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Saturday 29 December 2012

Dietary Sources of Vitamin C

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Food sources of vitamin C are ranked by milligrams (mg) of vitamin C per standard amount; also calories in the standard amount. (All amounts listed provide 20% or more of the Recommended Dietary Allowance (RDA) of 90 mg/day for adult men.)

Food, Standard Amount Vitamin C (mg) Calories
Guava, raw, ½ cup 188 56
Red bell pepper, raw, ½ cup 142 20
Red bell pepper, cooked, ½ cup 116 19
Kiwi fruit, 1 medium 70 46
Orange, raw, 1 medium 70 62
Orange juice, ¾ cup 61 to 93 79 to 84
Green bell pepper, raw, ½ cup 60 15
Green bell pepper, cooked, ½ cup 51 19
Grapefruit juice, ¾ cup 50 to 70 71 to 86
Vegetable juice cocktail, ¾ cup 50 34
Strawberries, raw, ½ cup 49 27
Brussels sprouts, cooked, ½ cup 48 28
Cantaloupe, ¼ medium 47 51
Papaya, raw, ¼ medium 47 30
Kohlrabi, cooked, ½ cup 45 24
Broccoli, raw, ½ cup 39 15
Edible pod peas, cooked, ½ cup 38 34
Broccoli, cooked, ½ cup 37 26
Sweet potato, canned, ½ cup 34 116
Tomato juice, ¾ cup 33 31
Cauliflower, cooked, ½ cup 28 17
Pineapple, raw, ½ cup 28 37
Kale, cooked, ½ cup 27 18
Mango, ½ cup 23 54

Source: USDA/HHS Dietary Guidelines for Americans, 2005External Web Site Icon

Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures. Food items and weights in the single nutrient reports are adapted from those in the 2002 revision of USDA Home and Garden Bulletin No. 72, Nutritive Value of Foods. Mixed dishes and multiple preparations of the same food item have been omitted from this table.

Dietary Sources of Iron

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Food Sources of Iron ranked by milligrams of iron per standard amount; also calories in the standard amount. (All amounts listed provide 10% or more of the Recommended Dietary Allowance (RDA) for teenage and adult females, which is 18 mg/day.)

Food, Standard Amount Iron (mg) Calories
Clams, canned, drained, 3 oz 23.8 126
*Fortified dry cereals (various), about 1 oz 1.8 to 21.1  54 to 127
Cooked oysters, cooked, 3 oz 10.2 116
Organ meats (liver, giblets), cooked, 3 oza 5.2 to 9.9 134 to 235
*Fortified instant cooked cereals (various), 1 packet 4.9 to 8.1 Varies
*Soybeans, mature, cooked, ½ cup 4.4  149
*Pumpkin and squash seed kernels, roasted, 1 oz 4.2 148
*White beans, canned, ½ cup 3.9 153
*Blackstrap molasses, 1 Tbsp 3.5 47
*Lentils, cooked, ½ cup 3.3  115
*Spinach, cooked from fresh, ½ cup 3.2 21
Beef, chuck, blade roast, cooked, 3 oz 3.1  215
Beef, bottom round, cooked, 3 oz 2.8  182
*Kidney beans, cooked, ½ cup 2.6  112
Sardines, canned in oil, drained, 3 oz 2.5  177
Beef, rib, cooked, 3 oz 2.4 195
*Chickpeas, cooked, ½ cup 2.4 134
Duck, meat only, roasted, 3 oz 2.3  171
Lamb, shoulder, cooked, 3 oz 2.3  237
*Prune juice, ¾ cup 2.3 136
Shrimp, canned, 3 oz 2.3 102
*Cowpeas, cooked, ½ cup 2.2 100
Ground beef, 15% fat, cooked, 3 oz 2.2 212
*Tomato puree, ½ cup 2.2 48
*Lima beans, cooked, ½ cup 2.2 108
*Soybeans, green, cooked, ½ cup 2.2 127
*Navy beans, cooked, ½ cup 2.1 127
*Refried beans, ½ cup 2.1 118
Beef, top sirloin, cooked, 3 oz 2.0 156
*Tomato paste, ¼ cup 2.0 54

Food Sources of iron are ranked by milligrams of iron per standard amount; also calories in the standard amount. (All amounts listed provide 10% or more of the Recommended Dietary Allowance (RDA) for teenage and adult females, which is 18 mg/day.)
aHigh in cholesterol.

