THE DIURETIC ACTION OF WEAK AND STRONG ALCOHOLIC

THE DIURETIC ACTION OF WEAK AND STRONG ALCOHOLIC BEVERAGES IN ELDERLY MEN: A RANDOMIZED DIET-CONTROLLED CROSSOVER TRIAL Presented by: Megan Gawronski

AUTHORS • Kristel C. M. M. Polhuis: Ph. D Candidate, Wageningen University & Research • Annemarthe H. C. Wijnen: ? ? • Aafje Sierksma: Director of The Dutch Beer Institute • Wim Calame: Ph. D • Michael Tieland: Nutrition, Exercise and Aging Physiologist at Wageningen

PRESENTATION OUTLINE • Background and Current Research • Hypothesis • Purpose of the Study • Research Methods • Study Design • Results • Conclusion/Findings • Strength and Weaknesses • Conflicts of Interest

BACKGROUND

ELDERLY • The ageing population in Europe/Northern America is increasing rapidly. • By 2030, more than 25% of the population will be over 60. • A large proportion of the elderly consume alcohol.

HYDRATION • Older adults are at risk for dehydration. • Polypharmacy may influence hydration status. • Dehydration can lead to poor health outcomes.

ALCOHOL • A standard drink is equal to 14. 0 grams (0. 6 ounces) of pure alcohol. This is generally found in: • 12 ounces of beer (5% alcohol content) • 5 ounces of wine (12% alcohol content) • 1. 5 ounces or a “shot” of 80 -proof (40% alcohol content) distilled spirits or liquor • Women- 1 drink/day • Men- 2 drinks/day

PREVIOUS RESEARCH • A study in rats in 1968 showed that the diuretic response is directly related to alcohol concentration. • In 2005, the Institute of Medicine concluded that there is only a brief relationship between alcohol consumption and fluid losses. • Studies on the effects of alcohol in the elderly are lacking.

THE PURPOSE OF THE STUDY

PURPOSE • “The aim of the study is to examine the diuretic effect of moderate amounts of commercially available weak and strong alcoholic beverages and their non-alcoholic counterparts in elderly men in a normal-life situation. ”

HYPOTHESIS NO HYPOTHESIS (from these researchers) Referenced hypothesis: “Strong (distilled) alcoholic beverages provoke more dehydration than weaker alcoholic beverages. ”

RESEARCH METHODS

PARTICIPANTS • 20 Dutch men • Between the ages of 60 -75 • Recruited around Wageningen, Netherlands

INCLUSION CRITERIA • Occasional consumption of alcoholic beverages • <21 standard drinks per week, 10 grams of alcohol per drink • No family/personal history of alcoholism • No use of drugs or medication that could interfere with diuresis

INCLUSION CRITERIA • Normal renal function • Creatinine: 60 -110 mmol/L • Urea: 2. 5 -6. 4 mmol/L • No exclusion criteria

PARTICIPANT FLOW • 45 assessed for eligibility • 25 excluded • 20 chosen and randomly distributed over 6 crossover interventions • Attrition = 1 • Due to loss of interest • Data from NAB, NAW and S trials have been used • One water trial was excluded due to incomplete data

TYPES OF BEVERAGES TESTED Alcoholic beer: • Pilsner, Heineken • 5% Non-alcoholic beer: • Amstel 0. 0, Heineken • 0% Alcoholic wine: • Merlot • 13. 5% Non-alcoholic wine: • Merlot • 0% Spirits: • Bols Genever (gin) • 35% Water: • 0%

STUDY DESIGN • Randomized, diet-controlled crossover trial consisting of 6 interventions and a preliminary screening visit. • Each intervention separated by 7 days. • 30 grams of alcohol was supplied during each alcohol-related trial. • Equal volume of liquid supplied for other interventions.

STUDY DESIGN • Urine collected for 24 hours • Testing: urine output, urine osmolality, urine sodium and potassium concentrations • Beverages consumed during lunch • In 3 equal portions over 30 -minute period • 4 -hour observation phase • Urine collected after every hour • After 4 hours, participants went home and continued collecting urine until the next morning.

STUDY DESIGN • Not blinded • Familiar tastes and odors of beverages • Block randomization done by an independent scientist not involved in the study.

DIET CONTROLLED • Participants maintained normal dietary habits and exercise routines on days without interventions. • Refrained from alcoholic beverages and caffeinated foods and drinks after 6: 00 PM the day before an intervention. • Drank 500 ml of water the night before to assume similar hydration prior to each intervention.

