the lack of observed association between binge drinking and heart failure but it could be due to the fact that there was only a small proportion of binge drinkers. The inconsistency surrounding the risk or benefit of moderate drinking in relation to heart failure could be explained by the variation in age of population, definition of heart failure with the presence of co-morbidities.

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Atzendorf, J., Apfelbacher, C., de Matos, E. G., Lochbühler, K., Piontek, D., Seitz, N.-N., & Kraus, L. (2020). Do smoking, nutrition, alcohol use, and physical activity vary between regions in Germany? - results of a cross-sectional study. BMC Public Health, 20(1), 1–8. https://doi-org.ezproxy.uky.edu/10.1186/s12889-020-8352-2

- This survey, Epidemiological Survey of Substance Abuse (ESA) is important because it discussed the main four aspects related to health: smoking, nutrition status, alcohol use, and physical activity in different regions in Germany.

- The key finding of this survey is that higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Moreover, women and individuals with higher education were less likely to report unhealthy nutrition compared to men and individuals with a lower education. These findings are related to nutritional sciences because it can lead to a better understanding of the social epidemiology of lifestyle risk factors in Germany. Therefore, this provides starting points to develop health policies for reducing lifestyle risk factors by considering different regions in Germany.

- The main clinical applications of this survey are that the regional differences for at-risk alcohol consumption should be considered for the implementation of prevention measures for the reduction of alcohol consumption.

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Timary P de, Cani PD, Duchemin J, et al. The Loss of Metabolic Control on Alcohol Drinking in Heavy Drinking Alcohol-Dependent Subjects. PLoS ONE. 2012;7(7):1-10. doi:10.1371/journal.pone.0038682

Alcohol dependence (AD) is associated with weight gain but also has a high rate of malnutrition. This study  aimed to analyze energy metabolism in all populations of alcohol dependent subjects, rather than only subjects who consumed very large quantities of alcohol.  Knowing how alcohol dependence affects energy balance in a wide range of alcohol intake quantities will help treat nutrition status of patients appropriately.

The researchers found that  AD subjects who drink large quantities of alcohol had lower weight, BMI, and fat mass (FM) than the AD subjects drinking lower amounts of alcohol. This observation could explain why previous studies have shown AD linked to both increases and decreases in body weight. They also observed that AD subjects had higher than theoretical values of basal metabolism.

Knowing how much alcohol a patient with AD consumes daily can make an impact on how to manage and correct their energy imbalance.

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Citation:  Zhong, Wei, et al. "Dietary Zinc Deficiency Exaggerates Ethanol-Induced Liver Injury in Mice: Involvement of Intrahepatic and Extrahepatic Factors." PLoS ONE, vol. 8, no. 10, 2013, p. e76522. Gale In Context: Opposing Viewpoints, link.gale.com/apps/doc/A478272631/OVIC?u=uky_main&sid=OVIC&xid=2a7c1bc7. Accessed 15 Mar. 2021.                                This study is important because it shows that zinc deficiency further exacerbates the effects of hepatic lipid accumulation and the generation of pro-inflammatory cytokines which is often indicative of the first stage of a damaged liver due to the effects of ethanol metabolism. Chronic alcohol users tend to have lower intakes of dietary zinc, which causes transcriptional silencing of a variety of genes associated with detoxification processes.

Modifying levels of zinc, that is, increasing zinc intake through the diet or supplementation may potentially attenuate disease presentation and progression caused by chronic alcohol use. Zinc plays a variety of roles in the body including modulating the immune system, cellular division and growth, wound healing and the breakdown of carbohydrates.Maintainig or introducing proper zinc levels into the body can influence the capacity of these cellular processes to work more efficiently thus modulating the development of inflammation.

Monitoring micronutrient intake can help assess the risk of disease progression. Ethanol consumption in combination with zinc deficiency worked together to activate pro-inflammatory responses and the down-regulation of detoxification enzymes. This leads to an increase in lipid accumulation within the liver and the signaling of pro-inflammatory cytokines that will set the stage for chronic inflammation cellular by-stander destruction. Responsible drinking habits should be encouraged along with a nutrition plan to compensate for the generation of toxic metabolites the body will generate from the metabolic degradation of the ethanol.