*These are non-heme iron sources. To improve absorption, eat these with a vitamin-C rich food.
Source: USDA/HHS Dietary Guidelines for Americans, 2005External Web Site Icon

Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures. Food items and weights in the single nutrient reports are adapted from those in the 2002 revision of USDA Home and Garden Bulletin No. 72, Nutritive Value of Foods. Mixed dishes and multiple preparations of the same food item have been omitted from this table.

Anemia a.k.a Iron Deficiency

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The following information is adapted from:Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR 1998;47 (No. RR-3) p. 5

What is iron and why do we need it?

Iron is a mineral needed by our bodies. Iron is a part of all cells and does many things in our bodies. For example, iron (as part of the protein hemoglobin) carries oxygen from our lungs throughout our bodies. Having too little hemoglobin is called anemia. Iron also helps our muscles store and use oxygen.
Iron is a part of many enzymes and is used in many cell functions. Enzymes help our bodies digest foods and also help with many other important reactions that occur within our bodies. When our bodies don't have enough iron, many parts of our bodies are affected.


What is iron deficiency and why is it a concern?

Iron deficiency is a condition resulting from too little iron in the body. Iron deficiency is the most common nutritional deficiency and the leading cause of anemia in the United States.1
The terms anemia, iron deficiency, and iron deficiency anemia often are used interchangeably but equivalent. Iron deficiency ranges from depleted iron stores without functional or health impairment to iron deficiency with anemia, which affects the functioning of several organ systems.2
Iron deficiency is a concern because it can:
  • Iron deficiency can delay normal infant motor function (normal activity and movement) or mental function (normal thinking and processing skills).3-6
  • Iron deficiency anemia during pregnancy can increase risk for small or early (preterm) babies.7-8 Small or early babies are more likely to have health problems or die in the first year of life than infants who are born full term and are not small.
  • Iron deficiency can cause fatigue that impairs the ability to do physical work in adults.9-10 Iron deficiency may also affect memory or other mental function in teens.11


What causes iron deficiency?

Iron deficiency has many causes. (See table below for a summary). These causes fall into two main categories:
1. Increased iron needs
Many common conditions can cause people to need additional iron:
  • Because of their rapid growth, infants and toddlers need more iron than older children. Sometimes it can be hard for them to get enough iron from their normal diet.
  • Women who are pregnant have higher iron needs. To get enough, most women must take an iron supplement as recommended by their healthcare provider.
  • When people lose blood, they also lose iron. They need extra iron to replace what they have lost. Increased blood loss can occur with heavy menstrual periods, frequent blood donation, as well as with some stomach and intestinal conditions (food sensitivity, hookworms.)
2. Decreased iron intake or absorption (not enough iron taken into the body)
The amount of iron absorbed from the diet depends on many factors:
  • Iron from meat, poultry, and fish (i.e., heme iron) is absorbed two to three times more efficiently than iron from plants (i.e., non-heme iron).
  • The amount of iron absorbed from plant foods (non-heme iron) depends on the other types of foods eaten at the same meal.
  • Foods containing heme iron (meat, poultry, and fish) enhance iron absorption from foods that contain non-heme iron (e.g., fortified cereals, some beans, and spinach).
  • Foods containing vitamin C (see Dietary Sources of vitamin C) also enhance non-heme iron absorption when eaten at the same meal.
  • Substances (such as polyphenols, phytates, or calcium) that are part of some foods or drinks such as tea, coffee, whole grains, legumes and milk or dairy products can decrease the amount of non-heme iron absorbed at a meal. Calcium can also decrease the amount heme-iron absorbed at a meal. However, for healthy individuals who consume a varied diet that conforms to the Dietary Guidelines for Americans, the amount of iron inhibition from these substances is usually not of concern.
  • Vegetarian diets are low in heme iron, but careful meal planning can help increase the amount of iron absorbed.
  • Some other factors (such as taking antacids beyond the recommended dose or medicine used to treat peptic ulcer disease and acid reflux) can reduce the amount of acid in the stomach and the iron absorbed and cause iron deficienc

 

Who is most at risk?

