In This Issue of Archives of Internal Medicine FREE

A systematic review was conducted to evaluate the efficacy of brief alcohol interventions aimed at reducing chronic alcohol use and related harm, focusing on individuals attending primary care practices. Seventeen trials reported a measure of alcohol consumption, of which 8 reported a significant effect. The adjusted intention-to-treat meta-analysis showed a mean pooled difference of −38 g of ethanol per week in favor of the brief alcohol intervention group, corresponding to a decrease of about 4 drinks. The reduction in alcohol consumption was persistent at 6 and 12 months.

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Both microvascular disease and hypertension have been linked with risk of diabetes mellitus. This study examined the association of retinal arteriolar narrowing and hypertension with risk of diabetes in a prospective, population-based cohort study of 3251 persons living in Wisconsin. After controlling for baseline risk factors, retinal arteriolar narrowing and hypertension were independently associated with incident diabetes. Individuals with both hypertension and retinal arteriolar narrowing were 3-times more likely to develop diabetes (relative risk, 3.41; 95% confidence interval, 1.66- 6.98) compared with normotensive individuals without arteriolar narrowing. These results suggest a link between systemic arteriolar disease associated with hypertension and diabetes development.

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Moderate alcohol consumption has been associated with beneficial health effects on cardiovascular disease. In contrast, the association between alcohol consumption and renal dysfunction is less clear. In this prospective cohort study among more than 11 000 apparently healthy men, Schaeffner and colleagues evaluated the association between alcohol consumption and the risk of renal dysfunction after 14 years of follow-up. The data indicate an inverse association between alcohol consumption and risk of renal dysfunction.

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The consumption of trans-fatty acids adversely affects serum lipid levels. The relationship with the incidence of gallstone disease is unknown. This study prospectively examined consumption of trans-fatty acids in relation to the risk of gallstone disease in a cohort of 45 912 men. trans-Fatty acid consumption was assessed using a validated semiquantitative food frequency questionnaire. Newly diagnosed gallstone disease was ascertained biennially. During 14 years of follow-up, 2356 new cases of symptomatic gallstones were documented. After adjusting for age and other potential risk factors, compared with men in the lowest quintile of dietary intake of trans-fatty acids, the relative risk (RR) of gallstone disease for those in the highest quintile was 1.23 (95% confidence interval [CI], 1.04-1.44: P for trend, .03). Among individual trans-fatty acids, the RR for trans-oleic fatty acid, when extreme quintiles were compared, was 1.24 (95% CI, 1.06-1.45; P for trend, .02). Intakes of trans-palmitoleic fatty acid (RR, 1.09; 95% CI, 0.90-1.31), trans,trans 18:2 fatty acid (RR, 1.14; 95% CI, 0.96-1.34), and cis-trans 18:2 fatty acid (RR, 1.00; 95% CI, 0.86-1.16) were not significantly associated with the risk. The results suggest that a higher intake of trans-fatty acids modestly increases risk of gallstone disease.

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Research shows that marriage is associated with health benefits for men, but the evidence is less consistent in women, perhaps owing to a failure to consider the quality of the marriage. In a sample of 413 middle-aged women from the Pittsburgh Healthy Women Study, Troxel and colleagues examined whether women’s marital status and satisfaction predicted reduced risk of developing the metabolic syndrome in the next 11.5 years. Results showed that maritally satisfied women were significantly less likely to develop the metabolic syndrome over the next 11.5 years compared with maritally dissatisfied, divorced, or widowed women. Single women and moderately satisfied women did not significantly differ from maritally satisfied women in their metabolic risk. Given the prevalence of the metabolic syndrome, roughly 32% among women aged 50 to 59 years, it may be useful to assess marital quality as part of the patient’s social history.

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