Alcohol consumption and changes in blood pressure among African Americans. The Pitt County Study

Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies

BACKGROUND

Alcohol consumption may increase blood pressure but the details of the relationship are incomplete, particularly for the association at low levels of alcohol consumption, and no meta-analyses are available for nonexperimental cohort studies.

METHODS

We performed a systematic search of longitudinal studies in healthy adults that reported on the association between alcohol intake and blood pressure. Our end points were the mean differences over time of systolic (SBP) and diastolic blood pressure (DBP), plotted according to baseline alcohol intake, by using a dose-response 1-stage meta-analytic methodology.

RESULTS

Seven studies, with 19 548 participants and a median follow-up of 5.3 years (range, 4-12 years), were included in the analysis. We observed a substantially linear positive association between baseline alcohol intake and changes over time in SBP and DBP, with no suggestion of an exposure-effect threshold. Overall, average SBP was 1.25 and 4.90 mm Hg higher for 12 or 48 grams of daily alcohol consumption, compared with no consumption. The corresponding differences for DBP were 1.14 and 3.10 mm Hg. Subgroup analyses by sex showed an almost linear association between baseline alcohol intake and SBP changes in both men and women, and for DBP in men while in women we identified an inverted U-shaped association. Alcohol consumption was positively associated with blood pressure changes in both Asians and North Americans, apart from DBP in the latter group.

CONCLUSIONS

Our results suggest the association between alcohol consumption and SBP is direct and linear with no evidence of a threshold for the association, while for DBP the association is modified by sex and geographic location.

Alcohol Consumption and Systemic Hypertension (from the Third National Health and Nutrition Examination Survey)

Epidemiological studies have established the association between excessive alcohol consumption and systemic hypertension (SH). However, there are conflicting reports of the association of low to moderate alcohol consumption with SH. The objective of the study was to examine the associations of alcohol consumption and blood pressure categories using the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines. This analysis included 17,059 participants from the Third National Health and Nutrition Examination Survey. Alcohol consumption was ascertained by way of a questionnaire. Blood pressure (mm Hg) was measured during the in-home interview and the participant's visit to the mobile examination center. We used multivariable logistic regression models to examine cross-sectional associations of alcohol consumption and blood pressure categories based on new American College of Cardiology/American Heart Association High Blood Pressure guidelines. Models were adjusted for age, gender, income, and cardiovascular risk factors. Compared with never drinkers, moderate drinkers (7 to 13 drinks/week) had increased odds of prevalent stage 1 and stage 2 SH (odds ratio [95% confidence interval] 1.51 [1.22 to 1.87] and 1.55 [1.20 to 2.00]). Similarly, there were significantly higher odds of prevalent stage 1 and stage 2 SH among heavy drinkers (≥14 drinks/week) (odds ratio [95% confidence interval] 1.65 [1.33 to 2.05] and 2.46 [1.93 to 3.14]). We did not find any association between alcohol consumption and elevated blood pressure category. Response bias must be considered because alcohol consumption was self-reported. Our study indicates the need for further research to understand the potential mechanisms by which alcohol consumption increases the risk of SH. In conclusion, this analysis from a population-based survey showed an association between moderate and heavy alcohol consumption and a higher prevalence of SH.

A Randomized Trial of Home Blood-Pressure Reduction by Alcohol Guidance During Outpatient Visits: OSAKE Study

BACKGROUND

To evaluate the effectiveness of the nurse-led alcohol guidance to control home blood pressure (HBP) in the morning among male patients with hypertension during outpatient visits.

METHODS

We enrolled 53 male patients with an HBP of ≥135/85 mm Hg with excessive drinking (alcohol ≥210 g/week or ≥60 g/day habitually) among outpatients in a randomized trial. Patients were assigned to a nurse-led alcohol guidance intervention or to the control. The primary outcomes were the mean HBP of 5 consecutive days at 6 months and alcohol consumption.

RESULTS

Twenty-eight and 25 patients were randomized to intervention and control groups, respectively (mean age; 62.7 years old and 64.5, respectively). At baseline, the groups were well balanced across most characteristics. At 6 months, the mean HBP was 131/82 mm Hg in the intervention group vs. 145/87 mm Hg in the control group (SBP <0.001, DBP = 0.09). An HBP level of less than 135/85 mm Hg was achieved among 55.6% of the participants in the intervention group vs. 16.7% in the control group (P = 0.004). The alcohol consumption at 6 months was 256 ± 206 g/w vs. 413 ± 260 g/w, respectively (P = 0.020).