  • Young children and pregnant women are at higher risk of iron deficiency because of rapid growth and higher iron needs.
  • Adolescent girls and women of childbearing age are at risk due to menstruation.
  •  Among children, iron deficiency is seen most often between six months and three years of age due to rapid growth and inadequate intake of dietary iron. Infants and children at highest risk are the following groups:
    • Babies who were born early or small.
    • Babies given cow's milk before age 12 months.
    • Breastfed babies who after age 6 months are not being given plain, iron-fortified cereals or another good source of iron from other foods.
    • Formula-fed babies who do not get iron-fortified formulas.
    • Children aged 1–5 years who get more than 24 ounces of cow, goat, or soymilk per day. Excess milk intake can decrease your child's desire for food items with greater iron content, such as meat or iron fortified cereal.
    • Children who have special health needs, for example, children with chronic infections or restricted diets.

Signs and Symptoms of Iron Deficiency

Too little iron can impair body functions, but most physical signs and symptoms do not show up unless iron deficiency anemia occurs. Someone with early stages of iron deficiency may have no signs or symptoms. This is why it is important to screen for too little iron among high risk groups.
Signs of iron deficiency anemia include12
  • Feeling tired and weak
  • Decreased work and school performance
  • Slow cognitive and social development during childhood
  • Difficulty maintaining body temperature
  • Decreased immune function, which increases susceptibility to infection
  • Glossitis (an inflamed tongue)


How is iron deficiency detected?

Your doctor or healthcare provider will do blood tests to screen for iron deficiency. No single test is used to diagnose iron deficiency. The most common tests for screening are
  • Hemoglobin test (a test that measures hemoglobin which is a protein in the blood that carries oxygen)
  •  Hematocrit test (the percentage of red blood cells in your blood by volume)
    These tests show how much iron is in your body. Hemoglobin and hematocrit levels usually aren't decreased until the later stages of iron deficiency, i.e., anemia.
Sometimes other blood tests are used to confirm that anemia is due to iron deficiency. These might include
  • Complete blood count (to look at the number and volume of the red blood cells)
  • Serum ferritin (a measure of a stored form of iron)
  • Serum iron (a measure of the iron in your blood)
  • Transferrin saturation (a measure of the transported form of iron)
  • Transferrin receptor (a measure of increased red blood cell production)

How is iron deficiency treated?

  • If you are found to have an iron deficiency, it is important to see your healthcare provider for treatment. Your treatment will depend on factors such as your age, health, and cause of iron deficiency.
  • If your doctor or health care provider thinks that you have iron deficiency she or he may prescribe iron supplements for you to take and then ask that you return after a period to have your hemoglobin or hematocrit tested.
  • If your healthcare provider determines that the iron deficiency is due to a diet low in iron, you might be told to eat more iron-rich foods. Your health care provider may also prescribe an iron supplement for you.
Again, it is important to be diagnosed by your healthcare provider because iron deficiency can have causes that aren't related to your diet. Your healthcare provider's recommendations will be specific to your needs.

What can I do to prevent iron deficiency?

In general, you can eat a healthful diet that includes good sources of iron. A healthful diet includes fruits, vegetables, whole grains, fat free or nonfat milk and milk products, lean meats, fish, dry beans, eggs, nuts, and is low in saturated fat, trans fats, cholesterol, salt, and added sugars.
In addition to a healthful diet that includes good sources of iron, you can also eat foods that help your body absorb iron better. For example, you can eat a fruit or vegetable that is a good source of vitamin C (see table on Dietary Sources of vitamin C) with a food or meal that contains non-heme iron (see table below for Dietary Sources of Iron). Vitamin C helps your body absorb the non-heme iron foods you eat, especially when the food containing non-heme iron and the vitamin-C rich food are eaten at the same meal.
The following recommendations are for specific groups who are at greater risk for iron deficiency.

