





































Clinical Medicine Insights
Received 25 June 2021 | Revised 22 July 2021 | Accepted 18 Aug 2021 | Published Online 31 Aug 2021

DOI: https://doi.org/10.52845/CMI/2021-2-3-5 
CMI JOURNAL 2 (3), 169−184 (2021) ISSN (O) 2694-4626 

REVIEW ARTICLE

Alcohol and Noncommunicable Diseases: Part I Cardiovascular Diseases,
Obesity, Respiratory Diseases, Depression, Liver Diseases

Shashi K. Agarwal, MD ∗
 

12227 US Highway 1, #309 North
Brunswick, NJ 08902 USA

Abstract
Alcohol is a popular drink and is consumed globally. It has received
considerable scrutiny in its effect on health. Although its relationship
with most cardiovascular diseases is J/U shaped, in general, alcohol
intake can increase the risk of several diseases. Heavy intake may
induce weight gain. Although no definite relationship has been noted
with COPD, asthma, and lung cancer, it does appear to increase the
propensity for the development of pneumonia. Its use is strongly
related to chronic liver disorders. Its relationship with depression is
bidirectional, and deleterious for both conditions. In general, alcohol
intake of 2 drinks per day for men and 1 drink per day for women
appears to be relatively safe.
Keywords: alcohol, non-communicable diseases, cardiovascular dis-
eases, respiratory diseases, COPD, obesity, depression, liver diseases

Copyright : © 2021 The Authors. Published by Medical Editor and
Educational Research Publishers Ltd. This is an open access article
under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

1 INTRODUCTION

Non-communicable diseases (NCD) are
chronic andmay lead to prolonged disability
and premature death1,2. It is estimated that

NCDs are responsible for over 70% of total global
deaths each year3. The majority of these occur in
low- and middle-income countries4 and a severe
financial burden5. The Sustainable Development
Goals hope to reduce by 2030 (relative to 2015
levels) premature mortality from NCDs by one
third6.

The effects of alcohol on health can vary depending
on the amount and pattern of intake7−9. In the United
States, a standard drink contains 12–15 g of pure
ethanol and this is present in 100–125 ml of wine,
240–300 mL of beer, and 30–37.5 mL of spirits10.
Moderate alcohol intake is considered as two stan-
dard drinks a day for men and one standard drink
a day for women11,12. Heavy drinking is defined as,
high-dose intake, of >60 g/day in men and >40 g/day
in women, usually taken over long term13. Binge
drinking is considered as 4 or more drinks for women
and 5 or more drinks for men over a 2-hours or in

CMI JOURNAL 2 (3), 169−184 MEERP LTD 169

Open Access Journal

https://doi.org/10.52845/CMI/2021-2-3-8
https://orcid.org/0000-0003-0007-5582
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://medicineinsights.info/


ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
one sitting14,15. Compulsive excessive alcohol intake
may lead to alcohol use disorder (AUD)16. The Na-
tional Institute on Alcohol Abuse and Alcoholism
defines AUD as “a chronic relapsing brain disease
characterized by an impaired ability to stop or control
EtOH use despite adverse social, occupational, or
health consequences”17. Although low to moderate
alcohol intake may have some beneficial effects,
alcohol consumption, in general, is associated with
several negative health consequences18. Besides its
impact on diseases mentioned in this manuscript,
alcohol intake can cause cancers of the breast,
mouth, throat, esophagus, liver, and colon19, learning
and memory difficulties (including dementia)20,21,
and mental health disorders, such as depression
and anxiety20,22. Alcoholics tend to be more prone
to trauma20,23 and more likely to be involved in
homicide, suicide, sexual assault, and violence24−27.
Drinking alcohol during pregnancy can be extremely
dangerous, and can increase the risk of miscarriage,
stillbirth, or fetal alcohol disorder28−30. Alcohol poi-
soning is a medical emergency and is associated with
extremely high blood alcohol levels31. The World
Health Organization estimated that, in 2018, around
5% of global deaths were attributable to alcohol
consumption32.

The health effects of alcohol on NCDs are discussed
in this two-part manuscript. Part I discusses the re-
lationship between alcohol intake and cardiovascu-
lar diseases (CVD), chronic obstructive pulmonary
disease (COPD), depression, and liver diseases. Part
II discusses its impact on cancer, diabetes mellitus,
kidney diseases, Alzheimer’s disease, and arthritis.

Supplementary information The online version 
of this article (10.52845/CMI/2021-2-3-5) contains 
supplementary material, which is available to autho-
rized users.

Corresponding Author: Shashi K. Agarwal, MD 
Shashi K. Agarwal, MD 2227 US Highway 1, #309 
North Brunswick, NJ 08902 USA
Email: usacardiologist@gmail.com

2 DISCUSSION

Cardiovascular diseases (CVDs) are an array of dis-
eases that affect the cardiovascular system33. They
include hypertension (HTN), coronary heart disease
(CHD), stroke, heart failure (HF), cardiac arrhyth-
mias, congenital heart disease, peripheral artery dis-
ease (PAD), vasculogenic erectile dysfunction (ED),
and venous thromboembolism (VTE)33. They cause
considerable morbidity and are the number one cause
of mortality worldwide34,35. Almost one-third of all
worldwide deaths are attributable to CVDs36. In
2016, chronic respiratory diseases were responsi-
ble for 7% of all global deaths37,38. Community-
acquired bacterial pneumonia, although not an NCD,
is strongly associated with alcoholism39. Pulmonary
tuberculosis is also deleteriously affected by al-
coholism40. Overweight refers to a BMI of 25–
29.9 kg/m2 while obesity exists when the BMI
is ≥30 kg/m2.41. Obesity affected 42.4% of the
US population in 2017–201842. Obesity is asso-
ciated with several NCDs43,44, especially type 2
diabetes mellitus (DM) and CVDs45. Depression
is a common cause of emotional suffering46. It
is closely associated with anxiety47, dementia48,
DM49, CHD50, Parkinson’s disease51, epilepsy52,
pain53, several cancers54, osteoporosis55, and irrita-
ble bowel syndrome56. Chronic liver pathologies are
also common57. Themajor chronic diseases affecting
the liver are hepatitis B virus (HBV)58 and hepatitis
C virus (HCV) 59infections, steatohepatitis due to
non-alcoholic fatty liver disease60, alcoholic liver
disease61, hepatic cirrhosis62, and primary hepatocel-
lular carcinoma63.

The development and progression of NCDs are de-
pendent on several modifiable and non-modifiable
risk factors. Non-modifiable risk factors include
heredity, age, race, and gender. Socioeconomic, cul-
tural, political, and environmental factors may also
play a role. The major modifiable factors include
diet, obesity, physical activity, and non-smoking.
Alcohol consumption is also a modifiable factor that
impacts NCDs and is discussed in this manuscript.

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 170

mailto:usacardiologist@gmail.com


MEERP LTD
SHASHI K. AGARWAL, MD

2.1 CARDIOVASCULAR DISEASES

Light to moderate alcohol intake has been associ-
ated with a lower risk of cardiovascular disease64.
Heavy consumption has been associated with delete-
rious CV outcomes including increased mortality65.
Studies have established that alcohol consumption
and CVD have a J- or U-shaped relationship66.
Harmful CVD effects are also noted with binge
drinking67 and alcohol use disorder68. About 5%
to 24% of hypertension cases are associated with
ethanol consumption69,70. It is estimated that intake
of 3 to 4 drinks per day raises the prevalence of
hypertension by 50%, when compared with non-
drinkers, while an intake of 6 to 7 drinks per day,
increases the prevalence by 100%71. Binge drinking,
in the short term, raises the blood pressure from 4
to 7 mmHg systolic and 4 to 6 mmHg diastolic72−74.
Reduction in alcohol intake to <2 alcoholic drinks
per day helps reduce the blood pressure in a dose-
response manner75. Most studies indicate that alco-
hol consumption between 2.5 g/day and 30 to 60
g/day (mild to moderate drinking) is cardioprotec-
tive for both CV mortality and CHD mortality76. In
a meta-analysis done by Bagnardi and colleagues,
the risk of CHD was higher in binge and heavy
drinkers, when compared with non-drinkers77. A
similar pattern has been noted between alcohol in-
take and stroke78. Larsson et al in a systemic review
and meta-analysis of 27 prospective studies con-
cluded that light to moderate alcohol consumption
(1-2 drinks/day) was associated with a lower risk
of ischemic stroke, whereas heavy drinking (>2-4
drinks/day) was associatedwith an increased risk, es-
pecially of hemorrhagic stroke78. HF also appears to
be less in individuals consuming <7 drinks/week79.
Wannamethee et al. found that heavier drinking
(≥5 drinks/day or ≥35 drinks/week) significantly
increased the risk for HF80. Heavy alcohol intake
may also induce alcoholic cardiomyopathy81. The
causal relationship between alcohol intake and atrial
fibrillation has also been known for a long time82.
In a recently published study of 107,485 subjects
followed for nearly 14 years, Csengeri et al. found
that alcohol increased the risk of developing atrial
fibrillation by16%, irrespective of the type of bever-
age consumed83. According to Koskinen and group,