CONCLUSIONS

We confirmed the effectiveness of the nurse-led alcohol guidance to control the HBP in male patients with hypertension during outpatient visits.

PUBLIC TRIALS REGISTRY NUMBER

UMIN000017454 (UMIN Clinical Trials Registry).

The positive association between physical activity and alcohol use in African American adults

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Alcohol intake positively associated with physical activity in African Americans.

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This association appears to be driven by females, with no association in males.

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Alcohol intake not associated with Body Mass Index in this African American sample.

African Americans have highest incidence and mortality from obesity-related cancers. Physical activity (PA), minimal alcohol use, and maintaining a low body mass index (BMI) are important cancer prevention behaviors, though there is little research on how these behaviors are associated with one another in African Americans. The purpose of this study is to assess the relationship between PA, alcohol use, and BMI using secondary data from an African American cohort recruited from Houston-area churches. Self-administered questionnaires measured self-reported PA, alcohol use, height, weight, and sociodemographic factors. Univariate and multivariable analyses assessed the relation between PA, alcohol use, BMI, controlling for covariates. Participants (N = 1009) were mostly female (77%), employed (72%), and college graduates (55%). Most (53%) reported both light-to-moderate alcohol use & moderate-to-high levels of PA. There was a statistically significant positive linear association between PA and alcohol use (Pearson’s r = 0.15, p < 0.001). We also found that every one hour increase per week in PA was associated with 3% increased odds of being a heavy drinker (>2 drinks/day men, >1 drink/day women), as compared to an abstainer (Adjusted OR = 1.03, 95%CI 1.01–1.06). There was a statistically significant inverse association between PA and BMI, but no statistically significant association between alcohol use and BMI. In this sample of African Americans, PA and alcohol use were positively associated, mirroring results among Non-Hispanic Whites. However, alcohol use and BMI were not statistically significantly associated. Cancer and obesity prevention for African Americans should stress PA promotion while emphasizing messaging to curtail any associated increases in alcohol use.

Race- and sex-specific association between alcohol consumption and hypertension in 22 cohort studies: A systematic review and meta-analysis

BACKGROUND AND AIMS

The alcohol-hypertension relation has been well documented, but whether women have protective effect or race and type of beverage consumed affect the association remain unclear. To quantify the relation between total or beverage-specific alcohol consumption and incident hypertension by considering the effect of sex and race.

METHODS AND RESULTS

Articles were identified in PubMed and Embase databases with no restriction on publication date. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random effects models. Restricted cubic splines were used to model the dose-response association. This study involved 22 articles (31 studies) and included 414,477 participants. The hypertension risk was different among liquor, wine, and beer at 5.1-10 g/d of ethanol consumption (P_{-across subgroups} = 0.002). The hypertension risk differed between men (RR: 1.14, 95% CI: 1.07, 1.20) and women (RR: 0.98, 95% CI: 0.89, 1.06) at 10 g/d (P_{-across subgroups} = 0.005). We found a linear alcohol-hypertension association among white (P-_linearity = 0.017), black people (P-_linearity = 0.035), and Asians (P-_linearity<0.001). With 10 g/d increment of consumption, the RRs for hypertension were 1.06 (95% CI: 1.04, 1.08), 1.14 (95% CI: 1.01, 1.28), and 1.06 (95% CI: 1.01, 1.10) for Asians, black, and white people, respectively.

CONCLUSION

Sex modifies the alcohol-hypertension association at low level of alcohol consumption and we did not find evidence of a protective effect of alcohol consumption among women. Black people may have higher hypertension risk than Asians and white people at the same ethanol consumption.

The effect of alcohol dose on the development of hypertension in Asian and Western men: systematic review and meta-analysis

BACKGROUND/AIMS

There are inconsistencies in the effects of low to moderate dose alcohol consumption on the development of hypertension in adult men. We hypothesized that a region-specific effect might participate in this heterogeneity.