Babies
  • If possible, breastfeed your baby for at least 12 months and starting at 4 to 6 months of age, give your baby plain, iron-fortified infant cereal and/or pureed meat. Just two or more servings a day can meet a baby's iron needs at this age. Meats should be home prepared or commercially prepared plain pureed (chopped until smooth in a blender) meats.
  • When your baby is about 6 months of age, include a feeding per day of foods rich in vitamin C with foods that are rich in non-heme iron to improve iron absorption.
  • If you can't breastfeed, use iron-fortified formula.
  • Don't give low-iron milks (e.g. cow's milk, goat's milk, and soy milk) until your baby is at least 12 months old.
  • If your baby was born early or small, talk to your doctor about giving iron drops to your baby.
  • If your baby can't get two or more servings per day of iron rich foods (such as iron-fortified cereal or pureed meats), talk to your doctor about giving iron drops to your baby.
Young children (aged 1–5 years)
  • After your child is one year old, give no more than three 8 ounce servings of whole cow, goat, or soy milk per day. After your child is 2 years old, low fat or nonfat milks should be used in place of whole milks. Vitamin D-fortified milk is a good source of calcium and vitamin D, but not iron.
  • Give your child a diet with iron-rich foods such as iron-fortified breads and iron-fortified cereals and lean meats. See Dietary Sources of Iron
  • Include fruits, vegetables or juices that are rich in vitamin C. Vitamin C helps your child absorb non-heme iron especially when the food that is a source of non-heme iron and the vitamin C-rich food are eaten at the same meal. See Dietary Sources of Vitamin C.
Adolescent girls and women of childbearing age
  • Eat iron-rich foods. See Dietary Sources of Iron.
  • Eat foods that are vitamin C sources. Vitamin C helps your body absorb non-heme iron especially when the food that is a source of non-heme iron and the vitamin C-rich food are eaten at the same meal. See Dietary Sources of Vitamin C.
  • Eat lean red meats, poultry, and fish. The iron in these foods is easier for your body to absorb than the iron in plant foods.
Pregnant women
  • Eat iron-rich foods. See Dietary Sources of Iron.
  • Eat foods that are vitamin C sources. Vitamin C helps your body absorb non-heme iron especially when the food that is a source of non-heme iron and the vitamin-C rich food are eaten at the same meal. See Dietary Sources of Vitamin C below.
  • Eat lean red meats, poultry, and fish. The iron in these foods is easier for your body to absorb than the iron in plant foods.
  • Talk to your doctor about taking an iron supplement.

How much iron do I need?

If you have already been diagnosed with iron deficiency, talk to your doctor or healthcare provider about treatment. For healthy individuals, the Recommended Dietary Allowance (RDA) for iron is listed in the following table.

Recommended Dietary Allowance (RDA) for iron by age and sex.
Age/Group Life Stage Iron (mg/day)
Infants 0–6 months 0.27*
7–12 months 11
Children 1–3 years 7
4–8 years 10
Males 9–13 years 8
14–18 years 11
19–30 years 8
31–50 years 8
51–70 years 8
>70 years 8
Females 9–13 years 8
14–18 years 15
19–30 years 18
31–50 years 18
51–70 years 8
>70 years 8
Pregnant Women 14–18 years 27
19–30 years 27
31–50 years 27
Lactating Women 14–18 years 10
19–30 years 9
31–50 years 9
*This value is an Adequate Intake (AI) value.  AI is used when there is not enough information known to set a Recommended Dietary Allowance (RDA).

Source: Dietary Reference Intakes, Institute of Medicine, Food and Nutrition Board Adobe PDF fileExternal Web Site Icon.* (PDF-86k)

More info on iron and Dietary Source for Anemia

Warning

Iron Overload and Hemochromatosis

Iron overload is the accumulation of excess iron in body tissues. Hemochromatosis is the disease resulting from significant iron overload. Hemochromatosis can have genetic and non-genetic causes. For more information, see Iron Overload and Hemochromatosis

 

Alzheimer's Disease

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What is Alzheimer’s Disease?

Alzheimer’s disease is the most common form of dementia among older adults. Alzheimer’s disease involves parts of the brain that control thought, memory, and language and can seriously affect a person’s ability to carry out daily activities. Although scientists are learning more every day, right now, they still do not know what causes Alzheimer’s disease.