5%-10% of all new episodes of atrial fibrillation
are related to alcohol use84. Alcohol also plays a
significant role in sudden cardiac death (SCD)85. In a
study of the Finnish population, 4 of 10 victims of un-
expected SCD exhibited evidence of alcohol intake
before the fatal event86. Drinking during pregnancy
is also harmful to the offspring, who may be born
with congenital anomalies such as aberrant great
vessels, atrial septal defects, and ventricular septal
defects87,88. High levels of alcohol intake are also
associated with an increased risk of PAD89. Wang et
al, in ametanalysis, determined that light tomoderate
alcohol intake (<21 drinks/week) correlated with a
decreased risk of erectile dysfunction90. Alcohol is
also associated with many other CVD risk factors,
such as sleep disorders91, chronic kidney disease92,
weight gain93, depression94, and smoking95. The
beneficial effects of alcohol are related to several
actions96−104. Alcohol intake has an inverse associa-
tionwith T2DM (low tomoderate intake)96 and tends
to increase HDL-C and apolipoprotein A-I97−99 –
these effects are CVD protective. Alcohol helps alter
the atherosclerotic plaque composition and provides
stabilization100. Alcohol also exerts several effects
on factors involved in hemostasis, such as inhibition
of platelet aggregation101, lowering of fibrinogen
levels102 and plasma viscosity103, as well as increas-
ing levels of tissue plasminogen activator104.

2.2 OBESITY

The relationship between alcohol intake and obesity
has been well studied105,106. Several studies have
however produced conflicting findings105,107. Since
alcohol provides extra calories (1 gram of alcohol
provides 7.1 kcal (29 kJ), its intakewith a regular diet
may lead to a positive energy balance, and weight
gain108. It is estimated that in the US, 16% of adult
drinkers’ total energy intake comes from alcohol109.
However, alcohol’s relationship with obesity is not
that simple110−112. Several studies show that light-
to-moderate alcohol intake is not associated with
weight gain105,108. Moderate drinkers are more likely
to follow healthier lifestyles, such as exercising regu-
larly and eating fruits and vegetables, which tends to
prevent weight gain107,113. Heavy drinking does tend
to be associated with an increased risk of obesity107.

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 171



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
A recent study confirmed that high alcohol con-
sumption, especially binge drinking, was associated
with higher risks of obesity in Korean men114. The
increased tendency for men to gain weight with
excessive alcohol drinking may be because they tend
to drink about three times the amount of alcohol con-
sumed by women and are more likely to drink beer
and spirits115. Beer is rich in carbohydrates and may
provide more calories108,116. Women tend to drink
more wine, which is more likely to protect against
weight gain105. Many other factors like socioeco-
nomic status117, behavioral changes118, metabolic
effects119, etc. may also play a role. The available
data, however, does not conclusively confirm a pos-
itive association between alcohol consumption and
weight gain105,120.

2.3 RESPIRATORY DISEASES

There is no definitive association between alco-
hol intake and COPD, or lung cancer121−123. The
association between alcohol abuse and pneumonia
is, however, strong124−126. Although not an NCD,
this association will be briefly discussed. AUD in-
dividuals are often affected by bacterial pneumo-
nia with Streptococcus pneumoniae and Klebsiella
pneumoniae127,128. These patients are more prone
to bacteremia, sepsis, septic shock126,129, and adult
respiratory distress syndrome (ARDS)130. ARDS is
almost four times more likely to occur in AUD pa-
tients than nonalcoholic patients131,132. Its presence
is associated with poorer outcomes, including persis-
tent hospitalization and death133. Abusers of alcohol
are not only less likely to receive preventive anti-
pneumococcal vaccination134 but may also experi-
ence a less protective response135. Individuals with
AUD are also more likely to develop tuberculosis
(TB)136 and respiratory syncytial virus infection137.
Acute lung injury is also seen more commonly in
alcoholics after major trauma, such as a motor ve-
hicle accident, gunshot wound, or burns138,139. Ex-
cessive alcohol consumption increases susceptibility
to pneumonia through multiple mechanisms140−143.
These include a reduced immunity140, altered micro-
bial composition in the lung passages and alveoli141,
and an increased risk of aspiration142. Several other
factors are also known to play a deleterious role143.

2.4 DEPRESSION

Alcohol misuse and depression commonly co-
occur144,145. AUD individuals are many times
more likely to have suffered from major depres-
sive disorder146,147. Depression may also lead
to alcohol abuse in some individuals148. The
alcohol–depression relationship appears to be
curvilinear, with alcohol abstinence and heavy
drinking both being associated with a higher risk
of depression149,150. Both conditions are interlinked
and co-existence results in greater severity and
a worse prognosis for both disorders than either
condition independently151−154. Data indicates that
men usually develop AUD before depression, while
women develop depression and then progress on
to AUD155,156. Patients who abuse alcohol may
also exhibit more depression and tend to be not
adherent to treatment157. Alcohol abstinence appears
to significantly improve depressive symptoms in
depressed individuals158. Antidepressants may be
useful for the treatment of depression, alcohol
dependence, or both, concurrently. Behavioral
treatments are also effective in both159−161.

2.5 LIVER DISEASES

Alcohol-related hepatoxicity appears to be the “old-
est form of liver injury known to humankind”162,163.
Alcohol-related damage to the liver is broadly called
alcoholic liver disease (ALD) and includes alco-
holic fatty liver, alcoholic hepatitis, and alcoholic
cirrhosis164. About 90% of alcoholics develop al-
coholic fatty liver (steatosis), about 25% develop
alcoholic hepatitis, about 15% develop alcoholic
cirrhosis, and about 10% develop hepatocellular
carcinoma (HCC)165−168. Continued alcohol con-
sumption usually leads to progression from alco-
holic fatty liver to hepatitis and then on to cirrho-
sis. Alcoholic steatosis is usually asymptomatic (al-
though some nausea, anorexia, and vomiting may be
present)169 and these patients exhibit mild elevations
of gamma-glutamyl transpeptidase (GGT), aspartate
aminotransferase (AST), and alanine aminotrans-
ferase (ALT) levels170. There is no abnormality of
the serum bilirubin, International Normalized Ra-
tio (INR), or albumin level. On liver biopsy, there

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 172



MEERP LTD
SHASHI K. AGARWAL, MD

is microvesicular and macrovesicular fat accumula-
tion within hepatocytes, minimal inflammatory re-
action, and no hepatic fibrosis171. Abstinence will
often revert these changes172. Patients with alco-
holic hepatitis may have jaundice, pyrexia, uninten-
tional weight loss, malnutrition, and an enlarged,
tender liver173. There are moderate elevations in
GGT, AST, and serum bilirubin174. Typically, the
AST:ALT ratio is ≥ 2:1 in these patients175. The
liver biopsy usually shows neutrophilic infiltration,
hepatocyte necrosis, steatosis, and the presence of
Mallory bodies176. Patients with alcoholic cirrho-
sis may also exhibit gynecomastia, palmar ery-
thema, spider angiomata, testicular atrophy, parotid
gland enlargement; signs of portal hypertension, and
Dupuytren’s contracture177. Laboratory findings of-
ten include hypoalbuminemia, hyperbilirubinemia,
thrombocytopenia, and prolonged prothrombin time,
and increased INR173. The liver biopsy usually re-
veals bridging fibrosis and regenerating nodules, and
these are uniformly sized and micronodular178. In
Western countries, alcohol is responsible for up to
50% of end-stage liver disease179. It is estimated
that almost 50% of all deaths from cirrhosis in the
world are related to ALD180. Potentiating factors for
ALD include metabolic syndrome181, diabetes182,
smoking183, obesity184, iron overload185, and chronic
viral hepatitis B or C186,187. Genetic factors may
also play a role188. Although abstinence markedly
reducesmortality189, the only definitive treatment for
ALD remains liver transplantation190−193. Alcohol
abuse in patients with hepatitis B or HCV infection
will often hasten the development of cirrhosis and
its complications including HCC194. Alcohol abuse
is reported to be responsible for approximately 15%–
30% of HCC195,196.

