Contexte: Le cancer de l'ovaire est le cancer gynécologique le plus meurtrier chez les Canadiennes. Compte tenu de son mauvais pronostic et de ses méthodes de dépistage précoce limitées, il est nécessaire de mener des recherches pour identifier les facteurs susceptibles d'empêcher le cancer de l'ovaire de se développer. L’alcool est un facteur de risque pour de nombreux cancers, mais sa relation avec le cancer de l’ovaire demeure floue. Nous avons décidé d’étudier la relation entre la consommation d'alcool au cours de la vie et le risque de cancer de l'ovaire. Méthodes: Dans une étude cas-témoins basée sur la population à Montréal (2011-2016), 497 cas et 904 témoins ont rapporté leur consommation au cours de leur vie de vin rouge, de vin blanc, de bière et de spiritueux, ainsi que d'autres variables. Pour la consommation totale d'alcool et pour chaque type d'alcool spécifique, les rapports de cotes ajustés (OR) et les intervalles de confiance (IC) à 95% pour l'association avec le risque de cancer de l'ovaire ont été estimés à l'aide de la régression logistique inconditionnelle. Résultats: Le lien entre la consommation totale d'alcool au cours de la vie et le risque de cancer de l'ovaire explicitait une relation en forme de U: comparées à celles qui n'ont jamais bu, l’OR (IC à 95%) était de 0,72 (0,52-0,99) pour les participantes qui buvaient >0 à <1 consommation par semaine, de 0,83 (0,61-1,15) pour 1 à <3 consommations/semaine et de 0,98 (0,72-1,33) pour ³3 consommations/semaine. Une relation en forme de U a été suggérée pour la consommation de bière et de spiritueux au cours de la vie, mais les OR étaient plus proches de la valeur nulle. Les analyses par comportement tumoral ont suggéré que la consommation totale d'alcool au cours de la vie était associée à un risque réduit de cancer de l'ovaire invasif, mais à un risque accru de cancer de l'ovaire limite. Une tendance similaire a été observée pour la consommation de bière, mais pas pour les spiritueux, le vin rouge ou le vin blanc. Conclusion: La consommation d'alcool pourrait être associée de manière non linéaire au cancer de l'ovaire et cette association pourrait varier en fonction du comportement tumoral. / Background: Ovarian cancer is the deadliest gynecological cancer among Canadian women. Given its poor prognosis and limited methods of early detection, research is necessary to identify factors that may prevent ovarian cancer from occurring in the first place. Alcohol is a risk factor for many cancer sites, but its relationship with ovarian cancer remains unclear. We investigated the relation between lifetime alcohol consumption and ovarian cancer risk. Methods: In a population-based case-control study in Montreal (2011-2016), 497 cases and 904 controls reported their lifetime consumption of red wine, white wine, beer and spirits and other variables. For total alcohol intake and each specific alcohol type, adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association with ovarian cancer risk were estimated using unconditional logistic regression. Results: The association between lifetime total alcohol intake and ovarian cancer risk was U-shaped: compared to lifetime never drinkers, the OR (95% CI) was 0.72 (0.52-0.99) for drinking >0 to <1 drink/week, 0.83 (0.61-1.15) for 1-<3 drinks/week and 0.98 (0.72-1.33) for 3+ drinks/week. A Ushaped relationship was suggested with lifetime consumption of beer and spirits but ORs were nearer the null value. Analyses by tumour behaviour suggested that lifetime total alcohol intake was associated with a reduced risk of invasive ovarian cancer but an increased risk of borderline ovarian cancer. A similar pattern was observed for intake of beer, but not spirits, red or white wine. Conclusion: Alcohol consumption may be non-linearly associated with ovarian cancer and the association may vary by tumour behaviour.