Who has Alzheimer’s Disease?

As many as 5 million Americans suffer from Alzheimer’s disease. While younger people may get Alzheimer’s disease, it is much less common. The disease usually begins after age 60, and risk goes up with age. About 5 percent of men and women ages 65 to 74 have Alzheimer’s disease, and nearly half of those age 85 and older may have the disease. It is important to note, however, that Alzheimer’s disease is not a normal part of aging.
A middle-aged man and woman sitting.  Both are smiling into the camera.  The woman is leaning onto the man with her head on his shoulder.

 What causes Alzheimer’s Disease?

Scientists do not yet fully understand what causes Alzheimer’s disease. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for Alzheimer’s disease. The number of people with the disease doubles every 5 years beyond age 65.
Family history is another risk factor. Researchers believe that genetics may play a role in developing Alzheimer’s disease.

Scientists still need to learn a lot more about what causes Alzheimer’s disease. In addition to genetics, they are studying education, diet, and environment to learn what role they might play in developing this disease. Scientists are finding more and more evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate may also increase the risk of Alzheimer’s disease. Evidence for physical, mental and social activities as protective factors against Alzheimer’s disease is also growing.


References

  1. MiniƱo, A; Xu, J; Kochanek, KD. “Deaths: Preliminary Data for 2008.” National Vital Statistics Reports. Hyattsville, Md.; National Center for Health Statistics; 2010.  
  2. Hebert, LE; Scherr, PA; Bienias, JL; Bennett, DA; Evans, DA. “Alzheimer’s disease in the U.S. population: Prevalence estimates using the 2000 Census.” Archives of Neurology 2003;60(8):1119–1122 and Alzheimer’s Association. Early-Onset Dementia: A National Challenge, A Future Crisis. Washington, D.C.: Alzheimer’s Association; 2006; as published by the Alzheimer’s Association, Alzheimer’s Disease Facts and Figures, 2011.  
  3. Hebert, LE; Scherr, PA; Bienias, JL; Bennett, DA; Evans, DA. “Alzheimer’s disease in the U.S. population: Prevalence estimates using the 2000 Census.” Archives of Neurology 2003;60(8):1119–1122; as published by the Alzheimer’s Association, Alzheimer’s Disease Facts and Figures, 2011.
  4. Alzheimer’s Association. Characteristics, Costs and Health Service Use for Medicare Beneficiaries with a Dementia Diagnosis: Report 1: Medicare Current Beneficiary Survey. Prepared under contract by Julie Bynum, M.D., M.P.H., Dartmouth Institute for Health Policy and Clinical Care, Center for Health Policy Research, January 2009; as published by the Alzheimer’s Association, Alzheimer’s Disease Facts and Figures, 2011.
  5. Alzheimer’s Association. Characteristics, Costs and Health Service Use for Medicare Beneficiaries with a Dementia Diagnosis: Report 1: Medicare Current Beneficiary Survey. Prepared under contract by Julie Bynum, M.D., M.P.H., Dartmouth Institute for Health Policy and Clinical Care, Center for Health Policy Research, January 2009; as published by the Alzheimer’s Association, Alzheimer’s Disease Facts and Figures, 2011.

Excessive Alcohol Use and Risks to Women’s Health

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Although men are more likely to drink alcohol and drink in larger amounts, gender differences in body structure and chemistry cause women to absorb more alcohol, and take longer to break it down and remove it from their bodies (i.e., to metabolize it). In other words, upon drinking equal amounts, women have higher alcohol levels in their blood than men, and the immediate effects occur more quickly and last longer. These differences also make women more vulnerable to alcohol’s long-term effects on their health.1

Reproductive Health

  • National surveys show that about 1 in 2 women of child-bearing age (i.e., aged 18–44 years) use alcohol, and 15% of women who drink alcohol in this age group binge drink.2
  • About 7.6% of pregnant women used alcohol.2
  • Excessive drinking may disrupt menstrual cycling and increase the risk of infertility, miscarriage, stillbirth, and premature delivery.3, 4
  • Women who binge drink are more likely to have unprotected sex and multiple sex partners. These activities increase the risks of unintended pregnancy5 and sexually transmitted diseases.6

Alcohol and Pregnancy

  • Women who drink alcohol while pregnant increase their risk of having a baby with Fetal Alcohol Spectrum Disorders (FASD). The most severe form is Fetal Alcohol Syndrome (FAS), which causes mental retardation and birth defects.
  • FASD are completely preventable if a woman does not drink while pregnant or while she may become pregnant.
  • Studies have shown that about 1 of 20 pregnant women drank excessively before finding out they were pregnant.7 No amount of alcohol is safe to drink during pregnancy. For women who drink during pregnancy, stopping as soon as possible may lower the risk of having a child with physical, mental, or emotional problems.
  • Research suggests that women who drink alcohol while pregnant are more likely to have a baby die from Sudden Infant Death Syndrome (SIDS). This risk substantially increases if a woman binge drinks during her first trimester of pregnancy.8
  • The risk of miscarriage is also increased if a woman drinks excessively during her first trimester of pregnancy.9

Other Health Concerns

  • Liver Disease: The risk of cirrhosis and other alcohol-related liver diseases is higher for women than for men.10
  • Impact on the Brain: Excessive drinking may result in memory loss and shrinkage of the brain.11 Research suggests that women are more vulnerable than men to the brain damaging effects of excessive alcohol use, and the damage tends to appear with shorter periods of excessive drinking for women than for men.12
  • Impact on the Heart: Studies have shown that women who drink excessively are at increased risk for damage to the heart muscle than men even for women drinking at lower levels.13
  • Cancer: Alcohol consumption increases the risk of cancer of the mouth, throat, esophagus, liver, colon, and breast among women. The risk of breast cancer increases as alcohol use increases.14-17
  • Sexual Assault: Binge drinking is a risk factor for sexual assault, especially among young women in college settings. Each year, about 1 in 20 college women are sexually assaulted. Research suggests that there is an increase in the risk of rape or sexual assault when both the attacker and victim have used alcohol prior to the attack.18, 19

References:

Excessive Alcohol Use and Risks to Men's Health

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Men are more likely than women to drink excessively. Excessive drinking is associated with significant increases in short-term risks to health and safety, and the risk increases as the amount of drinking increases. Men are also more likely than women to take other risks (e.g., drive fast or without a safety belt), when combined with excessive drinking, further increasing their risk of injury or death.1-4

Drinking levels for men

  • Approximately 63% of adult men reported drinking alcohol in the last 30 days. (Men 24%) were two times more likely to binge drink than women during the same time period.5
  • Men average about 12.5 binge drinking episodes per person per year, while women average about 2.7 binge drinking episodes per year.3
  • Most people who binge drink are not alcoholics or alcohol dependent.6, 7
  • It is estimated that about 17% of men and about 8% of women will meet criteria for alcohol dependence at some point in their lives.8

Injuries and deaths as a result of excessive alcohol use

  • Men consistently have higher rates of alcohol-related deaths and hospitalizations than women.1, 9, 10
  • Among drivers in fatal motor-vehicle traffic crashes, men are almost twice as likely as women to have been intoxicated (i.e., a blood alcohol concentration of 0.08% or greater).11
  • Excessive alcohol consumption increases aggression and, as a result, can increase the risk of physically assaulting another person.12
  • Men are more likely than women to commit suicide, and more likely to have been drinking prior to committing suicide.13-15

Reproductive Health and Sexual Function

Excessive alcohol use can interfere with testicular function and male hormone production resulting in impotence, infertility, and reduction of male secondary sex characteristics such as facial and chest hair.16, 17
Excessive alcohol use is commonly involved in sexual assault. Impaired judgment caused by alcohol may worsen the tendency of some men to mistake a women’s friendly behavior for sexual interest and misjudge their use of force. Also, alcohol use by men increases the chances of engaging in risky sexual activity including unprotected sex, sex with multiple partners, or sex with a partner at risk for sexually transmitted diseases.4

Cancer

Alcohol consumption increases the risk of cancer of the mouth, throat, esophagus, liver, and colon in men.18-20
There are a number of health conditions affected by excessive alcohol use that affect both men and women.

