Date: 24 Jul 2012

Alcohol, Overweight and Obesity

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Increased body weight and, in particular, abdominal obesity is associated with increased cardiovascular disease risk [1]. In many developed countries, the average alcohol intake in those who drink is about 10–30 g/day or 3–9 % of the total energy intake [2], and the efficiency of alcohol for the maintenance of metabolizable energy is the same as for carbohydrate [3]. Alcohol suppresses the oxidation of fat, favouring fat storage and can serve as a precursor for fat synthesis [4, 5]. Moderate alcohol consumers usually add alcohol to their daily energy intake rather than substituting it for food, thus increasing energy balance [5]. On the basis of this, it would seem surprising if alcohol did not contribute directly to body weight. While laboratory studies on energy and nutrient balances show that alcohol is a nutrient that is efficiently utilized by the body and that alcohol calories do count, the epidemiological evidence is conflicting and whether moderate amounts of alcohol is a risk factor for weight gain and obesity is still controversial [6]. Several factors have been proposed which may explain the inconsistencies between studies, including the suggestion that the effect of alcohol on adiposity is influenced by type of drink [5], whether the alcohol is consumed with meals or not [5] and the pattern and amount of drinking in the population study [7]. A review conducted in 2005 concluded that the issue of whether alcohol calories count may be dependent on the characteristic of the drinker and the amount and pattern of drinking [6]. Moreover, evidence from a number of studies suggests that in drinkers, fat is preferentially deposited in the abdominal area [5] and that alcohol may be more associated with abdominal obesity than with general obesity [8–11]. The aim of this chapter is to review the epidemiological evidence for alcohol as a risk factor for overweight and obesity with particular focus on prospective studies. The influence of type of alcohol, pattern of drinking and confounding will also be discussed.