METHODS

We conducted a systematic review and meta-analysis to evaluate the effect of alcohol dose on hypertension incidence using contemporary data through December 2017. Subjects were categorized according to their level of alcohol consumption as non-drinkers (reference) and low- (0.01 to 20.0 g/day), moderate- (20.1 to 40.0 g/day), moderate- to high- (40.1 to 60.0 g/day), and high-dose (> 60.0 g/day) drinkers. We defined hypertension as a blood pressure ≥ 140/90 mmHg and/or the use of anti-hypertensive drugs.

RESULTS

In total, 11 articles (seven Asian and four Western) were selected for our analysis. Among Asian men, a significantly elevated risk was observed even in the low alcohol dose group in comparison with the group with no alcohol consumption, and the risk increased in a dose-dependent manner (pooled relative risks [95% confidence intervals (CI)]: 1.25 [1.13 to 1.38], 1.48 [1.27 to 1.72], 1.75 [1.43 to 2.15], and 1.78 [1.51 to 2.09]). Among Western men, a similar dose-response relationship was noted in general (p for subgroup difference > 0.1), but a significantly elevated risk was evident only in the high-dose group (pooled relative risks [95% CI]: 1.22 [0.85 to 1.74], 1.57 [0.90 to 2.75], 1.47 [0.44 to 4.91], and 1.49 [1.02 to 2.18]).

CONCLUSION

Even low doses of alcohol can lead to the development of hypertension, particularly in Asian men. Our findings could serve as additional evidence for developing an appropriate preventive strategy in each region.

Alcohol intake, hypertension development and mortality in black South Africans

BACKGROUND

Excessive alcohol intake is a risk factor for cardiovascular disease (CVD) and predicts cardiovascular and all-cause mortality. We determined which alcohol marker (self-reported alcohol intake, gamma-glutamyltransferase (GGT) or percentage carbohydrate deficient transferrin (%CDT)) relates best with mortality and predicts hypertension development over five years in black South Africans.

DESIGN

This was a longitudinal study as part of the PURE (Prospective Urban and Rural Epidemiology) study in the North West Province, South Africa.

METHOD

We included 2010 participants and followed 1471 participants. Over five years, 230 deaths occurred, of which 66 were cardiovascular-related. At enrolment, participants completed questionnaires on alcohol intake (yes, for former and current use; no, for alcohol never used). We measured blood pressure, collected blood samples and measured GGT and %CDT.

RESULTS

When comparing hazard ratios (HRs) of self-report, GGT and %CDT, we found that only GGT predicted cardiovascular (HR = 2.76 (1.49-5.12)) and all-cause mortality (HR = 2.47 (1.75-3.47)) and hypertension development ((HR = 1.31 (1.06-1.62)). Participants self-reporting yes for alcohol intake had a 30% increased risk of developing hypertension (HR = 1.30 (1.07-1.60)) but not an increased risk for mortality. When adding both GGT and self-report in the prediction model for hypertension, only self-reporting of alcohol was significant (HR = 1.24 (1.01-1.53)). The alcohol marker, %CDT, did not show any significant association with mortality or hypertension development.

CONCLUSION

GGT independently predicted cardiovascular and all-cause mortality, as well as hypertension development in black South Africans. Despite non-specificity to excessive alcohol consumption, GGT may be a useful general marker for hypertension development and mortality, also due to its significant association with self-reported alcohol intake.

Population blood pressure and low to moderate alcohol intake in an untreated population followed over 20years. Copenhagen City heart study

The aim of this study is to evaluate whether a changing population alcohol intake is capable of setting off a shift in the blood pressure distribution in the untreated part of a population. The focus is on subjects with an alcohol intake well below the limits of alcoholism because these subjects make out the majority of the population. The Copenhagen City Heart Study is a prospective longitudinal epidemiological study. The untreated study population was followed over 20years. Specially trained technicians using a blinded sphygmomanometer measured BP once with the subject in the sitting position. The BP measurement was fully standardised and the measurement method was unchanged throughout the observation period. A questionnaire concerning drinking habits was completed by the participants and double-checked by the technicians. The results were a decreasing population systolic BP and an increasing self-reported alcohol intake. The population increase was based on an increasing proportion of light to moderate drinkers. There was no effect of a moderately increasing alcohol intake as a covariate in a multivariate analysis of population systolic BP.

CONCLUSION

A moderately increasing population alcohol intake cannot explain the observed changes in population systolic blood pressure.

Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis

AIMS

To analyze the dose-response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta-analysis.

DESIGN

A computer-assisted search was completed for 10 databases, followed by hand searches of relevant articles. Only studies with longitudinal design, quantitative measurement of alcohol consumption and biological measurement of outcome were included. Dose-response relationships were assessed by determining the best-fitting model via first- and second-degree fractional polynomials. Various tests for heterogeneity and publication bias were conducted.

FINDINGS

A total of 12 cohort studies were identified from the literature from the United States, Japan and Korea. A linear dose-response relationship with a relative risk of 1.57 at 50 g pure alcohol per day and 2.47 at 100 g per day was seen for men. Among women, the meta-analysis indicated a more modest protective effect than reported previously: a significant protective effect was reported for consumption at or below about 5 g per day, after which a linear dose-response relationship was found with a relative risk of 1.81 at 50 g per day and of 2.81 at an average daily consumption of 100 g pure alcohol per day. Among men, Asian populations had higher risks than non-Asian populations.

CONCLUSIONS

The risk for hypertension increases linearly with alcohol consumption, so limiting alcohol intake should be advised for both men and women.

Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study

AIMS

Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence.

PARTICIPANTS

Subjects included 1383 people participating in the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, a large multi-center treatment study for alcohol dependence.

MEASUREMENTS

Methods appropriate for repeated-measures data were used to assess the relationship of percentage of drinking days (PDD) to systolic and diastolic blood pressure over a 16-week treatment period. Modification of these associations by demographic and other variables was assessed.

FINDINGS

Blood pressure reduction was evident only in people who were above the median blood pressure at baseline. In this group, systolic blood pressure decreased by an average of 12 mmHg and diastolic blood pressure decreased by an average of 8 mmHg. Blood pressure reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body mass index, reported history of hypertension and use of anti-hypertensive medications. An observed association between blood pressure and PDD in Caucasians was not evident in African Americans due largely to their lower pre-treatment blood pressure.

CONCLUSIONS

Reduction in alcohol consumption has a potent anti-hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol-dependent people, treatment for alcoholism should be considered a major component of anti-hypertensive therapy.

Alcohol consumption and hypertension

Hypertension is a major independent risk factor for cardiovascular disease. In alcohol-consuming populations, the amount of alcohol consumption has significant impact on blood pressure values, the prevalence of hypertension, and cardiovascular as well as all-cause mortality. In this review, we focus on the connection between alcohol consumption and hypertension, and discuss the consequences on cardiovascular risk.

Alcohol consumption and risk of colon cancer: evidence from the national health and nutrition examination survey I epidemiologic follow-up study

The epidemiologic findings on the relationship between alcohol consumption and colon cancer are inconsistent. The National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-Up Study (NHEFS) included a prospective cohort population representative of the general U.S. population, which had not been fully utilized for examining the risk between colon cancer and alcohol drinking. The NHEFS consisted of 10,220 participants prospectively followed over a decade. Alcohol consumption, amount and type of beverage, and drinking patterns at baseline were considered in examination of the effect of alcohol consumption on the risk of colon cancer. The consumption of one or more alcoholic beverages a day at baseline was associated with approximately a 70% greater risk of colon cancer [relative risk (RR)=1.69; 95% confidence interval (CI)=1.03, 2.79], with a strong positive dose-response relationship (P=0.04). This association appeared to be exclusively related to daily drinking of one or more drinks of liquor (RR=2.48; 95% CI=1.66, 4.53). Additionally, more than a 70% increased risk of colon cancer was observed for more than 34 yr of alcohol drinking history compared with nondrinkers (RR=1.73; 95% CI=1.08, 2.78). Overall, alcohol consumption was significantly associated with increased risk of colon cancer. The most important factor for colon cancer seems to be liquor consumption.

