Jayadeep Patra1,2, Charlotte Buckley3, William C Kerr4, Alan Brennan5, Robin C Purshouse3, Jürgen Rehm1,2,6,7,8,9,10. 1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada. 2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 3. Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK. 4. Alcohol Research Group, Public Health Institute, Emeryville, CA, USA. 5. School of Health and Related Research, University of Sheffield, Sheffield, UK. 6. Institute of Clinical Psychology and Psychotherapy, Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany. 7. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada. 8. Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada. 9. Department of Psychiatry, University of Toronto, Toronto, Canada. 10. Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Abstract
INTRODUCTION: Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all-cause or liver mortality. METHODS: We obtained self-reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking. RESULTS: Obese (≥30 kg m-2 ) adults with consumption of >40 g day-1 (women) or >60 g day-1 (men) pure ethanol were at risk of increased mortality from all-cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m-2 , each 5 kg m-2 higher BMI was associated with an elevated all-cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16-1.40) and women (1.12, [1.02-1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60-11.00]) than women (2.90, [0.50-5.30]). DISCUSSION AND CONCLUSIONS: Obesity and excess alcohol are both related to all-cause and liver mortality-the latter with evidence of a supra-additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research.
INTRODUCTION: Nationally representative studies of the combined impact of drinking and body mass (BMI) on mortality outcomes are unavailable. We investigate whether both act together to elevate risk of all-cause or liver mortality. METHODS: We obtained self-reported histories of drinking and BMI from 129 098 women (mean age 47.2 years) and 102 568 men (mean age 45.6 years) ≥18 years interviewed from 1997 to 2004 in the National Health Interview Survey and related these data to the deaths that occurred by 31 December 2006 (women = 8486; men = 7819 deaths). Death hazards among current drinkers in different BMI groups were adjusted for age, education, race and smoking. RESULTS: Obese (≥30 kg m-2 ) adults with consumption of >40 g day-1 (women) or >60 g day-1 (men) pure ethanol were at risk of increased mortality from all-cause and chronic liver disease (P trend <0.0001). For heavy drinkers with BMI ≥30 kg m-2 , each 5 kg m-2 higher BMI was associated with an elevated all-cause mortality in men (hazard ratios 1.27, 95% confidence interval [CI]: 1.16-1.40) and women (1.12, [1.02-1.24]). The excess risk due to interaction was more pronounced in men (7.30, [3.60-11.00]) than women (2.90, [0.50-5.30]). DISCUSSION AND CONCLUSIONS: Obesity and excess alcohol are both related to all-cause and liver mortality-the latter with evidence of a supra-additive interaction between the risk factors. The presence of both factors in the same population and their impact should inform treatment, public health policies and research.
Authors: Jürgen Rehm; Jayadeep Patra; Alan Brennan; Charlotte Buckley; Thomas K Greenfield; William C Kerr; Jakob Manthey; Robin C Purshouse; Pol Rovira; Paul A Shuper; Kevin D Shield Journal: Drug Alcohol Rev Date: 2021-03-30