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Jeynes KD, Gibson EL. The importance of nutrition in aiding recovery from substance use disorders: A review. Drug Alcohol Depend. 2017 Oct 1;179:229-239. doi: 10.1016/j.drugalcdep.2017.07.006. Epub 2017 Aug 4. PMID: 28806640.

Importance: This is a review of the literature on nutrition in both alcohol and other substance use recovery. Given how many people struggle with either drugs or alcohol at some point in their lives, it’s important to look at modifiable risk factors and things within the field of nutrition that can promote recovery.

Key Finding: In addition to deficiencies in nearly all micronutrients, this paper discusses the effect of alcohol on several different hormones. Alcohol suppresses ghrelin secretion, leading to a suppressed appetite.  Conversely, an increase in plasma ghrelin that occurs when patients stop drinking alcohol can then in turn cause cravings for alcohol. Alcohol also causes insulin dysregulation, leading to high fasting insulin levels and slow postprandial response. They also looked at the relation between AUD and mood – there have been studies that show high tryptophan diets are associated with less depression. While tryptophan supplementation hasn’t been shown to have an effect on mood, adequate nutrition to ensure good intake of tryptophan is important. Low omega-3 levels have also been correlated with negative mood and even with higher rates of relapse in a few studies.

Clinical Implications: Involvement of a dietician in an inpatient or outpatient AUD treatment could be a useful part of recovery. In addition to  recommendations on vitamin supplementation, focusing on balancing macronutrients (given frequent sugar cravings) and teaching patients ways to eat better long term could all be useful things that a dietician could add to a recovery program.

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Citation: Zgheib, Elias, et al. “Factors Associated with Functional Disability Among Lebanese Elderly Living in Rural Areas: Role of Polypharmacy, Alcohol Consumption, and Nutrition-Based on the Aging and Malnutrition in Elderly Lebanese (AMEL) Study.” Journal of Epidemiology and Global Health, vol. 8, no. 1-2, 2018, pp. 82–90.
The study investigates older people's polypharmacy, alcohol consumption, and nutrition in Lebanon. Although Lebanese are different from Americans' lifestyles, they struggled with health insurance as Americans. Most Lebanese elders have multi-complication, so it is important to understand what nutritional status is related to the pharmacy intakes. It provides that the government or clinicians manage the elders' health status.

One of the key findings in multivariable analysis. The researchers observed polypharmacy and alcohol consumption correlation. Polypharmacy is a classification of proton pump inhibitors (PPI) and anti-gout drugs. The results showed that the participants who take dementia and ant-gout drugs would associate with skin ulcers. Moreover, the drugs interact with alcohol consumption. Interestingly, alcohol consumption is no significant with activities of daily living. Although the authors did not mention the elder's multifactor and alcohol consumption correlation, I realized that the alcohol intake would influence humans' mechanism.

I believed that the study shows clinic trials to get the organization's society and researchers inspire to improve the recommendation guidelines.

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Jackson, S. E., Brown, J., Aveyard, P., Dobbie, F., Uny, I., West, R., & Bauld, L. (2019). Vaping for weight control: A cross-sectional population study in England. Addictive behaviors, 95, 211-219.

1. Why is this important?
For this weekly wall, I tried to go into a different direction and focus on a cross-sectional study that looked at two topics that we've discussed extensively in this class: obesity and smoking/vaping. With the new trend of vaping being much more prominent than cigarette smoking, I think a comparison study between the two epidemics facing society is extremely important. Understanding the relationship between these two topics is key in gaining a better and broader understanding of patient health in all of its factors.

2. One Key Finding
One major key finding was that in over 1000 people, most people did not want to quit vaping because they were concerned with significant weight gain as they had anecdotally noticed significant weight loss with the introduction of vaping. As vaping and smoking have significant implications for longitudinal health, the thought of this as a weight management agent does seem ludicrous. Significant research in nutrition has shown the avenues to which weight loss can be achieved; exploring the relationship between these two things could improve how nutritional guidelines are recommended and followed.

3. Clinical Implications
Clinically, this should change a lot about how providers and professionals are counseling their patients in both weight management and in vaping cessation. Ignoring the major relationship between the two factors is irresponsible and would likely lead to failure on the patient's part to follow recommended health/nutritional guidelines. However, vaping is a great stepping stone in fight for patients to stop smoking, so in-depth conversations with patients about their smoking, vaping, and eating habits would provide better, personalized healthcare.