Meeting the challenge to improve the treatment of hypertension in blacks

Hypertension is more prevalent and severe in African descendent populations living outside Africa than in any other population. Given this greater burden of hypertension in blacks, it is increasingly necessary to refine strategies to prevent the disorder as well as improve its treatment and control. This review assesses results from clinical trials on lifestyle and pharmacologic interventions to identify which approaches most effectively prevent adverse hypertension-related outcomes in African descendent populations. The Dietary Approaches to Stop Hypertension (DASH) study provided evidence that a carefully controlled diet rich in fruits, vegetables, low-fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (i.e., the DASH diet) reduces blood pressure in blacks and is well accepted. The combination of the DASH diet with reduction in dietary sodium below 100 mmol/d may provide a reduction in blood pressure beyond that reached by the DASH diet alone. Physical exercise and interventions to reduce psychological stress may also reduce blood pressure in blacks. Strong evidence from numerous studies is a compelling argument for continuing to recommend diuretics and beta blockers as first-line antihypertensive therapy for persons of all races. Some new studies also favor angiotensin-converting enzyme inhibitors as first-line antihypertensive drugs. The African American Study of Kidney Disease and Hypertension provided evidence that an angiotensin-converting enzyme inhibitor-based treatment program is more beneficial than calcium channel blockers and beta blockers in reducing the progression of renal failure in blacks with hypertensive nephropathy. Studies in patients with diabetes have also shown evidence that both angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists are more effective than other classes of antihypertensives in reducing adverse renal events. Studies to evaluate the effects of the new antihypertensives in improving outcomes in blacks living outside the United States are needed.

Nondrug interventions in hypertension prevention and control

This review was undertaken to address the relation of various factors to HBP and their potential for preventing and controlling this widespread problem. With respect to salt intake and BP, the 1999 Workshop on Sodium and Blood Pressure of the (US) National Heart, Lung, and Blood Institute [5] will serve the reader well as a point of departure. The body of the present review provides more detailed discussion especially of recent epidemiologic research, including the DASH-Sodium trial, published more recently than the proceedings of that workshop. The DASH-Sodium trial demonstrates significant increases in SBP and DBP, with sodium intake greater than 65 mmol/d (= 3.7 g NaCl--see equivalencies in Appendix A) and with the usual American diet (versus the DASH diet). These results provide substantial evidence against current dietary practices in many populations where daily intakes of salt are much higher than recommended. We also have addressed alcohol consumption, micronutrients/macronutrients, physical activity and inactivity, obesity, cigarette smoking, and alternative approaches to treatment such as stress reduction/biofeedback, yoga/meditation, and acupuncture. Evidence for the efficacy of certain nonpharmacologic approaches to preventing and controlling HBP is strong. This evidence offers a basis for public health policies and clinical approaches that can greatly affect the incidence and consequences of HBP in the population at large. What is needed now is implementation of the policies and practices addressed here. Unless such action is taken on a large scale, we will have made poor use of the knowledge accrued over decades of research. The clinician is referred to the National Heart, Lung and Blood Institute Web site at www.nhlbi.gov/health/prof/heart/index.htm for resource and guideline information for hypertension. Patients and the general public are referred to the sister web page at www.nhlbi.gov\health\public\heart\index.htm for educational fact sheets and general information on hypertension.

Defining alcohol-related fatal medical conditions for social-cost studies in western societies: an update of the epidemiological evidence

OBJECTIVES

To elaborate a state-of-the-art list of alcohol-related fatal medical conditions for future social-cost studies in Western societies.

METHODS

Three major social-cost studies were compared with regard to their respective section on fatal health effects attributable to long-term as well as short-term use of alcohol. On discordant conditions, a systematic literature search was conducted in the Medline and ETOH databases.

RESULTS

There is no consensus between social-cost studies with respect to alcohol-related causes of mortality. Based on the recent epidemiological evidence on alcohol and health, this paper suggests an up-to-date list of fatal medical conditions for which the causal relationship has been established with sufficient scientific evidence. A further investigation is needed, however, to reestimate relative risks by meta-analysis.

CONCLUSIONS

Evaluating new epidemiological evidence regularly is necessary for the purpose of up-to-date social-cost studies.

