1. 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 Insulin resistance
Atherogenic dyslipidemia Prothrombotic state
Raised blood pressure Proinflammatory state
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
2
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

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
3
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
4
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
5
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
6
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

7. Methods I
WHR was calculated from waist and hip
circumference and the following categories were
used:
Normal <1.00 <0.85
Pathologic >1.00 >0.85
SPSS version 12.0 was used for statistical analysis,
student’s t-test and non parametric tests were used
http://www.eiep.gr/
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
7
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

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 no alcohol
<50 mg
moderate alcohol consumption
50 - 150 mg
150 - 300 mg
heavy alcohol consumption
>300 mg
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
8
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

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
9
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

10. Waist-to-hip ratio
in men and women
100%
32,2
42,3
80%
60%
Above normal
40% 67,8 values (>1,00 in
57,7
men and >0,85 in
20% women)
Normal w/h (<1,00
in men and <0,85
0%
in women)
men women
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
10
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

11. How much alcohol do
men drink?
5,9 %
12,8 % 21,5 %
no alcohol
<50 mg
31,2 % 51-150 mg
28,6 151-300 mg
% >300 mg
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
11
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 %
no alcohol
<50 mg
33,9 % 51-150 mg
54,6 %
151-300 mg
>300 mg
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
12
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

13. Results
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.)
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
13
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
1,05
1
0,95
Waist-to-hip ratio
0,9
0,85
0,8
0,75
no alcohol <50 mg 51-150 mg 151-300 <300 mg
mg
men
Alcohol consumption women
p=0.044 , p=0.823, Kendall’s tau-b
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
14
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

15. Waist-to-hip ratio Vs alcohol
consumption in men
1,05
1
Waist-to-hip ratio in
0,95
0,9
20-35 yrs
0,85 35-50 yrs
>50 yrs
0,8
no alcohol <50 mg 51-150 mg 151-300 <301 mg
mg
Alcohol consumption
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
15
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

16. Waist-to-hip ratio Vs alcohol
consumption in women
1,2
20-35 yrs
35-50 yrs
1,1
>50 yrs
Waist-to-hip ratio
1
0,9
0,8
0,7
no alcohol <50 mg 51-150 mg 151-300 <301 mg
mg
Alcohol consumption
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
16
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

17. Waist-to-hip ratio compared
with consumption of specific
types of alcohol
0,99
1,00 0,98
0,97
0,96
0,95
Waist-to-hip ratio
0,90
0,89
0,90 0,88 0,87 Men
Women
0,85
0,80
only beer only wine only liquer only whiskey
Alcohol consumption
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
17
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

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
18
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
19
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
Am J Epidemiol 1991;133:810-817
American Journal of Clinical Nutrition, Vol. 69, No. 2, 173-174, February 1999
Hellenic Medical Association for Obesity (HMAO), Athens, Greece
20
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults

21. 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
21
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
22
First National Epidemiological Large Scale Survey on the Prevalence of Obesity in Greek Adults