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Rehm J, Hasan OSM, Black SE, Shield KD, Schwarzinger M. Alcohol use and dementia: a systematic scoping review. Alzheimers Res Ther. 2019;11(1):1. Published 2019 Jan 5. doi:10.1186/s13195-018-0453-0

Dementia is estimated to affect 150 million people in 2050 globally, three time more than 2015.  However, it is possible to be intervened and prevented by treatment of causing factors. Since people with dementia under 65 years old are likely to be related to alcohol use, this study conducted a systematic review of relationship between dementia and alcohol use.

Although light to moderate level of alcohol intake in people of middle to late ages is expected to lower the risk of dementia, some studies found contradiction. Changes in brain structures and cognitive function of heavy alcohol users are observed in MRI images, which are related to the risks of any kinds of dementia.

The data exclude people with heavy alcohol use and AUD from the samples: They tend to stop participating or die young. However, AUDs show the highest RR of dementia’s all risk factors, and the impact of alcohol use should be considered in the health and social welfare system

Even though quality of alcohol-dementia studies are still inadequate, and the finding of the relationship is not significant as of now, this study concludes that screening and interventions at the primary health-care system is effective to lower the level of alcohol use, resulting in lower risks of dementia.

I think that determining the cause/effect between dementia and alcohol use is difficult because onset of dementia can be years before it is diagnosed, but education of healthy behaviors including diets and exercise would help to reduce alcohol abuse and future dementia.

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Citation: Eakin, Michelle N., and Enid Neptune. "Smoking and COVID-19: The Real Deal." Annals of the American Thoracic Societyja (2021).

Importance
This is a very practically written review article that summarizes the current findings on the impact  smoking and nicotine dependence on COVID-19 outcomes. It disects what is known about the disease mechanisms that impact covid outcomes, altered host defencsesm abd smoking-associated injury as it relates to COVID-19 outcomes. This is a great, easy to understand read that can likely be understood by the common population!!

Key Findings
This is a great review of what we know about what habits impact COVID-19 outcomes and where we should continue to try and improve. The different topics include airway/airspace injury, direct toxic injury, inflammation profile that supports viral pathogenesis, alteration in ACE2 Abundance, disturbances in RAS signaling, nicotine signaling and SARS-CoV2 Infection. I like that they refute the theory of nicotine's protective effect. The underlie all these ideas with the fact that nicotine dependence overall decimates much of our health outcomes. Pushing a message such as this will only incentivize people to smoke more. Research in that direction should be pursued with extreme caution to avoid a societal trend toward more smoking. I'm so happy they think so! Let's keep the big picture in mind and make everyone's lives better.

Clinical Implications
The summary of this article provides a well thought out direction of what we need to discover and how this information can be useful. Pursuing objectives such as more epidemiological population health data and the inclusion of smoking/ vaping status in vaccine trials. This relationship is very complex. The fact that nicotine provided some evidence of a protective effect from SARS-CoV2 is baffling to scientists. The mechanistic discovery of what is actually going on with COVID and how it interacts with the body and what factors are correlated with symptoms will further elucidate and serve the public better to defend against this unique virus.

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Pradeep Yarra

Citation: Parekh, Niyati, Lin, Yong, Chan, Melany, Juul, Filippa, & Makarem, Nour. (2021). Longitudinal dimensions of alcohol consumption and dietary intake in the Framingham Heart Study Offspring Cohort (1971–2008). The British Journal of Nutrition., 125(6), 685-694.

Question 1:   Why is this study important?

Alcohol consumption is highly prevalent in United States, with nearly 55% reporting they drank in the last month. Even though, multiple studies have evaluated direct effect of alcohol on health outcomes or chronic disease risk, its influence on other health behaviors, namely diet, is much less explored. In this study, authors evaluate the multidimensionality of alcohol drinking patterns (quantity, drinking frequency, binge drinking and beverage preference) throughout adulthood and their influence on dietary intakes. Due to large database, assessment over decades, this study is able to evaluate longitudinal data from Framingham database to examine associations of alcohol dimensions with measures of diet quality at specific periods in early-, mid- and late adulthood.