3 CONCLUSION

Alcohol drinking is popular all over the world. This
manuscript focuses on the relationship between al-
cohol intake and cardiovascular diseases, obesity,
respiratory diseases, depression, and liver disorders.
Alcohol consumption is generally safe, provided the
consumption is in low to moderate amounts. It ap-
pears to be beneficial in these amounts for CVDs.

However higher levels of alcohol consumption are
harmful. Alcohol intake of more than 3 drinks per
day in men and more than 2 drinks in women, should
be avoided.
Acknowledgment: None
Funding: None
Conflict of interest: None
REFERENCES

1. WHO. Noncommunicable diseases. 2018. htt
p://www.who.int/news-room/fact-sheets/detail/
noncommunicable-diseases. Accessed 20 Sept
2020.

2. Kruk ME, Nigenda G, Knaul FM. Re-
designing primary care to tackle the global
epidemic of noncommunicable disease. Am
J Public Health. 2015;105:431–437. doi:
10.2105/AJPH.2014.302392.

3. WHO. Noncommunicable diseases. 2018. htt
p://www.who.int/news-room/fact-sheets/detail/
noncommunicable-diseases. Accessed 20 Sept
2020.

4. WHO. Noncommunicable diseases: the slow-
motion disaster. 2017.

5. NCD Alliance. The financial burden of NCDs.
https://ncdalliance.org/why-ncds/the-financial-
burden-of-ncds. Accessed 11 Dec 2020.

6. United Nations Transforming our world: the
2030 agenda for sustainable development. http
s://sdgs.un.org/sites/default/files/publications/2
1252030%20Agenda%20for%20Sustainable%
20Development%20web.pdf.

7. O’Keefe E.L., DiNicolantonio J.J., O’Keefe
J.H., Lavie C.J. Alcohol and CV Health: Jekyll
and Hyde J-Curves. Prog. Cardiovasc. Dis.
2018;61:68–75. doi: 10.1016/j.pcad.2018.02.001.

8. PianoM.R. Alcohol’s Effects on the Cardiovas-
cular System. Alcohol Res. 2017;38:219–241.

9. Alcohol Research: Current Reviews Editorial
Staff. Drinking Patterns and Their Definitions.
Alcohol Res. 2018;39(1):17-18.

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 173



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
10. Alcohol Facts and Statistics In: Alcoholism

NIoAAa, editor.2017.

11. Weber MA, Schiffrin EL, White WB, et al.
Clinical practice guidelines for the management
of hypertension in the community: A state-
ment by the American Society of Hypertension
and the International Society of Hypertension.
Journal of Clinical Hypertension (Greenwich)
2014;16(1):14–26.

12. Xi B., Veeranki S.P., Zhao M., Ma C., Yan
Y., Mi J. Relationship of Alcohol Con-
sumption to All-Cause, Cardiovascular, and
Cancer-Related Mortality in U.S. Adults. J.
Am. Coll. Cardiol. 2017;70:913–922. doi:
10.1016/j.jacc.2017.06.054.

13. Fernández-Solà J. Cardiovascular risks and
benefits of moderate and heavy alcohol con-
sumption. Nat. Rev. Cardiol. 2015;12:576–587.
doi: 10.1038/nrcardio.2015.91.

14. Kuntsche E., Kuntsche S., Thrul J., Gmel
G. Binge drinking: Health impact, preva-
lence, correlates and interventions. Psy-
chol. Health. 2017;32:976–1017. doi:
10.1080/08870446.2017.1325889.

15. Fillmore M.T., Jude R. Defining “binge” drink-
ing as five drinks per occasion or drinking
to a .08% BAC: Which is more sensitive to
risk? Am. J. Addict. 2011;20:468–475. doi:
10.1111/j.1521-0391.2011.00156.x.

16. Esser MB, Hedden SL, Kanny D, Brewer RD,
Gfroerer JC, Naimi TS. Prevalence of Alcohol
Dependence Among US Adult Drinkers, 2009–
2011. Prev Chronic Dis 2014;11:140329.

17. https://www.niaaa.nih.gov/.

18. European Association for the study of the liver
EASL Clinical practice guidelines: Manage-
ment of alcohol-related liver disease. J Hepatol,
69 (2018), pp. 154-181 Accessed 1/11/2018 at
https://doi.org/10.1016/fjhep.2018.03.018.

19. World Health Organization. Global status
report on alcohol and health—2018external
icon. Geneva, Switzerland: World Health
Organization; 2018.; International Agency
for Research on Cancer. Personal Habits and
Indoor Combustions: A Review of Human
Carcinogens, Volume 100E 2012. Available
from: http://monographs.iarc.fr/ENG/Monogra
phs/vol100E/index.phpexternal icon.

20. World Health Organization. Global status re-
port on alcohol and health—2018. Geneva,
Switzerland: World Health Organization; 2018.

21. Miller JW, Naimi TS, Brewer RD, Jones SE.
Binge drinking and associated health risk be-
haviors among high school students. Pediatrics.
2007;119(1):76-85.

22. Castaneda R, Sussman N, Westreich L, Levy
R, O’Malley M. A review of the effects of
moderate alcohol intake on the treatment of
anxiety and mood disorders. J Clin Psychiatry
1996;57(5):207–212.

23. Smith GS, Branas CC,Miller TR. Fatal nontraf-
fic injuries involving alcohol: a metaanalysis.
Ann of Emer Med 1999;33(6):659–668.

24. Smith GS, Branas CC,Miller TR. Fatal nontraf-
fic injuries involving alcohol: a metaanalysisex-
ternal icon. Ann of Emer Med 1999;33(6):659–
668.

25. Greenfield LA. Alcohol and Crime: An Analy-
sis of National Data on the Prevalence of Alco-
hol Involvement in Crime. Report prepared for
the Assistant Attorney General’s National Sym-
posium onAlcohol Abuse and Crime.Washing-
ton, DC: U.S. Department of Justice, 1998.

26. Mohler-Kuo M, Dowdall GW, Koss M, Wech-
sler H. Correlates of rape while intoxicated in
a national sample of college women. Journal of
Studies on Alcohol 2004;65(1):37–45.

27. Abbey A. Alcohol-related sexual assault: a
common problem among college students. J
Stud Alcohol Suppl. 2002 Mar;(14):118-28.
doi: 10.15288/jsas.2002.s14.118.

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 174



MEERP LTD
SHASHI K. AGARWAL, MD

28. Naimi TS, Lipscomb LE, Brewer RD, Colley
BG. Binge drinking in the preconception period
and the risk of unintended pregnancy: Implica-
tions for women and their children. Pediatrics
2003;11(5):1136–1141.

29. Kesmodel U, Wisborg K, Olsen SF, Henriksen
TB, Sechler NJ. Moderate alcohol intake in
pregnancy and the risk of spontaneous abortion.
Alcohol & Alcoholism 2002;37(1):87–92.

30. American Academy of Pediatrics, Committee
on Substance Abuse and Committee on Chil-
dren with Disabilities. 2000. Fetal alcohol syn-
drome and alcohol-related neurodevelopmental
disorders. Pediatrics 2000;106:358–361.

31. KannyD, Brewer RD,Mesnick JB, Paulozzi LJ,
Naimi TS, LuH.Vital Signs: Alcohol Poisoning
Deaths — United States, 2010–2012. MMWR
2015;63:1238-1242.

32. Poznyak V, FleischmannA, Rekve D, Rylett M,
Rehm J, Gmel G. The world health organiza-
tion’s global monitoring system on alcohol and
health. Alcohol Res. (2013) 35:244–9.

33. https://www.who.int/news-room/fact-sheets/de
tail/cardiovascular-diseases-(cvds) – accessed
August 4, 2021.

34. WHO, The Top 10 Causes of Death, https://w
ww.who.int/news-room/fact-sheets/detail/the-t
op-10-causes-of-death,- Accessed date: 20 June
201;

35. https://www.afro.who.int/health-topics/cardiov
ascular-diseases - accessed July 30, 2021.

36. Roth GA, Johnson C, Abajobir A, Abd-Allah
F, Abera SF, Abyu G, et al. Global, regional,
and national burden of cardiovascular diseases
for 10 causes, 1990 to 2015. Journal of the
American College of Cardiology. 2017; 70(1):
1–25. DOI: 10.1016/j.jacc.2017.04.052.

37. Noncommunicable Diseases Country Profiles
2018. Geneva: World Health Organization;
2018, 223. Available online: https://www.who
.int/nmh/publications/ncd-profiles-2018/en.

38. GBD Chronic Respiratory Disease Collabora-
tors. Prevalence and attributable health bur-
den of chronic respiratory diseases, 1990-2017:
a systematic analysis for the Global Burden
of Disease Study 2017. Lancet Respir Med.
2020 Jun;8(6):585-596. doi: 10.1016/S2213-
2600(20)30105-3.

39. Mandell LA. Community-acquired pneu-
monia: An overview. Postgrad Med. 2015
Aug;127(6):607-15. doi: 10.1080/00325481.2015.1074030.

40. World Health Organizationc1948. Tuberculo-
sis fact sheet. Geneva (Switzerland): WHO
global TB programme (2014 Oct). Available
from: http://www.who.int/mediacentre/factshe
ets/fs104/en/.

41. Executive summary. Obes. Res. 1998.6, 51S-
179S. doi: 10.1002/j.1550-8528.1998.tb00690.x.

42. Hales C. M., Carroll M. D., Fryar C. D., Og-
den C. L. (2017). Prevalence of Obesity and
Severe Obesity Among Adults: United States,
2017-2018 Key Findings Data from the Na-
tional Health and Nutrition Examination Sur-
vey. Available online at: https://www.cdc.go
v/nchs/products/index.htm -accessed April 1,
2020.

43. Must A., McKeown N. M. (2000). The Dis-
ease Burden Associated with Overweight and
Obesity. MDText.com, Inc. Available online
at: http://www.ncbi.nlm.nih.gov/pubmed/2590
5320 (accessed July 30, 2021).

44. Allison D. B., Fontaine K. R., Manson J. A.
E., Stevens J., VanItallie T. B. (1999). An-
nual deaths attributable to obesity in the United
States. J. Am. Med. Assoc. 282, 1530–1538.
10.1001/jama.282.16.1530.

45. La Sala L, Pontiroli AE. Prevention of Dia-
betes and Cardiovascular Disease in Obesity.
Int J Mol Sci. 2020 Oct 31;21(21):8178. doi:
10.3390/ijms21218178.

46. Almeida OP. Prevention of depression in older
age. Maturitas. 2014 Oct;79(2):136-41. doi:
10.1016/j.maturitas.2014.03.005.

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 175



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
47. Ressler K.J., Mayberg H.S. Targeting abnormal

neural circuits in mood and anxiety disorders:
from the laboratory to the clinic. Nat. Neurosci.
2007;10(9):1116–1124. doi: 10.1038/nn1944.

48. Byers A.L., Yaffe K. Depression and risk
of developing dementia. Nat. Rev. Neu-
rol. 2011;7(6):323–331. doi: 10.1038/nrneu-
rol.2011.60.

49. Knol M.J., Twisk J.W., Beekman A.T., Heine
R.J., Snoek F.J., Pouwer F. Depression as a risk
factor for the onset of type 2 diabetesmellitus. A
meta-analysis. Diabetologia. 2006;49(5):837–
845. doi: 10.1007/s00125-006-0159-x.

50. Bucciarelli V, Caterino AL, Bianco F, Caputi
CG, Salerni S, Sciomer S, Maffei S, Gallina
S. Depression and cardiovascular disease: The
deep blue sea of women’s heart. Trends Car-
diovasc Med. 2020 Apr;30(3):170-176. doi:
10.1016/j.tcm.2019.05.001.

51. Depression and Parkinson’s disease: current
knowledge. Curr Neurol Neurosci Rep. 2013
Dec;13(12):409. doi: 10.1007/s11910-013-
0409-5.

52. Henning O, Nakken KO. Epilepsi og depresjon
[Epilepsy and depression]. Tidsskr Nor Laege-
foren. 2011 Jul 1;131(13-14):1298-301. Norwe-
gian. doi: 10.4045/tidsskr.10.0739.

53. Zis P, Daskalaki A, Bountouni I, Sykioti P,
Varrassi G, Paladini A. Depression and chronic
pain in the elderly: links and management chal-
lenges. Clin Interv Aging. 2017 Apr 21;12:709-
720. doi: 10.2147/CIA.S113576.

54. Pinquart M, Duberstein PR. Depression
and cancer mortality: a meta-analysis. Psy-
chol Med. 2010 Nov;40(11):1797-810. doi:
10.1017/S0033291709992285.

55. Mezuk B, Eaton WW, Golden SH. Depres-
sion and osteoporosis: epidemiology and po-
tential mediating pathways. Osteoporos Int.
2008 Jan;19(1):1-12. doi: 10.1007/s00198-007-
0449-2.

56. Mudyanadzo TA, Hauzaree C, Yerokhina O,
Architha NN, Ashqar HM. Irritable Bowel Syn-
drome and Depression: A Shared Pathogen-
esis. Cureus. 2018 Aug 21;10(8):e3178. doi:
10.7759/cureus.3178.

57. Williams R. Global challenges in liver dis-
ease. Hepatology. 2006 Sep;44(3):521-6. doi:
10.1002/hep.21347.

58. Nguyen MH, Wong G, Gane E, Kao JH,
Dusheiko G. Hepatitis B Virus: Advances in
Prevention, Diagnosis, and Therapy. Clin Mi-
crobiol Rev. 2020 Feb 26;33(2):e00046-19. doi:
10.1128/CMR.00046-19.

59. Applegate TL, Fajardo E, Sacks JA. Hepatitis C
Virus Diagnosis and the Holy Grail. Infect Dis
Clin North Am. 2018 Jun;32(2):425-445. doi:
10.1016/j.idc.2018.02.010.

60. Younossi Z, Anstee QM, Marietti M, Hardy
T, Henry L, Eslam M, George J, Bugianesi E.
Global burden of NAFLD and NASH: trends,
predictions, risk factors and prevention. Nat
Rev Gastroenterol Hepatol. 2018 Jan;15(1):11-
20. doi: 10.1038/nrgastro.2017.109.

61. Hosseini N, Shor J, Szabo G. Alcoholic Hep-
atitis: A Review. Alcohol Alcohol. 2019 Jul
1;54(4):408-416. doi: 10.1093/alcalc/agz036.

62. Jung YK, Yim HJ. Reversal of liver cirrho-
sis: current evidence and expectations. Korean
J Intern Med. 2017 Mar;32(2):213-228. doi:
10.3904/kjim.2016.268.

63. Forner A, Reig M, Bruix J. Hepato-
cellular carcinoma. Lancet. 2018 Mar
31;391(10127):1301-1314. doi: 10.1016/S0140-
6736(18)30010-2.

64. Goel S, Sharma A, Garg A. Effect of Al-
cohol Consumption on Cardiovascular Health.
Curr Cardiol Rep. 2018 Mar 8;20(4):19. doi:
10.1007/s11886-018-0962-2.

65. O’Keefe JH, Bhatti SK, Bajwa A, et al. Alcohol
and cardiovascular health: the dose makes the
poison…or the remedy. Mayo Clin Proc 2014;
89: 382–393.

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 176



MEERP LTD
SHASHI K. AGARWAL, MD

66. O’Keefe EL, DiNicolantonio JJ, O’Keefe JH, et
al. Alcohol and CV health: Jekyll and Hyde J-
curves. Prog Cardiovasc Dis 2018; 61: 68–75.