Alcohol consumption and the incidence of hypertension: The Atherosclerosis Risk in Communities Study

A close relationship between alcohol consumption and hypertension has been established, but it is unclear whether there is a threshold level for this association. In addition, it has infrequently been studied in longitudinal studies and in black people. In a cohort study, 8334 of the Atherosclerosis Risk in Communities (ARIC) Study participants, aged 45 to 64 years at baseline, who were free of hypertension and coronary heart disease had their blood pressures ascertained after 6 years of follow-up. Alcohol consumption was assessed by dietary interview. The type of alcoholic beverage predominantly consumed was defined by the source of the largest amount of ethanol consumed. Incident hypertension was defined as a systolic blood pressure >/=140 mm Hg or diastolic blood pressure >/=90 mm Hg or use of antihypertensive medication. There was an increased risk of hypertension in those who consumed large amounts of ethanol (>/=210 g per week) compared with those who did not consume alcohol over the 6 years of follow-up. The adjusted odds ratios (95% confidence interval) were 1.2 (0.85 to 1.67) for white men, 2.02 (1.08 to 3.79) for white women, and 2.31 (1.11 to 4.86) for black men. Only 4 black women reported drinking >210 g ethanol per week. At low to moderate levels of alcohol consumption (1 to 209 g per week), the adjusted odds ratios (95% confidence interval) were 0.88 (0.71 to 1.08) in white men, 0.89 (0.73 to 1.09) in white women, 1.71 (1.11 to 2.64) in black men, and 0.88 (0.59 to 1.33) in black women. Systolic and diastolic blood pressures were higher in black men who consumed low to moderate amounts of alcohol compared with the nonconsumers but not in the 3 other race-gender strata. Models with polynomial terms of alcohol exposure suggested a nonlinear association in white and black men. Higher levels of consumption of all types of alcoholic beverages were associated with a higher risk of hypertension for all race-gender strata. The consumption of alcohol in amounts >/=210 g per week is an independent risk factor for hypertension in free-living North American populations. The consumption of low to moderate amounts of alcohol also appears to be associated with a higher risk of hypertension in black men.

Alcohol consumption and blood pressure change: 5-year follow-up study of the association in normotensive workers

This study endeavours to clarify the effect of alcohol consumption on changes in the blood pressure of Japanese men. The subjects, who were followed from 1990 to 1995, were 2189 male normotensive steelworkers aged from 40 to 54 years in 1990. Drinking habits were represented by two variables: average daily baseline alcohol consumption, and change in alcohol consumption during the observation period, both derived from self-report questionnaires and interviews. Nine other items were analysed as covariates: systolic and diastolic blood pressure, age, body mass index (BMI), salt intake, physical activity, and levels of gamma glutamyl transpeptidase (GTP), uric acid and plasma glucose in 1990. The association between drinking habits and blood pressure was evaluated using ANCOVA. Subjects who had initiated antihypertensive therapy by 1995 were excluded from this dataset. The results of analysis disclosed that both daily alcohol consumption and its change were significantly associated with changes in systolic and diastolic blood pressure during the observation period. J-shaped associations of daily alcohol consumption with adjusted changes in systolic and diastolic blood pressure were found. Positive associations were observed between changes in alcohol consumption and adjusted changes in systolic and diastolic blood pressure. In conclusion, daily alcohol consumption was associated non-linearly with changes in blood pressure and with a threshold effect at 18 ml of ethanol per day in these middle-aged Japanese workers. In addition, increasing alcohol consumption was associated with blood pressure elevation, and decreasing consumption was associated with suppression of blood pressure elevation.

The behavioral characteristics of individuals who lose weight unintentionally

OBJECTIVE

To determine whether individuals who unintentionally lost weight differ from individuals who intentionally lost weight in behavioral characteristics related to chronic disease risk factors.

DESIGN

A random-digit dial telephone survey was conducted among a representative sample of American adults (n = 500).

SUBJECTS

Of the 500 individuals sampled, 139 were currently > or = 10% below their lifetime maximum weight. These individuals were asked whether their weight loss was unintentional or intentional. Unintentional (n =49) and intentional (n = 89) weight losers were compared on measures of dietary intake, physical activity, smoking, drinking, and self-reported health status.

RESULTS

Unintentional weight losers had higher levels of smoking and drinking, were less physically active, and were less concerned about their diet and fat intake. Unintentional weight losers did not report having higher levels of disease such as high blood pressure or diabetes. However, unintentional weight losers who reported having such diseases were more likely to report that their weight loss had no effect or had worsened their disorder.

DISCUSSION

Compared to intentional weight losers, those who lost their weight unintentionally reported engaging in more negative health behaviors that are related to disease morbidity and mortality. These data suggest that unintentional weight loss may be part of a cluster of behaviors that have a negative health impact.