Identify one key finding of this study and describe how it relates to nutritional sciences

Alcohol consumption decreased from 1971 to 2008 , along with decrease in proportion of moderate, heavy and binge drinkers. Non-binge drinkers consumed less sugary drinks and more whole grains than binge drinkers, and the latter consumed more total fat across all examinations (P < 0·05). There was a significant difference in consumption trends of total grains by drinking level (P < 0·05). Overall, abstainers, non-binge drinkers and moderate drinkers had healthier diets compared with binge and heavy drinkers. Furthermore, across all examinations, non-binge drinkers, non-drinkers and moderate drinkers consumed more fruits, vegetables and whole grains and consumed less red meat, sugary drinks and total fat compared with binge drinkers and heavy drinkers, respectively. On longitudinal assessment, this study concluded that as alcohol consumption increases, diet quality decreases.

What are the clinical implications of this study?

This study brings to the forefront that alcohol consumption may be an important target for efforts aimed at improving diet quality for promoting overall health and that such efforts may need to be tailored by age group. Study findings indicate that alcohol drinking patterns are not stable over time and that dietary attributes are differentially associated with drinking patterns, generally being less healthy with higher alcohol intakes. So, dietary advise should be based on pattern of alcohol intake based on age, quantity and quality of diet.

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Citation: Choi YR, Kim HS, Yoon SJ, Lee NY, Gupta H, Raja G, Gebru YA, Youn GS, Kim DJ, Ham YL, Suk KT. Nutritional Status and Diet Style Affect Cognitive Function in Alcoholic Liver Disease. Nutrients. 2021; 13(1):185. https://doi.org/10.3390/nu13010185

This study is important because it looks at how nutrition status in alcoholic liver disease (ALD) is correlated with cognitive function. They first used 20 mice to evaluate changes of cognitive function of ALD. Then, to induce the effect of diet in an alcohol mouse model, mice were divided into 5 groups: normal, control (5% EtOH + regular diet), high carbohydrate diet + 5% EtOH, high fat diet + 5% EtOH, and high protein + 5% EtOH.

For cognitive function, they used a T-maze test and measured the time that the mice searched for a food pellet. It was found that cognitive function improved in the high carbohydrate (HCD) and high fat diet (HFD) groups compared to the alcohol only control group (measured 11, 25, and 44 days after starting exposure to diets/alcohol). However, unsurprisingly, in the livers of these mice the HFD group exhibited significant increases in steatosis compared to the control group.

Even though high-fat diet induced obesity is known to cause cognitive dysfunction, in this study the effects of the diet were the opposite since it looked at the effects of diet in an ALD model as opposed to an obesity model. Clinically, this could give some insight on how to limit cognitive dysfunction in an ALD patient. However, certainly other studies are warranted.

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Chao, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Examining the effects of cigarette smoking on food cravings and intake, depressive symptoms, and stress. Eating behaviors, 24, 61–65. https://doi.org/10.1016/j.eatbeh.2016.12.009

This study is important because it looks at the relationship between cigarette smoking on food cravings and intake with the influence of depressive symptoms and stress. In this study, 712 adults measured their food cravings, food intake, and smoking history.

One key finding in this study is that smokers reported higher cravings of high fat foods and fast food fats compared to non-smokers. After accounting for depressive symptoms and stress the association between smoking and food cravings and intake was no longer significant. This data suggests that depression and stress may account for this relationship between food intake/cravings and smoking status. Nicotine dependence was also positively associated with how often the adults general food cravings and cravings for high fats, sweets, carbohydrates/starches.

This study is important clinically because it suggests that smokers have higher cravings for high fat foods. It also suggests that patients with nicotine dependence might have a harder time of managing food cravings and changing eating habits. Depressive symptoms and stress might make it even more difficult for these patients to address their eating habits and food cravings.

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Byaruhanga J, Atorkey P, McLaughlin M,Brown A, Byrnes E, Paul C, Wiggers J,Tzelepis F
Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review
J Med Internet Res 2020;22(9):e18621
doi: 10.2196/18621

Importance: Video counseling is becoming more prevalent and knowing the effectiveness is beneficial as we move forward. This article points out that some behavioral changes respond better to video counseling than other. In addition, as nutrition professionals is important to counsel patients on the nutritional implications of alcohol abuse and smoking.