DIET CONTROLLED • During intervention periods, participants were not allowed to eat or drink anything except what was supplied. • Lasagna!!? • Diet and hydration protocol helped to eliminate cofounding variables

RESULTS

URINE OUTPUT • First 4 hours: • Significant difference between wine and non-alcoholic wine (p < 0. 03) • Significant difference between spirits and water (p < 0. 001) • No significant difference between beer and non-alcoholic beer (p > 0. 70) • At 24 hours: • No significant differences between alcoholic beverages and their

URINE ANALYSIS

URINE OSMOLALITY • Urine osmolality decreased during first 2 hours, then increased thereafter. • No significant differences between alcoholic beverages and their non-alcoholic counterparts. • Beer had lowest osmolality and highest urine output. • Indicates better hydration status • Larger fluid volume intake with beer

SODIUM CONCENTRATION • Significant difference between alcoholic wine and nonalcoholic wine (p < 0. 001) • Significant difference between spirits and water only up to hour 2 (p < 0. 05) • No significant difference between beer and non-alcoholic beer (p > 0. 10)

POTASSIUM CONCENTRATION • Significant difference between wine and non-alcoholic wine (p < 0. 001) • Significant difference between spirits and water (p < 0. 001) • No significant difference between beer and nonalcoholic beer (p > 0. 80)

CONCLUSION

FINDINGS • Significant differences in urine output, sodium and potassium concentrations were only found between wine and nonalcoholic wine and between spirits and water.

FINDINGS • Moderate amounts of stronger alcoholic beverages (>13. 5%) will provide a short-term diuretic effect. • Wine and spirits • Weaker alcoholic beverages (5%), do not provide a diuretic effect. • Beer

DIURETIC EFFECT • Significant differences in urine appear only during first 4 hours. • Diuretic effect is relatively short-term. • Similar to caffeine

STRENGTHS AND LIMITATIONS

STRENGTHS • Diet control and hydration protocol minimizes cofounding variables • Moderate amounts of alcohol used • Commercially available alcoholic products used • Real-life scenario • 24 -hour urine testing • Previous studies were shorter

WEAKNESSES • Do people really only drink 30 grams (2 standard drinks) of alcohol in one sitting? • Incompliance with urine collection and dietary instruction at home (from hour 4 -24) • Polypharmacy does influence most of the elderly • Lacks real-life scenario

WEAKNESSES • Nutritional differences between alcoholic beverages and non-alcoholic counterparts • Rate of gastric emptying/hydration rate • Consuming alcohol in a fasting state vs. a fed state • No blood measurements were taken

ALL IN ALL The paper finishes with, “More research on this topic is needed. ”

IMPLICATIONS PUBLIC: • Information for family and friends who take care of elderly relatives. • These findings cannot be used for elderly women. CLINICAL: • Places such as nursing homes, comfort care, etc. will serve alcohol, these findings will give nurses an idea of what’s best for their patients. • Patient at risk for dehydration- offer beer instead of wine or spirits.

CONFLICTS OF INTEREST

HMM. . INTERESTING. . • The study was funded by The Dutch Beer Institute. • Three of the authors (Polhuis, Wijnen and Sierksma) were employed by The Dutch Beer Institute during the execution of the study. • Winjnen and Sierksma were in charge of data collection. • Polhuis lead data interpretation.

CITATIONS • Polhuis, Kristel, et al. “The Diuretic Action of Weak and Strong Alcoholic Beverages in Elderly Men: A Randomized Diet-Controlled Crossover Trial. ” Nutrients, vol. 9, no. 7, 2017, p. 660. , doi: 10. 3390/nu 9070660. • http: //www. who. int/en/news-room/fact-sheets/detail/alcohol • https: //www. cdc. gov/alcohol/faqs. htm • https: //health. gov/dietaryguidelines/2015/guidelines/appendix-9/ • Population Division, Department of Economic and Social Affairs, United Nations. World Population Ageing 2015; United Nations: New York, NY, USA, 2015. • Faes, M. C. Spigt, M. G. ; Olde Rikkert, M. G. M. Dehydration in Geriatrics. Geriatr. Aging, 2017, 10, 590 -596. • Schols, J. M. ; De Groot, C. P. , van der Cammen, T. J. ; Olde Rikkert, M. G. Preventing and treating dehydration in the elderly during periods of illness and warm weather. J. Nutr. Health Aging 2009, 13, 150 -157. • http: //www. kennisinstituutbier. nl/aboutus

PHOTOS • https: //viddyad. com/linkedin-retiring-products-and-services-pages-andlaunching-showcase-pages/stockvault-blue-water-texture 116093/ • http: //www. drinksguide. com. au/295? Page=2&Article=diageo-dominates 2018 -top-100 -spirits-brands • https: //dinnerthendessert. com/ultimate-meat-lasagna/ • https: //www. infocommshow. org/free-beer • http: //static 6. depositphotos. com/1004868/651/i/950/depositphotos_6515 776 -Doctor-with-thumbs-up. jpg

QUESTIONS