Alcohol consumption in the

Greek population: is it related

to abdominal obesity?

M. Kaklamanou, D. Kaklamanou, I. Ioannidis, C. Loupa, E. Kapantais

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the

Prevalence of Obesity in Greek Adults

2

Introduction I

The metabolic syndrome is characterised by a group of metabolic risk factors. They include:

Central obesity

Atherogenic dyslipidemia

Raised blood pressure

BMI is a tool for measuring obesity, but when

measuring abdominal obesity waist-to-hip ratio

and waist circumference are used

In this study waist-to-hip ratio measurements were used

http://www.mayoclinic.com/

George A. Bray, Claude Bouchard, W.P.T. James; Handbook of Obesity, Marcel Dekker, New York, 1998

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

Insulin resistance

Prothrombotic state

Proinflammatory state

3

Introduction II

Chronic alcohol consumption has both

adverse effects (e.g. hypertension,

cardiomyopathy and liver cancer, etc.)

beneficial effects (the French paradox, etc.)

http://www.mayoclinic.com/

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

4

Aim of this study

is to explore a potential relation of alcohol

consumption to abdominal obesity

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

5

Patients / Sample

The data analysed were

obtained from the first

national epidemiological

large scale survey on

the prevalence of

obesity in Greek adults,

conducted by the Hellenic

Medical Association for

Obesity.

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

6

First national epidemiological

survey on the prevalence of

obesity in Greece

Public schools throughout Greece were

randomly chosen and questionnaires were

filled by the students and all the members of

their households

The subpopulation used in the adult

HMAO study were Greek men and women,

20 to 70 years old

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

7

Methods I

WHR was calculated from waist and hipcircumference and the following categories wereused:

SPSS version 12.0 was used for statistical analysis, student’s t-test and non parametric tests were used

Normal

Pathologic

<1.00 <0.85

>1.00 >0.85

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

http://www.eiep.gr/

8

Methods II

Alcohol consumption was calculated by adding the number of units consumed weekly, multiplied by the alcohol comprehensiveness of beverages (in this case beer, wine, whiskey and liqueur). The following categories were applied:

0 mg <50 mg50 - 150 mg150 - 300 mg>300 mg

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

moderate alcohol consumption

heavy alcohol consumption

no alcohol

9

Results

8090 men, age 44.6+10.5 years (x+SD),

and 9313 women, 41.5+11.1 years,

were included

WHR was 0.97+0.3 and 0.87+0.3 in

men and women, respectively

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

10

Waist-to-hip ratio

in men and women

67,8

32,2

57,7

42,3

0%

20%

40%

60%

80%

100%

men women

Above normal

values (>1,00 in

men and >0,85 in

women)

Normal w/h (<1,00

in men and <0,85

in women)

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

11

How much alcohol do

men drink?

21,5

31,2

12,85,9

28,6

no alcohol

<50 mg

51-150 mg

151-300 mg

>300 mg

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

%%

%

%

%

12

How much alcohol do

women drink?

10,0 1,2 0,3

54,633,9

no alcohol

<50 mg

51-150 mg

151-300 mg

>300 mg

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

%

%%

%

13

In men, WHR was associated to alcohol

consumption (Kendall’s tau-b, p=0.044,

statistically significant)

This was not the case with women

(p=0.823, N.S.)

Results

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

14

Waist-to-hip ratio varies with alcohol

consumption in men and women

p=0.044 , p=0.823, Kendall’s tau-b

0,75

0,8

0,85

0,9

0,95

1

1,05

no alcohol <50 mg 51-150 mg 151-300

mg

<300 mg

Alcohol consumption

Wa

ist-t

o-h

ip r

atio

men

women

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

15

Waist-to-hip ratio Vs alcohol

consumption in men

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

0,8

0,85

0,9

0,95

1

1,05

no alcohol <50 mg 51-150 mg 151-300

mg

<301 mg

Alcohol consumption

Wai

st-t

o-h

ip r

atio

in

20-35 yrs

35-50 yrs

>50 yrs

16

Waist-to-hip ratio Vs alcohol

consumption in women

0,7

0,8

0,9

1

1,1

1,2

no alcohol <50 mg 51-150 mg 151-300

mg

<301 mg

Alcohol consumption

20-35 yrs

35-50 yrs

>50 yrs

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

Wais

t-to

-hip

rati

o

17

Waist-to-hip ratio compared

with consumption of specific

types of alcohol

0,99

0,88

0,96

0,87

0,98

0,90

0,97

0,89

0,80

0,85

0,90

0,95

1,00

only beer only wine only liquer only whiskey

Men

Women

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

Wa

ist-

to-h

ip r

ati

o

Alcohol consumption

18

Conclusions I

In the Greek population, men drink

more alcohol than women

Women are more likely to have

abnormal WHR than men

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

19

Conclusions II

In addition to the effects of alcohol

consumption to risk factors of various

diseases, alcohol is related to

abdominal obesity in men only

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

20

Discussion I

Jequier introduced the alcohol paradox,

which suggests increased alcohol induced

energy intake without weight gain

Other studies suggest that alcohol intake

promotes leanness in women , but not in men

This study shows that there is an association

between waist-to-hip ratio to alcohol

consumption in Greek men, but not in Greek

women

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

Am J Epidemiol 1991;133:810-817

American Journal of Clinical Nutrition, Vol. 69, No. 2, 173-174, February 1999

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Discussion II

A survey conducted in Japan, which

studied male self-defense officials,

showed that alcohol consumption is

strongly and independently associated

with waist-to-hip ratio in men

Eur J Epidemiol. 1997 Dec;13(8):893-8

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

22

Discussion III

Simply looking at the total quantity of alcohol consumed over time obscures the importance of the pattern of alcohol consumption. 1-2 drinks each day is associated with better health and greater longevity whereas consuming the same quantity (7-14 drinks) once a week is associates with negative health. The same quantity of alcohol can have either beneficial or harmful consequences depending on the pattern of its consumption.

National Health Interview Study (NHIS), American Journal of Epidemiology

Hellenic Medical Association for Obesity (HMAO), Athens, Greece

First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults