Alcohol intake in relation to diet and obesity in women and men13 Graham A Colditz, Edward Giovannucci, Eric B Rimm, Frank E Speizer, Enoch Gordis, and Walter C Willett We studied

ABSTRACT body

mass

in two

index,

cohort

and

studies.

r

decreased

from

1 53

drinking

25.0-49.9

intake

was

due

=

between

in 89 538

Total

(partial

sumption

relations

diet

energy
50 g alcohol/d).

J Stampfer,

48 493

and carbohydrate intake to 13 1 g/d in women

0.001),

g alcohol/d.

alcohol

women

Meir

reports interval.

to the follow-up

ofthis

validity

that

of diagnoses In

1980

a

mailing.

instrument

The participants Introduction

women 1980

and

The relation between light-to-moderate alcohol consumption and body mass index is of interest because alcohol and obesity are both related to risk of important diseases [eg, breast cancer

skin

cancer

(1) and

intakes.

coronary

heart

disease

sociated with altered patterns in the substitution of alcohol

(2)J.

Alcohol

of nutrient for other

intake

intake nutrients.

may

be as-

habits

may have different that these preferences

dietary may

studies,

alcohol

consumption

preferences than alter their dietary

was inversely

related

to body mass index in women (3, 5, 6, 8) but this relation has been less consistently observed in men (5, 8). In several studies, lower intake of carbohydrate was associated with increased alcohol intake (3-5). Most studies that addressed these relations between alcohol intake and specific components of diet have relied on 24-h recall for the assessment of diet (3, 5, 6) and alcohol intake (6), although some studies have used 7-d recall Am

J C/in Nuir

1991;54:49-55.

Printed

in USA.

incomplete

were (1).

who

free

Excluded

returned responses

The protocol

from

cancer,

from the food

or who

this

other

frequency

had

for the Nurses’

than

nonmelanoma

are the 5% of questionnaire with high or low food Study was approved

population

implausibly

Health

Alternatively,

(7).

In previous

women

who

(3, 4), resulting

energy from alcohol may add to that obtained from food sources (5, 6). It has been proposed that men and women who regularly

consume alcohol nondrinkers and

included in the present analysis are the 89 538 responded to the food frequency questionnaire in

who

© 1991 American

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Society

I From the Channing Laboratory, Department ofMedicine, Brigham and Women’s Hospital and Harvard Medical School, Boston; the Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston; and the National Institute on Alcohol Abuse and Al. coholism, Bethesda, MD. 2 Supported by a contract from the National Institute on Alcohol Abuse and Alcoholism; grants CA90356, HL35464, and DK36798 from the National Institutes ofHealth; and the National Institute of Environmental Health Services Research Award 5T32 E507069 from the Harvard School of Public Health (EBR). 3 Address reprint requests to GA Colditz, Channing Laboratory, 180 Longwood Avenue, Boston, MA 02115-5899. Receivediuly5, 1990. Accepted for publication October 4, 1990.

for Clinical

Nutrition

49

50

COLDITZ

by the

Committee

Research

for

Risks

1986

Health when

responded

40-75

y ofsix

podiatrists,

(1 5, 16). This

was longer

Nurses’

Health

Study

for 48 493 men the

and

that

population

and

osteo-

was

weight

used

were

in the

on

recorded

on the baseline

umented

the

substudies

validity

available

in 1986. These

analysis.

The

men

protocol

and

for each

of self-reported

for

weight

to validate

and

height

study.

was

We doc-

in participants

quantify

in

the responses

to

questionnaires. The self-reported weight is with technician-measured weight in both r = 0.97) and men (Pearson r = 0.97) (17).

women (Pearson The self-reported weight and the technician-measured the corresponding

We used

questionnaire

questionnaires

undertaken

the food frequency highly correlated

in women was 65.4 ± 13.3 kg (1 ± SD) weight was 67. 1 ± 12. 1 kg. In men

values

were

Index

(body

Quetelet’s

(in kg) divided

each

79.3

± 10.8

and

index)

mass

by the square

of height

80.4

Alcohol

intake

was recorded

Possible point

over glass),

calculated

as weight

(m) as a measure

of adi-

for frequency

that

from

ranged

to grams

ofalcohol

g ethanol,

one

of liquor

measure

ofwine

(45

search

dietitian

consumed. periods

records

l-wk and

food

responses

related

with

records

(r

for

the intake =

Study,

frequency

questionnaire

were

13.2

and

one

validity

of this

elsewhere

trained

the recording

records

ofall

intake

between

questionnaire.

wine,

of specific

and

0.83

for

the correlation was

liquor

beverages

were

wine,

and Health

diet intake records

The

ques-

highly

as noted

in the

between 0.86

foods

were completed

correlation

frequency

beer,

0.80

cor-

in the diet for

liquor)

Professionals

diet records

and food

(18).

