Alcohol 'flush' signals cancer risk in Asians

Orang Asia timur yang mengalami flush saat minum alkohol menghadapi risiko kanker esofagus bila minum banyak alkohol.

Hal ini disebabkan kurangnya enzim ALDH2 yang mengubah acetaldehyde menjadi acetate (bentuk senyawa aman).

Mereka yang mempunyai defisiensi gen ALDH2 mengalami flushing, mual dan takikardia bila meminum alkohol.

36% orang Asia timur mempunyai defisiensi gen ALDH2.

 

 

Alcohol 'flush' signals cancer risk in Asians

David Brill

Medical Tribune

 

East Asians who "flush" when drinking alcohol could be at increased risk of esophageal cancer if they do not drink responsibly, a recent study has warned.

 

The characteristic red cheeks and nausea are a well-recognized phenomenon, but few people are aware that the underlying enzyme deficiency also predisposes heavy drinkers to squamous cell esophageal carcinoma, say the researchers.

 

With some 36 percent of East Asians displaying the flush response, there is potential to save "a substantial number of lives" by counseling affected individuals against heavy drinking. [PLoS Med 2009 Mar 24;6(3):e50]

 

"Cancer of the esophagus is particularly deadly, with 5-year survival rates ranging from 12 to 31 percent throughout the world," said lead researcher Dr. Philip Brooks, of the US National Institute on Alcohol Abuse and Alcoholism. "And we estimate that at least 540 million people have this alcohol-related increased risk for esophageal cancer.

 

"We hope that by raising awareness of this important public health problem, affected individuals who drink will reduce their cancer risk by limiting their alcohol consumption," he said.

 

Flushing is caused by a deficiency in aldehyde dehydrogenase 2 (ALDH2) – an enzyme which breaks down acetaldehyde, a carcinogenic by-product of ethanol metabolism. People with normal ALDH2 function can convert acetaldehyde safely into acetate, but in ALDH2-deficient individuals it accumulates in the body, leading to facial redness, nausea and tachycardia.

 

In people who are homozygous for the ALDH2-deficiency gene, the response to alcohol is so unpleasant that they cannot consume large quantities, and are thereby protected from the associated risk of esophageal cancer.

 

Heterozygotes, however, can develop tolerance to acetaldehyde and may become heavy drinkers. Studies from Japan and Taiwan have shown that ALDH2-deficient heterozygotes who drink heavily are over 10 times as likely to develop esophageal cancer, [Jpn J Clin Oncol 2003 Mar;33(3):111-21; Int J Cancer 2008 Mar 15;122(6):1347-56]

 

Dr. Michael Wang, a radiation oncology consultant at the National Cancer Centre Singapore, agreed that the link between flushing and esophageal cancer is not likely to be common knowledge among doctors.

 

"From the article, it is fair to comment that there is a causative relation between deficiency of the gene and increased risk of esophageal cancer," he said.

 

"However, there has been a lot of material published since the 1970s regarding this condition. This relationship may be confounded by smoking, which is also related to esophageal cancer. Before we say something drastic like 'people who flush when drinking have a higher risk of contracting esophageal cancer,' we should research all the previously published articles."

 

Wang added that all heavy alcohol drinkers should be counseled, since drinking also predisposes people to other medical conditions and to drunk driving.

 

The study authors advise clinicians to determine whether East Asian patients are ALDH2 deficient by asking simple questions about their history of flushing when drinking alcohol. Identified flushers should then be advised of their cancer risk and encouraged to moderate their consumption, they say.

Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients

Red yeast rice (RYR) dapat digunakan untuk menurunkan kadar kolesterol LDL pada pasien yang tidak bisa diberikan preparat statin

 

Annals of Internal Medicine 150(12):830-839, 16 June 2009 © 2009 to the American College of Physicians
Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients-A Randomized Trial. David J. Becker, Ram Y. Gordon, Steven C. Halbert, Benjamin French, Patti B. Morris, and Daniel J. Rader.

 

16 June 2009 | Volume 150 Issue 12 | Pages 830-839

Background: Red yeast rice is an herbal supplement that decreases low-density lipoprotein (LDL) cholesterol level.

Objective: To evaluate the effectiveness and tolerability of red yeast rice and therapeutic lifestyle change to treat dyslipidemia in patients who cannot tolerate statin therapy.

Design: Randomized, controlled trial.

Setting: Community-based cardiology practice.

Patients: 62 patients with dyslipidemia and history of discontinuation of statin therapy due to myalgias.

Intervention: Patients were assigned by random allocation software to receive red yeast rice, 1800 mg (31 patients), or placebo (31 patients) twice daily for 24 weeks. All patients were concomitantly enrolled in a 12-week therapeutic lifestyle change program.

Measurements: Primary outcome was LDL cholesterol level, measured at baseline, week 12, and week 24. Secondary outcomes included total cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, liver enzyme, and creatinine phosphokinase (CPK) levels; weight; and Brief Pain Inventory score.