67. Kuntsche E., Kuntsche S., Thrul J., Gmel
G. Binge drinking: Health impact, preva-
lence, correlates and interventions. Psy-
chol. Health. 2017;32:976–1017. doi:
10.1080/08870446.2017.1325889.

68. National Institute on Alcohol Abuse Alco-
holism NIH. (2020). Turning Discovery Into
Health ® National Institute on Alcohol Abuse
and Alcoholism Alcohol Facts and Statistics.
Available online at: https://www.niaaa.nih.gov
(accessed March 30, 2020.

69. Milon H, Froment A, Gaspard P, Guidollet
J, Ripoll JP. Alcohol consumption and blood
pressure in a French epidemiological study. Eur
Heart J. 1982;3 Suppl C:59–64.

70. Friedman GD, Klatsky AL, Siegelaub AB. Al-
cohol intake and hypertension. Ann InternMed.
1983;98:846–849.

71. MacMahon S. Alcohol consumption and hyper-
tension. Hypertension. 1987;9:111–121.

72. Potter JF, Watson RD, Skan W, Beevers DG.
The pressor and metabolic effects of alco-
hol in normotensive subjects. Hypertension.
1986;8(7):625–631.

73. Rosito GA, Fuchs FD, Duncan BB. Dose-
dependent biphasic effect of ethanol on 24-h
blood pressure in normotensive subjects. Amer-
ican Journal of Hypertension. 1999;12(2 Pt
1):236–240.

74. Seppä K, Sillanaukee P. Binge drinking and
ambulatory blood pressure. Hypertension.
1999;33(1):79–82.

75. Roerecke M, Kaczorowski J, Tobe SW, Gmel
G, Hasan OSM, Rehm J. The effect of a re-
duction in alcohol consumption on blood pres-
sure: a systematic review and meta-analysis.
Lancet Public Health. 2017;2:e108–e120. doi:
10.1016/S2468-2667(17)30003-8.

76. Ronksley PE, Brien SE, Turner BJ, et al.
Association of alcohol consumption with
selected cardiovascular disease outcomes: A
systematic review and meta-analysis. BMJ.
2011;342:d671.

77. Bagnardi V, Zatonski W, Scotti L, La Vecchia
C, Corrao G. Does drinking pattern modify
the effect of alcohol on the risk of coronary
heart disease? Evidence from a meta-analysis.
J Epidemiol Community Health 2008;62:615-9.
10.1136/jech.2007.065607.

78. Larsson SC, Wallin A, Wolk A, Markus HS.
Differing association of alcohol consumption
with different stroke types: a systematic review
and meta-analysis. BMCMed. 2016;14(1):178.
Published 2016 Nov 24. doi:10.1186/s12916-
016-0721-4.

79. Larsson SC, Orsini N, Wolk A. Alcohol
consumption and risk of heart failure: A
dose-response meta-analysis of prospective
studies. European Journal of Heart Failure.
2015;17(4):367–373.

80. Wannamethee SG, Whincup PH, Lennon L, et
al. Alcohol consumption and risk of incident
heart failure in older men: A prospective cohort
study. Open Heart. 2015;2(1):e000266.

81. Fernández-Solà J. The Effects of Ethanol on the
Heart: Alcoholic Cardiomyopathy. Nutrients.
2020;12:572. doi: 10.3390/nu12020572.

82. Lowenstein SR, Gabow PA, Cramer J, Oliva
PB, Ratner K. The role of alcohol in new-
onset atrial fibrillation. Arch Intern Med. 1983
Oct;143(10):1882-5.

83. Csengeri D., Sprünker N.A., Di Castelnuovo A.
et al. Alcohol consumption, cardiac biomarkers,
and risk of atrial fibrillation and adverse out-
comes. Eur. Heart J. 2021;42:1170–1177. doi:
10.1093/eurheartj/ehaa953.

84. Koskinen P, Kupari M, Leinonen H, Luoman-
mäki K. Alcohol and new onset atrial fibrilla-
tion: a case-control study of a current series. Br
Heart J. 1987 May;57(5):468-73.

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 177



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
85. Hietanen S, Herajärvi J, Junttila J, Pakanen

L, Huikuri HV, Liisanantti J. Characteristics
of subjects with alcoholic cardiomyopa-
thy and sudden cardiac death. Heart. 2020
May;106(9):686-690. doi: 10.1136/heartjnl-
2019-315534.

86. Perkiömäki J, Hookana E, Kaikkonen K, Junt-
tila J, Kortelainen ML, Huikuri H. Blood alco-
hol in victims of sudden cardiac death in north-
ern Finland. Europace. 2016 Jul;18(7):1006-9.
doi: 10.1093/europace/euv341.

87. Chen Z, Li S, Guo L, Peng X, Liu Y. Prena-
tal alcohol exposure induced congenital heart
diseases: From bench to bedside. Birth Defects
Res. 2020 Jun 24. doi: 10.1002/bdr2.1743.

88. Denny L, Coles S, Blitz R. Fetal Alcohol Syn-
drome and Fetal Alcohol Spectrum Disorders.
Am Fam Physician. 2017 Oct 15;96(8):515-
522.

89. Xie X, Ma YT, Yang YN, et al. Alcohol con-
sumption and ankle-to-brachial index: Results
from the Cardiovascular Risk Survey. PLoS
One. 2010;5(12):e15181.

90. Wang XM, Bai YJ, Yang YB, Li JH, Tang
Y, Han P. Alcohol intake and risk of erectile
dysfunction: a dose-response meta-analysis of
observational studies. Int J Impot Res. 2018
Nov;30(6):342-351. doi: 10.1038/s41443-018-
0022-x. Epub 2018 Sep 19. PMID: 30232467.

91. Chakravorty S, Chaudhary NS, Brower KJ. Al-
cohol Dependence and Its Relationship With
Insomnia and Other Sleep Disorders. Alcohol
Clin Exp Res. 2016 Nov;40(11):2271-2282.
doi: 10.1111/acer.13217.

92. Pan CS, Ju TR, Lee CC, Chen YP, Hsu CY,
Hung DZ, Chen WK, Wang IK. Alcohol use
disorder tied to development of chronic kid-
ney disease: A nationwide database analysis.
PLoS One. 2018 Sep 6;13(9):e0203410. doi:
10.1371/journal.pone.0203410.

93. Sayon-Orea C, Martinez-Gonzalez MA, Bes-
Rastrollo M. Alcohol consumption and body
weight: a systematic review. Nutr Rev.
2011 Aug;69(8):419-31. doi: 10.1111/j.1753-
4887.2011.00403.x.

94. Boden JM, Fergusson DM. Alcohol and depres-
sion. Addiction. 2011 May;106(5):906-14. doi:
10.1111/j.1360-0443.2010.03351.x.

95. Stamler J, Caggiula AW,Grandits GA. Relation
of body mass and alcohol, nutrient, fiber, and
caffeine intakes to blood pressure in the special
intervention and usual care groups in the Mul-
tiple Risk Factor Intervention Trial. Am J Clin
Nutr 1997;65: 1 suppl: 338s–65s.

96. Knott C, Bell S, Britton A. Alcohol Consump-
tion and the Risk of Type 2 Diabetes: A System-
atic Review and Dose-Response Meta-analysis
of More Than 1.9 Million Individuals From
38 Observational Studies. Diabetes Care. 2015
Sep;38(9):1804-12. doi: 10.2337/dc15-0710.

97. Mori T.A., Burke V., Beilin L.J., Puddey
I.B. Randomized Controlled Intervention of
the Effects of Alcohol on Blood Pressure
in Premenopausal Women. Hypertension.
2015;66:517–523. doi: 10.1161/HYPERTEN-
SIONAHA.115.05773.

98. Gaziano JM, Buring JE, Breslow JL, Gold-
haber SZ, Rosner B, VanDenburgh M, Wil-
lett W, Hennekens CH. Moderate alcohol in-
take, increased levels of high-density lipopro-
tein and its subfractions, and decreased risk
of myocardial infarction. New Engl J Med
1993;329:1829–1834.

99. Rimm EB, Williams P, Fosher K, Criqui M,
Stampfer MJ. Moderate alcohol intake and
lower risk of coronary heart disease: meta-
analysis of effects on lipids and haemostatic
factors. BMJ 1999;319:1523–1528.