Total energy intake was calculated as the sum ofenergy fat, protein, carbohydrate, and alcohol. We also calculated energy

from

food,

trients

were

derived

ie, excluding from

the

(1,

by a re-

for total alcohol was 9.0 g/d from diet

of 130 participants

Follow-up

The

=

questionnaire

0.8 1 for beer,

(1 1). In a sample

and

1 y. The

was 0.90. The mean alcohol and 9.0 g/d from the food tionnaire

drinks

mL)

in detail

Weighed-diet

frequency

on a 9-

10.8 g ethanol,

=

Participants

during

were

We converted

was recorded as part of the questionnaire in 173 participants

in the use ofscales

for four

of intake

beer(360

was reported

Study.

and beverages

one

mL)

consumption frequency

Health

beverage

6/d.

15. 1 g ethanol.

=

intake

18). Briefly, alcohol validation ofthe food Nurses’

to

(120

mL)

of alcohol

in the

of each

never

per day as follows:

glass

frequency

preceding year: beer (one bottle or liquor, eg, whiskey, gin (one drink).

responses scale

drink

as the average

the and

energy responses

to

about

from

alcohol.

to the

food

in 1980 for women in the for the Health Professionals

past, and never; 1- 14, 1 5-24, and

sumption

and

each

level

body

mass

higher

intakes

index,

Because

cigarette

never

by

using

intake, regression

Because

of the cohorts

are adjusted with

the

differ,

to the mean

index

mass

50 y of age

for

energy

0.5 to all scores.

models

for men

estimated

age,

scores were skewed toward variables in our com-

distributions

45 y of age with a body and

were for

smoking,

we added

index

mass

regression

for women

nutrients

adjusted

nutrient-intake we used lo&-transformed

ofthese

who

and

for saccharin,

age and body

smoked

intake,

most

values,

putations; results

of various

of alcohol

age, cigarette women and both alcohol correlations candy con-

the

values

of 23 who never

a body

mass

index

of 25

smoked.

Results

± 1 1.7 kg.

posity. of each beverage can), wine (one

added

was asked

We explored the cross-sectional relations between smoking, body mass index, and alcohol intake in men. Because cigarette smoking is correlated with intake and with body mass index, we report partial adjusted for age and cigarette smoking. Sugar and

models.

recorded

of sugar

which

Analysis

measures was

of teaspoons

tea, cereal),

25 cigarettes/d.

Health.

Weight

number

coffee,

33%

the Health Professionals Follow-up Study was approved by the Human Subjects Committee of the Harvard School of Public

Exposure

the

Cigarette smoking was ascertained Nurses’ Health Study and in 1986

a detailed

the one

data

current

and

(including

Follow-up Study and was defined as current, current smokers were categorized as smoking

(dentists, and

included

than

dietary

for the

in

study of diet and health. ofthe dietary questionnaire,

Height

provided

established

at enrollment

detailed

in 1980.

who

was professions

response

more

questionnaire

food daily

optometrists,

invited into this long-term ofthe continued refinement

form

form

aged

for

Hospital.

Study

to a questionnaire

ofdiet

of those Because this

men

Subjects

AL

separately.

Follow-up

pharmacists,

assessment

Women’s

Study

Follow-up

51 529

of Human

and

Professionals

veterinarians, paths)

Protection

Brigham

Health Professionals The

the

of the

ET

from total

Other frequency

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nu-

Age

In women we observed little relation between age and alcohol intake although there was a slight trend for older women to drink

25 g/d.

