Alcohol's impact on food consumption - Food and Health - Brief Article

Nutrition Research Newsletter, Oct, 2001

The consequences of alcohol consumption have been extensively studied, with varying results. Moderate alcohol consumption (one to two drinks per day) has been shown to beneficially affect life expectancy, likely through the protective effect on coronary artery disease as mediated by an increase in HDL-cholesterol. This effect is independent of the type of alcoholic beverage consumed. For cancer, however, there is strong evidence that a high alcohol intake is a strong risk factor for cancer of the mouth, pharynx, larynx, esophagus, and liver. But moderate consumption of wine was related to lower risk of cancer death in a recent study. The most important confounding factor in epidemiologic studies is cigarette smoking, which in many studies has shown a correlation with alcohol consumption. The potential confounding role of dietary habits in the study of alcohol consumption and health, is unclear and in need of further evaluation.

In order to determine whether eating habits differ significantly according to the level of alcohol consumption, and whether the dietary correlates of alcohol consumption offer health benefits or disadvantages according to the level of alcohol consumption, French researchers analyzed data from participants in the French cohort of the European Prospective Investigation into Cancer and Nutrition. The cohort included 100,000 women aged 40-65 years who are covered by the French national teachers' health insurer. The dietary questionnaire was sent to the participants between June 1993 and July 1995. It contained two parts and was sent with a booklet of photos to facilitate the estimation of portion sizes. The first part was intended to analyze the frequency of 66 food groups. The second part included qualitative questions. Overall, the questionnaire covered the daily consumption of greater than 230 food items. Alcohol consumption was translated into daily amounts of ethanol. Subjects were placed into seven categories according to their daily alcohol consumption, ranging from nondrinkers to heavy drinkers (>32 g ethanol/day).

Approximately 72,900 completed questionnaires were used in the analysis. The mean amount of ethanol consumed was 10.5 g/day. The median value was 5.8 g/day. About 12.6% of women were nondrinkers while 7.0% were considered heavy drinkers. Wine was the most commonly consumed alcoholic beverage. The principal components analysis found food items that were associated with increasing alcohol consumption. Intakes of cheese, processed meat, seafood, vegetable oil, poultry, coffee, potatoes, eggs, and lamb were positively correlated with alcohol consumption. Intakes of soup, yogurts, vegetables, and fruit were negatively correlated with alcohol consumption. Energy intake increased significantly with alcohol consumption. Energy intake was 29.5% higher in heavy drinkers than in nondrinkers. When energy from alcohol was excluded, energy intake for heavy drinkers remained 12.4% higher than in nondrinkers. The percentage of energy from carbohydrates significantly fell as alcohol consumption increased. However, the percentage of energy from lipids increased with increasing alcohol consumption. Consumption of polyunsaturated fatty acids, saturated fatty acids, and monounsaturated fatty acids was higher in heavy drinkers than in nondrinkers. Cholesterol intake was 31.6% higher in heavy drinkers than in nondrinkers. Intakes of retinol, vitamin E, and iron increased while intake of [beta]-carotene decreased with alcohol consumption.

This study demonstrates that significant differences in nutrient intake and food consumption are present at varying degrees of alcohol consumption in middle-aged, educated women. The majority of differences noted in heavy consumers of alcohol, such as the increase of fat, represent negative health practices in and of themselves. Part of the detrimental effect of alcohol on health may be due to the less-healthy dietary habits of drinkers.

E. Kesse, F. Clavel-Chapelon, N. Slimani, et al. Do eating habits differ according to the alcohol consumption? Results of a study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC). Am J Clin Nutr; 74:322-327 (September 2001) [Correspondence: F. Clavel-Chapelon, INSERM U521, Equipe E3N, 39 rue Camille Demoulins, 94805 Villejuif Cedex, France. E-mail: clavel@igr.fr].