100. Gisbertz SS, Derksen WJ, de Kleijn DP, Vink
A, Bots ML, de Vries JP, Moll FL, Pasterkamp
G. The effect of alcohol on atherosclerotic
plaque composition and cardiovascular events

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 178



MEERP LTD
SHASHI K. AGARWAL, MD

in patients with arterial occlusive disease. J
Vasc Surg 2011;54:123–131.

101. Pace-Asciak CR, Hahn S, Diamandis EP,
Soleas G, Goldberg DM. The red wine pheno-
lics trans-resveratrol and quercetin block human
platelet aggregation and eicosanoid synthesis:
implications for protection against coronary
heart disease. Clin Chim Acta, (2):207-219
19957.

102. Dimmitt SB, Rakic V, Puddey IB, et al. The ef-
fects of alcohol on coagulation and fibrinolytic
factors: a controlled trial. Blood Coagul Fibri-
nolysis, (1):39-45 19988-10), factor VII (FVII),
von Willebrand factor (vWF.

103. Mukamal KJ, Jadhav PP, D’Agostino RB, et al.
Alcohol consumption and hemostatic factors:
analysis of the Framingham Offspring cohort.
Circulation, (12):1367-1373 200110.

104. Yarnell JW, Sweetnam PM, Rumley A, Lowe
GD. Lifestyle and hemostatic risk factors for
ischemic heart disease : the Caerphilly Study.
Arterioscler Thromb Vasc Biol, (1):271-279
2000.MED: 10634829.

105. Sayon-Orea C, Martinez-Gonzalez MA,
Bes-Rastrollo M. Alcohol consumption and
body weight: a systematic review. Nutr
Rev. 2011;69:419–31. doi: 10.1111/j.1753-
4887.2011.00403.x.

106. Gruchow HW, Sobocinski KA, Barboriak J, et
al. Alcohol consumption, nutrient intake and
relative body weight among US adults. Am J
Clin Nutr. 1985;42:289–95.

107. Traversy, G & Chaput, JP (2015) Alcohol con-
sumption and obesity: an update. Curr Obes Rep
4, 122–130.

108. Yeomans MR. Alcohol, appetite and energy
balance: is alcohol intake a risk factor for obe-
sity? Physiol Behav. 2010 Apr 26;100(1):82-9.
doi: 10.1016/j.physbeh.2010.01.012.

109. Nielsen SJ, Kit BK, Fakhouri T, Ogden CL.
Calories Consumed From Alcoholic Beverages
by U.S. Adults, 2007–2010. NCHS Data Brief,
no 110. Hyattsville, MD: National Center for
Health Statistics; 2012: 1–8.

110. MacInnis RJ, Hodge AM, Dixon HG, et
al. Predictors of increased body weight and
waist circumference for middle-aged adults.
Public Health Nutr. 2014;17:1087–97. doi:
10.1017/S1368980013001031.

111. Sayon-Orea C, Bes-Rastrollo M, Nuñez-
Corboda JM, Basterra-Gortari FJ, Beunza
JJ, Martinez-Gonzalez MA. Type of al-
coholic beverage and incidence of over-
weight/obesity in a Mediterranean cohort: The
SUN project. Nutrition. 2011;27:802–8. doi:
10.1016/j.nut.2010.08.023.

112. Schütze M, Schulz M, Steffen A, et al. Beer
consumption and the ’beer belly’: scientific
basis or common belief? Eur J Clin Nutr.
2009;63:1143–9. doi: 10.1038/ejcn.2009.39.

113. French, MT, Popovici, I & Maclean, JC (2009)
Do alcohol consumers exercise more? Findings
from a national survey. Am J Health Promot 24,
2–10.

114. Kim, BY., Nam, H., Yoo, JJ. et al. Associa-
tion between alcohol consumption status and
obesity-related comorbidities in men: data from
the 2016 Korean community health survey.
BMC Public Health 21, 733 (2021). https://do
i.org/10.1186/s12889-021-10776-y.

115. Nielsen SJ, Kit BK, Fakhouri T, Ogden CL.
Calories Consumed From Alcoholic Beverages
by U.S. Adults, 2007–2010. NCHS Data Brief,
no 110. Hyattsville, MD: National Center for
Health Statistics; 2012: 1–8.

116. Bendsen NT, Christensen R, Bartels EM, et al.
Is beer consumption related to measures of ab-
dominal and general obesity? A systematic re-
view and meta-analysis. Nutr Rev. 2013;71:67–
87. doi: 10.1111/j.1753-4887.2012.00548.x.

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 179



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
117. GBD 2015 Risk Factors Collaborators (2016)

Global, regional, and national comparative risk
assessment of 79 behavioural, environmental
and occupational, and metabolic risks or clus-
ters of risks, 1990–2015: a systematic analysis
for the Global Burden of Disease Study 2015.
Lancet 388, 1659–1724.

118. Robinson E., Roberts C., Vainik U., Jones
A. (2020). The psychology of obesity: an
umbrella review and evidence-based map of
the psychological correlates of heavier body
weight. Neurosci. Biobehav. Rev. 119, 468–
480. 10.1016/j.neubiorev.2020.10.009.

119. Bonnet, F., Disse, E., Laville, M. et al. Mod-
erate alcohol consumption is associated with
improved insulin sensitivity, reduced basal in-
sulin secretion rate and lower fasting glucagon
concentration in healthy women. Diabetologia
55, 3228–3237 (2012). https://doi.org/10.1007/
s00125-012-2701-3.

120. O’Donovan, G., Stamatakis, E., & Hamer, M.
(2018). Associations between alcohol and obe-
sity in more than 100 000 adults in England and
Scotland. British Journal of Nutrition, 119(2),
222-227. doi:10.1017/S000711451700352X.

121. Kaluza J, Harris HR, Linden A, Wolk A. Alco-
hol Consumption and Risk of Chronic Obstruc-
tive Pulmonary Disease: A Prospective Cohort
Study of Men. Am J Epidemiol. 2019 May
1;188(5):907-916. doi: 10.1093/aje/kwz020.

122. Ayres JG, Clark TJ. Alcoholic drinks and
asthma: a survey. Br J Dis Chest. 1983
Oct;77(4):370-5.

123. Freudenheim JL, Ritz J, Smith-Warner SA, Al-
banes D, Bandera EV, van den Brandt PA,
Colditz G, Feskanich D, Goldbohm RA, Har-
nack L, Miller AB, Rimm E, Rohan TE, Sellers
TA, Virtamo J,Willett WC, Hunter DJ. Alcohol
consumption and risk of lung cancer: a pooled
analysis of cohort studies. Am J Clin Nutr. 2005
Sep;82(3):657-67.

124. Garcia-Vidal C, Ardanuy C, Tubau F, Viasus D,
Dorca J, Liñares J, et al. Pneumococcal pneu-
monia presenting with septic shock: host- and
pathogen-related factors and outcomes. Thorax.
2010;65:77–81.

125. Mehta AJ, Guidot DM. Alcohol abuse,
the alveolar macrophage and pneumonia.
American Journal of the Medical Sciences.
2012;343(3):244–247.

126. Happel KI, Nelson S. Alcohol, immunosuppres-
sion, and the lung. Proceedings of the American
Thoracic Society. 2005;2(5):428–432.

127. Perlino CA, Rimland D. Alcoholism,
leukopenia, and pneumococcal sepsis. The
American Review of Respiratory Disease.
1985;132(4):757–760.

128. Jong G-M, Hsiue T-R, Chen C-R, et al.
Rapidly fatal outcome of bacteremic Klebsiella
pneumoniae pneumonia in alcoholics. Chest.
1995;107(1):214–217.

129. Plevneshi A, Svoboda T, Armstrong I, Tyrrell
GJ, Miranda A, Green K, et al. Population-
based surveillance for invasive pneumococcal
disease in homeless adults in Toronto. PLoS
One. 2009;4:e7255.

130. Moss M, Bucher B, Moore FA, Moore EE,
Parsons PE. The role of chronic alcohol abuse
in the development of acute respiratory distress
syndrome in adults. JAMA. 1996;275:50–54.

131. Adamuz J, Viasus D, Camprecios-Rodriguez P,
et al. A prospective cohort study of healthcare
visits and rehospitalizations after discharge of
patients with community-acquired pneumonia.
Respirology. 2011;16(7):1119–1126.