Overall,

32%

of women

were

abstainers,

consumed 0.01-4.9 g alcohol/d, 20% consumed 7% consumed 1 5.0-24.9 g/d, and 6% consumed

(Table I). In men, heavier alcohol age up to 65 y, and then decreased. of abstinence

was

relatively

consumption In contrast,

constant

up

34%

5.0-14.4 25.0-49.9

g/d, g/d

increased with the prevalence

to age

65 y and

then

increased. Cigarette

smoking

We observed smokers

a strong

between

the

relation amount

of

in women

who

alcohol

consumed

were

current and

the

P < 0.001). After adjusting for age and alcohol intake, the partial correlation for cigarette smoking and body mass index was -0.08, P < 0.001. Women smoking 15-24 cigarettes/d, for example, had a signifnumber

icantly

of cigarettes

lower

smoked

body

mass

(Spearman

index

that

r

was

=

0.21,

0.7

less

than

never

smokers after adjusting for age and alcohol intake. Only 10% of men in this study currently smoked cigarettes. Among the current smokers, alcohol intake was only slightly positively related to number of cigarettes smoked (Spearman r = 0.03, P = 0.05), and body mass index was also slightly positively related to number of cigarettes smoked (Spearman r = 0.04, P = 0.03). Men smoking 15-24 cigarettes/d, for example, had a body mass index that

was 0. 1 3 less than

alcohol

intake.

Mean

alcohol

intake,

varied

smoked

per

day

within

never

smokers

body

mass

little

after index,

by categories current

smokers.

adjusting adjusted ofnumber Past

for age and for

age

and

of cigarettes smokers

had

a

ALCOHOL TABLE Number

AND

OBESITY

I

of part icipants

(and

percent

f age group),

by alcoh ol intake

and age in 89 538 United Daily

Age

0 g/d

Women 34-39y 40-44 45-49 50-54 55-59 Men 40-44 45-49 50-54 55-59 60-64 65-69 70-75y

mean

y y y y

g/d

5.0-14.9

2452 (23.5) 1624 (22.9) 1657 (22.7) 1668 (22.9) 1685 (23.3) 1469 (26.2) 964(27.1)

2837 (27.2) 1833 (25.9) 1754 (24.1) 1602 (22.0) 1551 (21.4) 1288 (23.0) 836(23.5)

2848 (27.3) 1859 (26.3) 1890 (25.9) 1913 (26.3) 1896 (26.2) 1306 (23.3) 789(22.2)

1 157 (1 1.1) 822 (1 1.6) 898 (1 1.3) 937 (12.9) 881 (12.2) 661 (1 1.8) 408(11.5)

index

slightly

greater

than

that

of

never

in abstainers

index

age and

cigarette

relation was

between

observed

smoking,

index.

In men,

=

to 25.9

body

index

varied

mass for

There

little

was

a

level of in body

across

levels

-0.01, P = 0.01). The mean body men who drank only beer and for

for men

for men consuming index rose slightly from

drinking

only 25.5

Total in women

intake energy (partial

kJ/d,

whereas intake

50 g/d

115 124 169 166 124

women

g alcohol/d 50 g/d

had had

kJ/d,

=

(0.7) (0.9) (0.9) (1.0)

25.0-

and

of 8412.4 relation

intake (partial r in abstainers was

alcohol intake

(0.5)

274 (2.4) 221 (3.1) 271 (3.7) 300 (4.1) 295 (4.1) 205 (3.7) 129(3.6)

consuming

of 7035.8

50 g/d had a mean intake an even more pronounced

women

Id. In men, of increased

0. 19, P < 0.001). 7575.6 kJ/d. Men

a mean a mean

intake intake

of 8583.1 of 9821.5

kJ/d. When we examined energy intake without the contribution ofalcohol, we observed a small inverse relation between alcohol intake and energy intake in women but not in men (Fig 2). As with body mass index, there was a suggestion in women of a U-shaped distribution. cohol decreased with

In women, higher alcohol

energy intake

intake excluding alfrom 6276 Id in non-

drinkers to 5938.4 Id in women consuming 25.0-49.9 g/d, but then increased to 636 1 LI for women consuming > 50 g (overall r

P

-0.03,

=

association Energy

g/d

908 (8.7) 724 (10.2) 824 (1 1.3) 852 (1 1.7) 926 (12.8) 675 (12.0) 426(12.0)

a mean

consuming 25.0-49.9 U and men consuming

partial

50 g ethanol/d.

25.0-49.9

977(4.4) 1230 (8.7) 1297 (7.0) 1340 (7.4) 879 (7.3)

6276 had

energy intake with The mean energy

among

adjustment

0.001).