Key Findings: Video counseling is potentially more effective than a telephone counseling group in addressing physical inactivity and obesity and is not less or more effective in modifying smoking and alcohol consumption. This would be interesting to see a comparison to in person counseling for those with addition to alcohol and tobacco.

Clinical Implications:
The findings make me wonder if it’s the type of addiction that is presented. This could affect how the patients are counseled. Alcohol and smoking may need a more intensive counseling method Also, I wonder if nutrition counseling for the disease would see any differences in a video counseling method.

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Berkowitz, L., Schultz, B. M., Salazar, G. A., Pardo-Roa, C., Sebastián, V. P., Álvarez-Lobos, M. M., & Bueno, S. M. (2018). Impact of Cigarette Smoking on the Gastrointestinal Tract Inflammation: Opposing Effects in Crohn's Disease and Ulcerative Colitis. Frontiers in immunology, 9, 74. https://doi.org/10.3389/fimmu.2018.00074

Cigarette smoking is the leading cause for preventable deaths in the United States as it a major risk factor for so many other diseases throughout the body. This is mainly due to the high level of toxic constituents that are put into cigarettes and other smoked tobacco products, which have a negative effect on the GI tract. In module 1 we learned about inflammatory bowel disease (both Ulcerative colitis and Chron’s disease). This article is important because it explores the effect of cigarette smoking on GI inflammation and how it affects both Chron’s and Ulcerative Colitis. Smoking has various pathways to negatively affect the gastrointestinal tract, in each puff of a cigarette there is an exponential amount of free radicals, if not neutralized this can cause oxidative stress and lead to tissue damage in the GI tract. Secondly, the gastrointestinal tract by function is very susceptible to particulate matter and various circulating contents that increase in the presence of toxins due to cigarette smoke. This article is very surprising because it explores epidemiological evidence that suggests smoking actually provides protection again ulcerative colitis. This meta-analysis found that individuals were at a much lower risk for UC if they were also smokers and found that hospitalizations for UC was much lower in chronic smokers. This has actually led to some nicotine treatments for patients suffering from UC in the form of chewing gum which brings blood nicotine levels high enough to mimic the levels of chronic smokers to provide the same level protection. This is very interesting in a form of treatment because in the other form of IBD (Chron’s) these protective effects are not seen. In Chron’s disease smoking actually increases one’s risk.

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Bush, T., Lovejoy, J. C., Deprey, M., & Carpenter, K. M. (2016). The effect of tobacco cessation on weight gain, obesity, and diabetes risk. Obesity, 24(9), 1834-1841. doi:10.1002/oby.21582

This study is important because when talking to many of my patients who smoke and friends (especially female) who smoke, one of their biggest concerns about cessation is weight gain. This study looked at 35 past studies and assessed the average weight gain after smoking cessation. Per the studies evaluated, patient had anywhere from 2-10kg more weight gain than their smoking counterparts. However, it is also noted that the longer the follow up time was, the more weight gain was common, indicating that smoking cessation may not immediately lead to weight gain. This is interesting to me because in working with patients, several have told me the way they quit was to replace the habit with something else. Ideally, that would be with a healthy habit such as exercise or talking, but often it is with cooking or eating, which can lead to weight gain in any person.  The study also notes that some of the decreased energy use could be from the lack of effect on the CNS causing stimulation. It also states that “those who stop smoking have an increased preference for sweet tasting foods.” This increase in sugar intake can lead to not only weight gain, but also metabolic syndrome and diabetes. Despite the conflicting data on the risk of diabetes post-cessation, there is agreement in the cardiovascular benefits of tobacco cessation. The clinic implication to me is that when counselling patient on tobacco cessation, be prepared to help them deal with the possible weight gain and develop healthy post-cessation habits as opposed to ones that can exacerbate the problem.

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Citation: Ala'a Alkerwi, Burcu Baydarlioglu, Nicolas Sauvageot, Saverio Stranges, Paul Lemmens, Nitin Shivappa, James R. Hébert, Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study, Clinical Nutrition, Volume 36, Issue 5, 2017, Pages 1275-1282, ISSN 0261-5614, https://doi.org/10.1016/j.clnu.2016.08.013.

Relationship between food consumption/nutrient intake and tobacco smoking have been described but little is known about the association between smoking and overall diet quality. This study examined the associations between eight diet quality indices and smoking status with a focus on smoking intensity.