Women are a particularly vulnerable group when it comes to victimization while intoxicated. Personality traits and characteristics have been shown to have an impact on alcohol consumption. Previous research regarding the Big Five Personality Traits indicates higher drinking levels if a person scores high within “Extraversion” and “Neuroticism”, or scores low within the traits of “Agreeableness” and “Conscientiousness”. Concerning women, “Openness” seems to be the only personality related to alcohol consumption, but previous research is scarce. The main focus of previous research has been on the Big Five Personality Traits, people in general and alcohol consumption. Our focus was Swedish women, age range 18-50 years. We proposed that personality traits could affect alcohol consumption and because of the lack of research we specifically wanted to examine women. The results showed that personality traits have an impact on women’s alcohol consumption. In conclusion, women tend to drink more alcohol if they score high on “Extraversion” and “Neuroticism”, and, if they scored low on “Agreeableness” and “Conscientiousness”. This could mean that personality traits serves as risk factors for alcohol consumption. “Openness” and alcohol consumption showed no association. Future research should investigate how other factors combined with personality traits might affect alcohol consumption. / Kvinnor är en extra utsatt grupp när det kommer till viktimisering i samband med alkoholkonsumtion. Fortsättningsvis, vissa personlighetsdrag och karaktärsdrag har visats påverka alkoholkonsumtion. Tidigare forskning gällande Big-Five-teorin och dess personlighetsdrag indikerar vanligtvis högre nivåer av alkoholkonsumtion om en person skattar högre inom dragen “Utåtriktning” och “Känslomässig instabilitet”, eller skattar lägre inom dragen “Vänlighet” och “Målmedvetenhet”. Gällande kvinnor, draget “Öppenhet” verkar vara det enda som är kopplat till alkoholkonsumtion, men tidigare forskning är begränsad. Huvudfokuset inom tidigare forskning har varit på Big-Five-teorin, människor överlag och alkoholkonsumtion, vi ville därmed specifikt undersöka kvinnliga vanor. Vårt fokus har legat på svenska kvinnor i åldrarna 18- 50 år. Vi menade att personlighetsdrag kunde ha en påverkan på alkoholkonsumtion och ville undersöka specifikt kvinnor vad gäller detta då befintlig forskning ansågs bristfällig. Resultatet visade att olika personlighetsdrag påverkar alkoholkonsumtionen hos kvinnor. Sammanfattningsvis, kvinnor tenderar att dricka mer alkohol om de skattar högt inom “Utåtriktning” och “Känslomässig instabilitet”, och om de skattar lågt inom “Vänlighet” och “Målmedvetenhet”, vilket skulle kunna innebära att olika personlighetsdrag fungerar som riskfaktorer för alkoholkonsumtion. Dock visade “Öppenhet” inte på något samband med alkoholkonsumtion. Framtida forskning bör undersöka hur eventuellt andra faktorer kombinerat med personlighetsdrag kan ha en effekt på alkoholkonsumtion.

Orientador: Ana teresa de Abreu Ramos-Cerqueira / Resumo: Transtornos Mentais Comuns (TMC) e uso de risco de álcool entre estudantes universitários vêm sendo foco de pesquisas, sendo ainda raros os estudos com alunos de graduação em odontologia. O objetivo desta pesquisa foi investigar a prevalência de TMC e do uso de risco de álcool e suas associações com as características sociodemográficas, de saúde, relacionais, do ambiente acadêmico, de estratégias de enfrentamento e resiliência entre estudantes do curso de Odontologia da Universidade Estadual de Campinas - UNICAMP. Neste manuscrito, estão apresentados três estudos que representam os resultados obtidos: uma revisão integrativa sobre o tema e dois estudos empíricos que focalizaram dois diferentes desfechos: TMC e uso de risco de álcool em estudantes de odontologia. A revisão investigou, em pesquisas publicadas entre 2006 e 2016, fatores de risco e proteção para sofrimento psíquico de estudantes universitários. Os estudos empíricos utilizaram delineamentos transversais, descritivos e analíticos. A amostra nesses estudos foi composta por 230 alunos, 71,8% dos estudantes matriculados nos quatro anos do curso de odontologia. Foram aplicados formulário padronizado para caracterização da amostra e seis instrumentos que investigaram: Transtorno Mental Comum (Self Repporting Questionnarie-20 – SRQ-20), uso de risco de álcool (Alcohol Use Disorder Identification Test-AUDIT), apoio social (Escala de Apoio Social, do Medical Outcomes Study-EAS), percepção do ambiente educacional (Dundee Re... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor

This diploma thesis Family environment and adolescent alcohol consumpiton deals with a relationship between four dimensions of family environment and alcohol consumption of sixteen years old adolescents. These four dimensions are leisure time, family structure, parenting style and socioeconomic status. In the theoretical part family influence on child's development is described and then socialization process through which family influence child's development is delimited. Further, the relationship between family environment and alcohol consumption is discussed and then four dimensions of family environment are characterized in context of alcohol consumption. Relationship between family environment and alcohol consumption was studied using mixed research design. In the main quantitative part of the thesis general relationships between chosen dimensions of family environment and alcohol consumption indicators were examined using data from European School Project on Alcohol and Other Drugs (ESPAD) from the year 2007. Then a typology of adolescent alcohol consumers was made. Results of this part continued in the qualitative part. There ten semistrctured interviews were made to examine deeper connections and direction of relationships discovered in the quantitative data analysis. This part was primarily...

The thesis "Anti-alcohol Campaigh in the Soviet Union in the years 1985 - 1988" analyzes the various aspects of development and measures used to combat alcoholism , which were adopted in May 1985. This included, for example, significant reduction of the production and sale of alcoholic beverages and a variety of promotional tools. Chronologically, the main emphasis is on the period when the campaign took place. To clarify the context of the issue is also included a brief excursion to the roots of Russian alcoholism, which dates back to the Middle Ages. The situation after the introduction of the campaign is tracked within the Soviet Union, emphasis is placed on development of the policy within the nation's center. Concerning the severe economic impact of the measures adopted and the high level of public discontent alcohol program was eventually canceled. For these reasons, it is often interpreted as a failure. The main goal of the thesis is to assess the possibility of some successes and campaign evaluation, provided that the leaders of the Soviet Union, who prepared it, might have been aware of the contradiction between the stated objectives and actual results subsequent campaigns.

Background: Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors. Methods: A total of 3,189 non-demented, multi-morbid participants aged 65–85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted. Results: About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model. Conclusions: Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.

Introduktion: Alkoholkonsumtion har stor hälsopåverkan på världens befolkning, regelbundet intag av alkoholhaltiga produkter ökar risken för både sjukdom och skada. Utgifterna år 2017 i Sverige relaterade till alkoholkonsumtion var cirka 103 miljarder svenska kronor. Arbetsplatsen är arenan där vuxna befolkningen kan nås av hälsofrämjande åtgärder. Syfte: Identifiera tänkbara preventiva åtgärder för arbetsgivare gällande riskbruk av alkohol hos medarbetare. Metod: Strukturerad litteraturstudie där sökning organiserades i sökblock. Artiklarna kvalitetsgranskades och analyserades utifrån mallen för systematisk textkondensering. Utifrån analysen kodades och kategoriserades artiklarna. Resultat: Nio artiklar valdes och inkluderades i resultatet. Utifrån analysen fanns tre huvudkategorier: psykologiska faktorer, screening och hälsobeteende. Screening hade underkategorin preventiva åtgärder efter screening. Screening i kombination med att förebygga negativa psykologiska faktorer minskade alkoholintaget hos medarbetarna. Psykologiska faktorer var hörnstenen i alkoholkonsumtionen hos medarbetarna, viktigaste psykologiska faktorn var att skapa en känsla av psykologisk trygghet hos medarbetarna. Hälsobeteenden innebar att bryta vanor och erbjuda gruppdiskussioner för medarbetarna där information om hälsorisker förmedlades. Slutsats: För att kunna arbeta preventivt bör arbetsgivarna kombinera flertal preventiva åtgärder för bästa utfall. Inkludering av informationskommunikation kring hälsorisker vid riskkonsumtion av alkohol bör ske kontinuerligt. Screening bör genomföras för att i ett tidigt stadie fånga upp medarbetare som har ett riskbruk av alkohol. Individuellt anpassade preventiva åtgärder bör ske för de individerna med riskbruk av alkohol. Det är viktigt att arbetsgivaren tar hänsyn till de psykologiska faktorerna som kan spela en avgörande roll i det preventiva arbetet. / Introduction: Alcohol consumption has a significant impact on the health of the global population, with regular alcohol intake increasing the risk of both illness and injury. In 2017, expenditures related to alcohol consumption in Sweden amounted to 103 billion Swedish kronor. The workplace serves as a crucial arena for implementing health-promoting measures. Objective: To identify potential preventive measures for employers regarding alcohol misuse among employees. Method: A structured literature review with searches organized into searchblock. All articles were quality-reviewed and then analyzed using the systematic textcondensation method. The articles were coded and categorized based on the analysis. Results: Nine articles were selected and included in the results. Three main categories emerge from the analysis: psychological factors, screening, and health behaviour. There was a subcategory: preventive measures following screening. Screening, combined with addressing negative psychological factors, reduced alcohol intake among participating employees. Psychological factors were foundational in employee alcohol consumption, with the key psychological factor being the ability to create a sense of psychological safety among employees. Health behaviours involved breaking habits and offering group discussions for employees, providing informationon health risks. Conclusion: To work preventively, employers should combine multiplepreventive measures for optimal outcomes. Continuous communication of information on health risks related to alcohol misuse is essential. Screening should be conducted to identify employees with alcohol misuse at an early stage. Individually tailored preventive measures should be implemented for those with alcohol misuse. Employers should also consider psychological factors, which play a crucial role in preventive efforts.

This study explores how socioeconomic status influences lifestyle choices and chronicdiseases in Sweden. It investigates prevalent chronic diseases across different socio economicgroups and assesses policy interventions to address disparities. Theoretical frameworks suchas chronic disease prevention, health lifestyle and fundamental causes theories inform theanalysis. The method of this study is used to gather and analyse sensory data for the study. Itdescribed the systematic search for relevant articles, inclusion and exclusion criteria, dataextraction and thematic analysis. Ethical considerations are also addressed and maintained.The results highlighted socioeconomic disparities in lifestyle and chronic disease burden inSweden and other countries. The results show varying impacts in health behaviours andoutcomes based on socioeconomic status, emphasising on the need for targeted interventionwhich address preventable health conditions. The discussion of the study provides a detailedinterpretation of the results by linking theories and methods used.

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015