132. Moss M, Burnham EL. Chronic alco-
hol abuse, acute respiratory distress syn-
drome, and multiple organ dysfunction. Crit
Care Med 31, Suppl: S207–S212, 2003.
doi:10.1097/01.CCM.0000057845.77458.25.

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 180



MEERP LTD
SHASHI K. AGARWAL, MD

133. Clark BJ, Williams A, Feemster LM,
Bradley KA, Macht M, Moss M, Burn-
ham EL; NHLBI ARDS Network Investi-
gators. Alcohol screening scores and 90-
day outcomes in patients with acute lung
injury. Crit Care Med 41: 1518–1525, 2013.
doi:10.1097/CCM.0b013e318287f1bb.

134. Merrick EL, Hodgkin D, Garnick DW, Hor-
gan CM, Panas L, Ryan M, Saitz R, Blow
FC. Unhealthy drinking patterns and receipt of
preventive medical services by older adults. J
Gen Intern Med. 2008 Nov;23(11):1741-8. doi:
10.1007/s11606-008-0753-3.

135. Luján M, Burgos J, Gallego M, Falcó V,
Bermudo G, Planes A, et al. Effects of im-
munocompromise and comorbidities on pneu-
mococcal serotypes causing invasive respira-
tory infection in adults: implications for vac-
cine strategies. Clinical Infectious Diseases.
2013;57:1722–1730.

136. BorgdorffMW,Veen J, Kalisvaart NA, Nagelk-
erke N. Mortality among tuberculosis patients
in the Netherlands in the period 1993–1995. Eu-
ropean Respiratory Journal. 1998;11(4):816–
820.

137. Jerrells TR, Pavlik JA, DeVasure J, et al. Asso-
ciation of chronic alcohol consumption and in-
creased susceptibility to and pathogenic effects
of pulmonary infection with respiratory syn-
cytial virus in mice. Alcohol. 2007;41(5):357–
369.

138. Moss M, Burnham EL. Chronic alcohol abuse,
acute respiratory distress syndrome, and multi-
ple organ dysfunction. Critical Care Medicine.
2003;31(Suppl. 4):S207–S212.

139. Liffner G, Bak Z, Reske A, Sjöberg F. Inhala-
tion injury assessed by score does not contribute
to the development of acute respiratory distress
syndrome in burn victims. Burns. 2005;31:263–
268.

140. Cook RT. Alcohol abuse, alcoholism, and dam-
age to the immune system: A review. Alco-
holism: Clinical and Experimental Research.
1998;22:1927–1942.

141. Samuelson DR, Burnham EL, Maffei VJ, Van-
divier RW, Blanchard EE, Shellito JE, Luo M,
Taylor CM, Welsh DA. The respiratory tract
microbial biogeography in alcohol use disor-
der. Am J Physiol Lung Cell Mol Physiol.
2018 Jan 1;314(1):L107-L117. doi: 10.1152/aj-
plung.00277.2017.

142. Berkowitz H, Reichel J, Shim C. The effect of
ethanol on the cough reflex. Clin Sci Mol Med
45: 527–531, 1973.,; Joshi PC, Guidot DM.
The alcoholic lung: Epidemiology, pathophys-
iology, and potential therapies. American Jour-
nal of Physiology Lung Cellular and Molecular
Physiology. 2007;292(4):L813–L823.2012.

143. Simet SM, Sisson JH. Alcohol’s Effects on
Lung Health and Immunity. Alcohol Res.
2015;37(2):199-208.

144. Grant BF, Stinson FS, Dawson DA, et al. Preva-
lence and co-occurrence of substance use disor-
ders and independent mood and anxiety disor-
ders: Results from the National Epidemiologic
Survey on Alcohol and Related Conditions.
Arch Gen Psychiatry. 2004;61(8):807–816.

145. Guertler D, Moehring A, Krause K, Batra A,
Eck S, Freyer-Adam J, Ulbricht S, Rumpf
HJ, Bischof G, John U, Meyer C. Copat-
tern of depression and alcohol use in medical
care patients: cross-sectional study in Germany.
BMJ Open. 2020 May 6;10(5):e032826. doi:
10.1136/bmjopen-2019-032826.

146. Grant BF, Goldstein RB, Saha TD, et al. Epi-
demiology of DSM-5 alcohol use disorder: re-
sults from the National Epidemiologic Survey
on Alcohol and Related Conditions III. JAMA
Psychiatry. 2015;72(8):757–766.

147. Hasin DS, Goodwin RD, Stinson FS, Grant BF.
Epidemiology of major depressive disorder: re-
sults from the National Epidemiologic Survey
on Alcoholism and Related Conditions. Arch
Gen Psychiatry. 2005;62(10):1097–1106.

148. Foster KT, Hicks BM, IaconoWG, et al. Gender
differences in the structure of risk for alcohol

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 181



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES

use disorder in adolescence and young adult-
hood. Psychol Med. 2015;45(14):3047–3058.

149. Bell S, Britton A, Kubinova R, et al. Drinking
pattern, abstention and problem drinking as
risk factors for depressive symptoms: evidence
from three urban eastern European populations.
PLoS One 2014;9:e104384. 10.1371/jour-
nal.pone.0104384.

150. Bellos S, Skapinakis P, Rai D, et al. Lon-
gitudinal association between different lev-
els of alcohol consumption and a new on-
set of depression and generalized anxiety dis-
order: results from an international study in
primary care. Psychiatry Res 2016;243:30–4.
10.1016/j.psychres.2016.05.049.

151. Abraham HD, Fava M. Order of onset of
substance abuse and depression in a sample
of depressed outpatients. Compr Psychiatry.
1999;40(1):44–50.

152. Fergusson DM, Boden JM, Horwood LJ. Tests
of causal links between alcohol abuse or depen-
dence and major depression. Arch Gen Psychi-
atry. 2009;66(3):260–266.

153. Greenfield SF, Weiss RD, Muenz LR, et al.
The effect of depression on return to drink-
ing: A prospective study. Arch Gen Psychiatry.
1998;55(3):259–265.

154. Hasin D, Liu X, Nunes E, et al. Effects of
major depression on remission and relapse of
substance dependence. Arch Gen Psychiatry.
2002;59(4):375–380.

155. Hanna EZ, Grant BF. Gender differences in
DSM-IV alcohol use disorders and major de-
pression as distributed in the general popula-
tion: Clinical implications. Compr Psychiatry.
1997;38(4):202–212.

156. Prescott CA, Aggen SH, Kendler KS. Sex-
specific genetic influences on the comorbid-
ity of alcoholism and major depression in a
population-based sample of U.S. twins. Arch
Gen Psychiatry. 2000;57(8):803–811.

157. Boden JM, Fergusson DM. Alcohol and de-
pression. Addiction. 2011;106(5):906–914. doi:
10.1111/j.1360-0443.2010.03351.x.

158. Liappas J, Paparrigopoulos T, Tzavellas E, et al.
Impact of alcohol detoxification on anxiety and
depressive symptoms. Drug Alcohol Depend.
2002;68(2):215–220.

159. Agabio R, Trogu E, Pani PP. Antide-
pressants for the treatment of people
with co-occurring depression and alco-
hol dependence. Cochrane Database Syst
Rev. 2018 Apr 24;4(4):CD008581. doi:
10.1002/14651858.CD008581.pub2.

160. McCarter KL, Halpin SA, Baker AL, et al. As-
sociations between personality disorder charac-
teristics and treatment outcomes in people with
co-occurring alcohol misuse and depression.
BMC Psychiatry. 2016;16:210. Published 2016
Jul 7. doi:10.1186/s12888-016-0937-z.

161. Andrews G, editor. Management ofMental Dis-
orders. 4. Sydney: The World Health Organiza-
tion Collaborating Centre forMental Health and
Substance Abuse; 2004.

162. O’Shea R.S., Dasarathy S., McCullough A.J.
the Practice Guideline Committee of the Ameri-
can Association for the Study of Liver Diseases
and the Practice Parameters Committee of the
American College of Gastroenterology. Alco-
holic Liver Disease.Hepatology, 51 (2010), pp.
307-328.

163. Singal A.K., Anand B.S. Recent Trends in the
Epidemiology of Alcoholic Liver Disease. Clin
Liv Dis, 2 (2013), pp. 53-56.