In this study, participants were classified as never smoker, former smoker (>12mo cessation period), occasional/light smokers (<1cig/d), mod smoker (<20cig/d), and heavy smokers (>20cig/d). Compared to other groups, heavy smokers had significantly higher prevalence of dyslipidemia (83%), obesity (34%), elevated glycemic biomarkers. About 50% of former smokers had hypertension. Diet quality of heavy smoker was significantly poorer than those who never smoked independent of several SES, lifestyle, biologic confounding factors. They are also less compliant with national/international dietary recommendations and self reported less dietary diversity in food choices.

This study provides insight concerning inverse relationship between intensity of tobacco consumption and overall diet quality. Implication is that efforts aimed at tobacco control should target heavy smokers and intervention on smoking cessation should take into account diet quality of smokers and their nutritional habits.

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Citation: Hallgren M, Vancampfort D, Schuch F, Lundin A, Stubbs B. More Reasons to Move: Exercise in the Treatment of Alcohol Use Disorders. Front Psychiatry. 2017;8:160. Published 2017 Aug 28. doi:10.3389/fpsyt.2017.00160

Key clinical question: This article presents a rationale for adopting physical exercise interventions in those with AUDs.

Article findings:

A trend toward a positive effect was observed for alcohol craving and drinking behavior. Exercise interventions were considered safe with no adverse events reported. Another narrative review identified 11 studies of which 6 concluded that exercise may have a positive impact on consumption, abstinence, and the urge to drink (craving).

Recently, a meta-analysis reported the pooled treatment effects of exercise in AUDs across multiple health outcomes. Of 21 studies reviewed, exercise was shown to have significant positive effects on fitness and depression, and a positive but non-significant trend was observed for changes in anxiety and self-efficacy. There was no evidence to suggest that exercise reduced self-reported average daily alcohol consumption, or hazardous/harmful drinking patterns; however, these analyses were limited to only two RCTs.

Current treatment options are effective for some but not all patients and relapse is common. Physical exercise is a safe and feasible treatment option that can improve comorbid health problems and may reduce heavy drinking. However, more trials are needed to see if increasing physical activity truly has a clinical significance in reducing alcohol consumption.

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Citation: Haass-Koffler CL, Souza RD, Wilmott JP, Aston ER, Song JH. A Combined Alcohol and Smoking Cue-Reactivity Paradigm in People Who Drink Heavily and Smoke Cigarettes: Preliminary Findings. Alcohol Alcohol. 2021 Jan 4;56(1):47-56. doi: 10.1093/alcalc/agaa089. PMID: 32984874; PMCID: PMC7768621.

Why is this study important?

Researchers of this study hypothesized that people who drink and smoke cigarettes will spend more time interacting and paying attention to related alcohol and smoking cues, than to water.  According to the supportive documentation for this study, people who both drink and smoke are at a heightened risk of many co-morbidities and this population tends to be more resistant to interventions because the cravings for alcohol and smoking are stronger.

The study is important because the resistance might pertain to nutritional interventions (e.g. dietary changes to help manage malnutrition, hypertension, diabetes, cirrhosis, cancer), that may be needed in this population as well.  Some dietary behaviors could also be triggers associated with alcohol and smoking, although these were not a part of this study.

Due to my lack of familiarity with some of the addiction study tools, I did a little research to understand the methodologies of this study.  Cue Reactivity (CR) and Eye Tracking (ET) were utilized in this research to measure the time interacting with related alcohol and smoking cues. CR is the use of stimuli associated with the addiction (e.g., bottle of preferred alcohol, syringe, lighter, etc.) to obtain subjective reports of craving and physiological responses.  ET measures where we look to determine a possible bias toward substance related stimuli, which is believed to be an important contributor to the development and maintenance of drug abuse.

Key findings related to nutritional science: This study found that time spent with alcohol in both the CR and ET settings significantly correlated with craving for alcohol.  Results also indicated that there was a relationship between time spent with alcohol and craving for cigarettes and suggests that exposure to alcohol may induce cravings of both alcohol and cigarettes.

Clinical implications for this study: Based on this study finding, it is possible that treatment for alcohol use disorder could increase rates of smoking cessation, which could have a twofold effect on disease management and related co-morbidities.  Also, it’s possible that the presentation of addictive behavior could include many substances, including food and a second conclusion may be awareness of associated triggers between alcohol or smoking and various food selections.  Finally, given the higher co-morbidity rates in these populations and possible resistance to interventions it may be difficult to provide nutrition intervention if substance related triggers are present.