Results: In the red yeast rice group, LDL cholesterol decreased by 1.11 mmol/L (43 mg/dL) from baseline at week 12 and by 0.90 mmol/L (35 mg/dL) at week 24. In the placebo group, LDL cholesterol decreased by 0.28 mmol/L (11 mg/dL) at week 12 and by 0.39 mmol/L (15 mg/dL) at week 24. Low-density lipoprotein cholesterol level was significantly lower in the red yeast rice group than in the placebo group at both weeks 12 (P < 0.001) and 24 (P = 0.011). Significant treatment effects were also observed for total cholesterol level at weeks 12 (P < 0.001) and 24 (P = 0.016). Levels of HDL cholesterol, triglyceride, liver enzyme, or CPK; weight loss; and pain severity scores did not significantly differ between groups at either week 12 or week 24.

Limitation: The study was small, was single-site, was of short duration, and focused on laboratory measures.

Conclusion: Red yeast rice and therapeutic lifestyle change decrease LDL cholesterol level without increasing CPK or pain levels and may be a treatment option for dyslipidemic patients who cannot tolerate statin therapy.

Determining optimal approaches for weight maintenance

Penelitian ini menilai efektivitas 2 program pendukung dan dua jenis diet dalam mempertahankan penurunan berat badan.

 

Diikuti oleh 200 wanita yang telah berhasil turun >5% BB, desain randomized controlled, 2x2 faktorial. Dibandingkan antara program pendukung intensif terhadap program pendukung sederhana. Dan dibandingkan antara diet tinggi karbohidrat terhadap diet tinggi mono-unsaturated fatty acid (MUFA)

 

Setelah 2 tahun didapatkan tidak ada beda signifikan antara kedua program pendukung.

Sedangkan diet tinggi MUFA menyebabkan kadar kolesterol total dan LDL lebih tinggi signifikan dibanding konsumsi diet tinggi karbohidrat.

 

Kesimpulan setelah berhasil mencapai penurunan BB sebaiknya diikuti dengan program pendukung, meskipun sederhana (dan murah) namun terbukti dapat mempertahankan penurunan BB.

 

Research

CMAJ. May 12, 2009; 180 (10). doi:10.1503/cmaj.080974. © 2009 Canadian Medical Association or its licensors

Determining optimal approaches for weight maintenance: a randomized controlled trial

Kelly S. Dale, PhD MSc, Kirsten A. McAuley, MBChB PhD, Rachael W. Taylor, PhD BSc, Sheila M. Williams, DSc BSc, Victoria L. Farmer, MSc, Paul Hansen, PhD MEc, Sue M. Vorgers, RN, Alexandra W. Chisholm, MCApSc PhD and Jim I. Mann, DM PhD

From the Departments of Human Nutrition (Dale, McAuley, Taylor, Vorgers, Chisholm, Mann), Preventive and Social Medicine (Williams), and Economics (Hansen), University of Otago; and the Edgar National Centre for Diabetes Research (McAuley, Taylor, Farmer, Mann), Dunedin, New Zealand

Background: Weight regain often occurs after weight loss in overweight individuals. We aimed to compare the effectiveness of 2 support programs and 2 diets of different macronutrient compositions intended to facilitate long-term weight maintenance.

Methods: Using a 2 x 2 factorial design, we randomly assigned 200 women who had lost 5% or more of their initial body weight to an intensive support program (implemented by nutrition and activity specialists) or to an inexpensive nurse-led program (involving "weigh-ins" and encouragement) that included advice about high-carbohydrate diets or relatively high-monounsaturated-fat diets.

Results: In total, 174 (87%) participants were followed-up for 2 years. The average weight loss (about 2 kg) did not differ between those in the support programs (0.1 kg, 95% confidence interval [CI] –1.8 to 1.9, p = 0.95) or diets (0.7 kg, 95% CI –1.1 to 2.4, p = 0.46). Total and low-density lipoprotein (LDL) cholesterol levels were significantly higher among those on the high-monounsaturated-fat diet (total cholesterol: 0.17 mmol/L, 95% CI 0.01 to 0.33; p = 0.040; LDL cholesterol: 0.16 mmol/L, 95% CI 0.01 to 0.31; p = 0.039) than among those on the high-carbohydrate diet. Those on the high-monounsaturated-fat diet also had significantly higher intakes of total fat (5% total energy, 95% CI 3% to 6%, p < 0.001) and saturated fat (2% total energy, 95% CI 1% to 2%, p < 0.001). All of the other clinical and laboratory measures were similar among those in the support programs and diets.

Interpretation: A relatively inexpensive program involving nurse support is as effective as a more resource-intensive program for weight maintenance over a 2-year period. Diets of different macronutrient composition produced comparable beneficial effects in terms of weight loss maintenance.