164. Singal AK, Bataller R, Ahn J, Kamath PS, Shah
VH. ACG Clinical Guideline: Alcoholic Liver
Disease. Am J Gastroenterol. 2018;113(2):175-
194. doi:10.1038/ajg.2017.469.

165. Orman ES, Odena G, Bataller R. Alcoholic liver
disease: pathogenesis, management, and novel
targets for therapy. J Gastroenterol Hepatol.
2013;28 Suppl 1:77–84.

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 182



MEERP LTD
SHASHI K. AGARWAL, MD

166. Mann RE, Smart RG, Govoni R. The epidemi-
ology of alcoholic liver disease. Alcohol Res
Health. 2003;27:209–219.

167. MacSween RN, Burt AD. Histologic spectrum
of alcoholic liver disease. Semin Liver Dis.
1986;6:221–232.

168. O’Shea RS,McCulloughAJ. Treatment of alco-
holic hepatitis. Clin Liver Dis. 2005;9:103–134.

169. Rubin E, Lieber CS. Alcohol-induced hepatic
injury in nonalcoholic volunteers. N Engl JMed
1968; 278 : 869–76.

170. Pateria P, de Boer B, MacQuillan G. Liver ab-
normalities in drug and substance abusers. Best
Pract Res Clin Gastroenterol. 2013;27:577–
596.

171. MacSween RN, Burt AD. Histologic spectrum
of alcoholic liver disease. Semin Liver Dis.
1986;6:221–232.

172. Pateria P, de Boer B, MacQuillan G. Liver ab-
normalities in drug and substance abusers. Best
Pract Res Clin Gastroenterol. 2013;27:577–
596.

173. European Association for the Study of Liver.
EASL clinical practical guidelines: manage-
ment of alcoholic liver disease. J Hepatol.
2012;57:399–420.

174. Pateria P, de Boer B, MacQuillan G. Liver ab-
normalities in drug and substance abusers. Best
Pract Res Clin Gastroenterol. 2013;27:577–
596.

175. Sorbi D, Boynton J, Lindor KD. The ratio of as-
partate aminotransferase to alanine aminotrans-
ferase: potential value in differentiating nonal-
coholic steatohepatitis from alcoholic liver dis-
ease. Am J Gastroenterol. 1999;94:1018–1022.

176. MacSween RN, Burt AD. Histologic spectrum
of alcoholic liver disease. Semin Liver Dis.
1986;6:221–232.

177. Attali P, Ink O, Pelletier G, Vernier C, Jean
F, Moulton L, Etienne JP. Dupuytren’s con-
tracture, alcohol consumption, and chronic liver
disease. Arch Intern Med. 1987;147:1065–
1067.

178. MacSween RN, Burt AD. Histologic spectrum
of alcoholic liver disease. Semin Liver Dis.
1986;6:221–232.

179. Frazier TH, Stocker AM, Kershner NA,
Marsano LS, McClain CJ. Treatment of alco-
holic liver disease. Therap Adv Gastroenterol.
(2011) 4:63–81. 10.1177/1756283X10378925.

180. Liangpunsakul S., Haber P., McCaughan. Alco-
holic Liver Disease in Asia, Europe, and North
America. Gastroenterology, 150 (2016), pp.
1786-1797. Doi: 10.1053/j.gastro.2016.02.043.

181. Park EY, Lim MK, Oh JK, Cho H, Bae MJ,
Yun EH, Kim DI, Shin HR. Independent and
supra-additive effects of alcohol consumption,
cigarette smoking, and metabolic syndrome on
the elevation of serum liver enzyme levels.
PLoS One. 2013;8:e63439.

182. Taniai M, Hashimoto E, Tokushige K, Kodama
K, Kogiso T, Torii N, Shiratori K. Roles of
gender, obesity, and lifestyle-related diseases
in alcoholic liver disease: Obesity does not in-
fluence the severity of alcoholic liver disease.
Hepatol Res. 2012;42:359–367.

183. Naveau S, Giraud V, Borotto E, Aubert A,
Capron F, Chaput J. Excess weight risk fac-
tor for alcoholic liver disease. Hepatology.
1997;25:108–111.

184. Park EY, Lim MK, Oh JK, Cho H, Bae MJ,
Yun EH, Kim DI, Shin HR. Independent and
supra-additive effects of alcohol consumption,
cigarette smoking, and metabolic syndrome on
the elevation of serum liver enzyme levels.
PLoS One. 2013;8:e63439.

185. Fletcher LM, Halliday JW, Powell LW. Interre-
lationships of alcohol and iron in liver disease
with particular reference to the iron-binding
proteins, ferritin and transferrin. J Gastroenterol
Hepatol. 1999;14:202–214.

MEERP LTD CMI JOURNAL 2 (3), 169−184 (2021) 183



ALCOHOL AND NONCOMMUNICABLE DISEASES: PART I CARDIOVASCULAR DISEASES, 
OBESITY, RESPIRATORY DISEASES, DEPRESSION, LIVER DISEASES
186. Schmidt CS, Schön D, Schulte B, Lüth S,

Polywka S, Reimer J. Viral hepatitis in
alcohol-dependent inpatients: prevalence, risk
factors, and treatment uptake. J Addict Med.
2013;7:417–421.

187. Zhang M, Wu R, Jiang J, Minuk GY, Niu J.
The presence of hepatitis B core antibody is
associated with more advanced liver disease
in alcoholic patients with cirrhosis. Alcohol.
2013;47:553–558.

188. Hrubec Z, Omenn GS. Evidence of genetic pre-
disposition to alcoholic cirrhosis and psychosis:
twin concordances for alcoholism and its bi-
ological end points by zygosity among male
veterans. Alcohol Clin Exp Res 1981;5:207–15.

189. Xie, Y.-D., Feng, B., Gao, Y. and Wei, L.
(2014), Alcohol abstinence and survival. Hep-
atol Res, 44: 436-449. https://doi.org/10.1111/h
epr.12131.

190. Burra P, SenzoloM,AdamR, Delvart V, Karam
V, Germani G, Neuberger J. Liver transplan-
tation for alcoholic liver disease in Europe: a
study from the ELTR (European Liver Trans-
plant Registry) Am J Transplant. 2010;10:138–
148.

191. Singal AK, Guturu P, Hmoud B et al. Evolving
frequency and outcomes of liver transplantation
based on etiology of liver disease. Transplanta-
tion 2013;95:755–60.

192. Adam R, Karam V, Delvart V et al. Evolution
of indications and results of liver transplanta-
tion in Europe. A report from the European

Liver Transplant Registry (ELTR). J Hepatol
2012;57:675–88.

193. Burra P, Senzolo M, Adam R et al. Liver trans-
plantation for alcoholic liver disease in Europe:
a study from the ELTR (European Liver Trans-
plant Registry). Am J Transplant 2010;10:138–
48.

194. Poynard T, Bedossa P, Opolon P. Natural
history of liver fibrosis progression in pa-
tients with chronic hepatitis C. The OBSVIRC,
METaViR, CLINIVIR, and DOSVIRC groups.
Lancet 1997;349:825–32.

195. Testino G, Leone S, Borro P. Alcohol and hep-
atocellular carcinoma: a review and a point of
view. World J Gastroenterol 2014;20:15943–
54. 10.3748/wjg.v20.i43.15943.

196. Hlady RA, Tiedemann RL, Puszyk W, et al. .
Epigenetic signatures of alcohol abuse and hep-
atitis infection during human hepatocarcinogen-
esis. Oncotarget 2014;5:9425–43. 10.18632/on-
cotarget.2444.

How to cite this article: Agarwal S.K, MD. Alco-
hol and Noncommunicable Diseases: Part I 
Cardiovascular Diseases, Obesity, Respiratory 
Diseases, Depression, Liver Diseases. Clinical 
Medicine Insights. 2021;169−184. https://
doi.org /10.52845/CMI/2021-2-3-5

CMI JOURNAL 2 (3), 169−184 (2021) MEERP LTD 184


	Introduction
	Discussion
	CARDIOVASCULAR DISEASES
	OBESITY
	RESPIRATORY DISEASES
	DEPRESSION
	LIVER DISEASES

	CONCLUSION