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Chéruel, F., Jarlier, M., & Sancho-Garnier, H. (2017). Effect of cigarette smoke on gustatory sensitivity, evaluation of the deficit and of the recovery time-course after smoking cessation. Tobacco induced diseases, 15, 15. https://doi.org/10.1186/s12971-017-0120-4.

This study is important because chronic exposure to cigarette smoke can negatively impact taste sensation which in turn can have negative implications on the nutritional status of smokers, as loss of taste sensation results in poor eating habits.

A key finding of this study: Smokers exhibited significantly lower taste sensitivity than non-smokers, however, upon smoking cessation the decrease in taste sensation is reversed and reached the same taste sensation levels as those of non-smokers. The severity of taste disturbance was directly linked to the intensity of smoking.

Clinical Implications: Exact mechanism for how smoking negatively impacts taste sensation is not clear and more research is needed.  However, the study was able to demonstrate that when smoking cessation occurred that taste sensation quickly recovered.  The authors speculate that the quick recovery of taste sensation could be used as a motivator for those struggling to quit smoking because the results (recovery of taste sensation) can be seen within 8-24 days of cessation depending on the location of the taste buds on the tongue.

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Day, E., and Rudd, J. H. F. (2019) Alcohol use disorders and the heart. Addiction, 114: 1670– 1678. https://doi.org/10.1111/add.14703.

Alcohol is a very frequently consumed ingredient in drinks such as beer. It is reported to be consumed by the majority of surveyed individuals at some point in life. The consumption of too much alcohol leads to many negative effects on the body. Binge drinking and heavy alcohol leads to significant health risks. It is preventable, but with excessive use it can negatively impact the cardiovascular system. This study is important, because it looks at the increasing and associations of alcohol consumptions and heart problems later down the road. This directly relates to material covered in this course with a specific example of how the body can be impacted with over consumption. Alcoholic cardiomyopathy is a specific outcome from alcoholism, and the study indicates that nutrition variability can influence the occurrence of it. It also stated that nutritional deficiencies should be corrected to assist with complications caused by alcohol, and a balanced diet is very important while doing so. Clinical implications could possibly be raising awareness of these outcomes as soon as possible. Younger patients should know their risks, especially if they are predisposed to cardiovascular issues.

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Citation: Nwosu BU, Kum-Nji P. Tobacco smoke exposure is an independent predictor of vitamin D deficiency in US children. PLoS One. 2018 Oct 8;13(10):e0205342. doi: 10.1371/journal.pone.0205342. PMID: 30296288; PMCID: PMC6175516.

Importance:  This study is important because it uncovers an area of need regarding public health policies and recommendations for  identifying and treating vitamin D deficiency in children.   This would be especially important in our state, as smoking  rates are so prevalent, thus  adding to a growing list of negative health implications related to smoking or smoke exposure.

Key finding:  Data was accessed from the National Health and Nutrition Examination Survey (NHANES) 2009–2010 databank on 2,263 subjects of ages 3 to 17 years. Smoke exposure was verified using serum  levels in both passive and active smokers.   The prevalence of second-hand smoke exposure was 42.0%  while the prevalence of active smoking among teenagers was 9.0% (WOW!).   Vitamin D deficiency occurred at a frequency of 15.1% in children unexposed to tobacco smoke, 20.9% in children exposed to passive tobacco smoke, and 18.0% among actively smoking youth.  Tobacco smoke exposure independently predicted vitamin D deficiency after controlling for age, sex, race, BMI, maternal education, and family socio-economic status.

Clinical Importance:
Vitamin D is an important for optimal bone health, both mineralization and new bone growth as well as repair . Vitamin D sufficiency is also crucial in growing children and adolescents for the extra-skeletal functions of vitamin D such as its improvement of glycemic control, cardiovascular health as well as immune function.  This study suggests that a large number of US  children and adolescents are at increased risk of the negative effects of  vitamin D deficiency if they are exposed to cigarette smoke, both actively and passively.   While I do not practice in the  pediatric arena, it would seem beneficial to raise awareness of this and screen earlier so as to intervene as soon as possible in those at risk.