No abstract

Data from the first National Health and Nutrition Examination Survey (HANES I) were analyzed for differences in nutrient intakes based on the amounts of alcohol consumed by US adults, and for relationships between alcohol consumption, calorie intake, and relative body weight. Drinkers had significantly higher intakes of total calories than nondrinkers, but only because of their intakes of alcoholic calories. Among drinkers, the intakes of nonalcoholic calories decreased as alcohol intakes increased, and it was estimated that between 15 and 41% of the alcoholic calories replaced nonalcoholic calories. Despite their higher caloric intakes, drinkers were not more obese than nondrinkers, suggesting that alcoholic calories may be less efficiently utilized than nonalcoholic calories, or may interfere with utilization of nonalcoholic calories. The most salient difference in nutrient intake between drinkers and nondrinkers was the substantially lower carbohydrate intake of drinkers.

The role of body fat distribution, as assessed by the ratio of waist-to-hip circumferences (WHR), in statistically explaining differences in levels of lipoproteins between men and women was studied using data collected in [1985][1986] (Circulation 1990;81:1498-1506 W omen in Westernized countries have a much lower incidence of coronary heart disease than do men.1'2 Determinants of this sex differential have recently received increased attention,3,4 and evidence suggests that it might be, in part, because of male/female differences in levels of lipids and lipoproteins. Although the standard risk factors for coronary heart disease are at least as important among women as men,25 relatively low levels of triglycerides and high levels of high density lipoprotein (HDL) cholesterol might protect most women from developing extensive atherosclerosis.

The degree of coronary artery occlusion was compared between users and nonusers of postmenopausal estrogen among 933 female patients undergoing angiography between the ages 50 and 75 years in the Milwaukee Cardiovascular Data Registry. Users (n = 154) had less occlusion than nonusers (n = 779), and a significant increase in occlusion scores with age was evident for nonusers (p less than 0.001) but not for users (p = 0.50). The age-adjusted odds ratios for use of postmenopausal estrogen among women with moderate and severe levels of occlusion of the coronary arteries were 0.59 (95% confidence interval, 0.48 to 0.73) and 0.37 (95% confidence interval, 0.29 to 0.46), respectively, which indicated a statistically significant, apparent protective effect of postmenopausal estrogen on coronary occlusion. This effect was independent of the type of menopause or other risk factors but not independent of high-density lipoprotein-cholesterol levels. Higher high-density lipoprotein-cholesterol levels among users may indicate a biologic mechanism by which postmenopausal estrogen use lowers the risk of coronary occlusion.

The relation of body fat distribution as measured by the ratio of waist to hip circumferences (WHR) to plasma levels of lipids and lipoproteins was studied In 713 men and 520 women who were employed by two Milwaukee companies. Quetelet Index (kg/m 2 ), waist girth, hip girth, and WHR were each positively related to levels of total cholesterol, trlglycerldes, apollpoproteln B, and the ratio of total to high density llpoproteln (HDL) cholesterol. In addition, the anthropometrlc measures were Inversely associated with levels of HDL cholesterol. (Controlling for age, alcohol intake, exercise level, current smoking status, and oral contraceptive use only slightly reduced the strength of the correlations.) In addition, WHR and Quetelet Index were Independently related to llpld and llpoproteln levels, and the magnitudes of the associations were roughly equivalent For example, the mean (covarlate-adjusted) trlglycerlde level among men In the upper tortile of the Quetelet Index was 37 mg/dl higher than for men in the lower tertlle of the Quetelet Index; the corresponding difference according to WHR tertlles (upper to lower) was 39 mg/dl (p<0.01 for both effects). These findings Indicate that In healthy men and women a less favorable lipid and llpoproteln profile Is associated with elevated levels of both Quetelet Index and WHR.