Diuretic Effects of Alcoholic Beverages in Elderly Men: Controlled Trial Findings

1. The diuretic action of weak and strong alcoholic beverages in elderly men: A Randomized Diet-Controlled Crossover trial Presented by: Megan Gawronski

2. Authors • Kristel C. M. M. Polhuis: PhD Candidate, Wageningen University & Research • Annemarthe H. C. Wijnen: ?? • AafjeSierksma: Director of The Dutch Beer Institute • Wim Calame: PhD • Michael Tieland: Nutrition, Exercise and Aging Physiologist at Wageningen University

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

4. Background

5. 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.

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

7. 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

8. 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.

9. The purpose of the study

10. 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.”

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

12. Research methods

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

14. 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

15. INCLUSION Criteria • Normal renal function • Creatinine: 60-110 mmol/L • Urea: 2.5-6.4 mmol/L • No exclusion criteria

17. 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

18. 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: • BolsGenever (gin) • 35% Water: • 0%

19. 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.

20. 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.

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

22. 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.

23. 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

24. Results

25. 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 non-alcoholic counterparts.

26. Urine analysis

27. 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

28. Sodium concentration • Significant difference between alcoholic wine and non-alcoholic 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)

29. 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 non-alcoholic beer (p > 0.80)

30. Conclusion

31. Findings • Significant differences in urine output, sodium and potassium concentrations were only found between wine and non-alcoholic wine and between spirits and water.

32. 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

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

34. Strengths and Limitations

35. 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

36. 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

37. 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

38. All In All The paper finishes with, “More research on this topic is needed.”

39. 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.

40. Conflicts of interest

41. 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.

42. 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/nu9070660. • 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

43. Photos • https://viddyad.com/linkedin-retiring-products-and-services-pages-and-launching-showcase-pages/stockvault-blue-water-texture116093/ • 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://static6.depositphotos.com/1004868/651/i/950/depositphotos_6515776-Doctor-with-thumbs-up.jpg

44. QUESTIONS