References:

  1. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC.
  2. Levy DT, Mallonee S, Miller TR, Smith GS, Spicer RS, Romano EO, Fisher DA. Alcohol involvement in burn, submersion, spinal cord, and brain injuriesExternal Web Site Icon. Med Sci Monit 2004; 10(1):CR17–24.
  3. Naimi TS, Brewer RD, Mokdad A, Clark D, Serdula MK, Marks JS. Binge Drinking Among US AdultsExternal Web Site Icon. JAMA 2003; 289(1):70–75.
  4. Nolen-Hoeksema S. Gender differences in risk factors and consequences for alcohol use and problemsExternal Web Site Icon. Clinical Psychology Review 2004;24:981.
  5. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System prevalence data. Atlanta, GA: CDC.
  6. Dawson DA, Grant BF, LI T-K. Quantifying the risks associated with exceeding recommended drinking limitsExternal Web Site Icon. Alcohol Clin Exp Res 2005;29:902–908.
  7. Woerle S, Roeber J, Landen MG.  Prevalence of alcohol dependence among excessive drinkers in New MexicoExternal Web Site IconAlcohol Clin Exp Res 2007;31:293–298.
  8. Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United StatesExternal Web Site Icon. Arch Gen Psychiatry. 2007;64:830-842.
  9. Minino AM, Heron MP, Murphy SL, Kochanek KD. Deaths: final data for 2004 Adobe PDF file [PDF 3.37MB]. National Vital Statistics Report, Volume 55, No. 19, August 21, 2007. Hyattsville, MD: CDC National Center for Health Statistics.
  10. Chen CM, Yi H. Trends in alcohol-related morbidity among short-stay community hospital discharges, United States, 1979–2005 Adobe PDF fileExternal Web Site Icon [PDF 1.78MB].  Bethesda, MD: National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. NIAAA Surveillance Report #80, 2007.
  11. National Highway Traffic Safety Administration. Traffic Safety Facts 2006 Adobe PDF fileExternal Web Site Icon [PDF 990KB].  Washington, DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, National Center for Statistics & Analysis. DOT HS 810 818, 2008.
  12. Scott KD, Schafer J, Greenfield TK. The roles of alcohol in physical assault perpetration and victimizationExternal Web Site Icon. J Stud Alcohol 1999;60:528–536.
  13. Hayward l, Zubrick SR, Silburn S. Blood alcohol levels in suicide casesExternal Web Site Icon. J Epidemiol Community Health 1992;46(3):256–260.
  14. May PA, Van Winkle NW, Williams MB, McFeeley PJ, DeBruyn LM, Serna P. Alcohol and suicide death among American Indians of New Mexico: 1980-1998External Web Site Icon. Suicide Life Threat Behav 2002;32(3):240–255.
  15. Suokas J, Suominen K, Lonnqvist J. Chronic alcohol problems among suicide attempters—post-mortem findings of a 14-year follow-upExternal Web Site Icon. Nord J Psychiatry 2005;59(1):45–50.
  16. Adler RA. Clinically important effects of alcohol on endocrine functionExternal Web Site Icon. Journal of Clinical Endocrinology and Metabolism 1992;74(5):957–960.
  17. Emanuele MA, Emanuele NV. Alcohol’s effects on male reproductionExternal Web Site Icon. Alcohol Research and Health 1998; 22(3):195–201.
  18. American Cancer Society. Alcohol and Cancer Adobe PDF fileExternal Web Site Icon[PDF–181KB]. Atlanta, GA: American Cancer Society; 2006.
  19. Donato F, Tagger A, Chiesa R, Ribero ML, Tomasoni V, Fasola M, et al. Hepatitis B and C virus infection, alcohol drinking and hepatocellular carcinoma: a case-control study in ItalyExternal Web Site Icon. Hepatology 1997;26(3):579–584.
  20. Baan R, Straif K, Grosse Y, Secretan B, et al. on behalf of the WHO International Agency for Research on Cancer Monograph Working Group. Carcinogenicity of alcoholic beveragesExternal Web Site IconLancet Oncol 2007;8:292-293.