National Institute of Public Health and Environment (RIVM) Department of Chronic Diseases Epidemiology (pb 101) PO Box 1, NL-3720 BA Bilthoven, The Netherlands. E-mail: angelika.de.bree{at}rivm.nl
SirWe would like to complement recent publications1,2 on a potential beneficial health effect of moderate alcohol consumption on the cardiovascular system with data on the relation between alcohol consumption and the plasma total homocysteine concentration (tHcy). A high tHcy is associated with an increased risk of cardiovascular diseases, therefore, it is important to know how lifestyle factors might influence tHcy.
Observational studies indicate that alcohol consumption might be related to tHcy in a J-shaped fashion:3 alcoholics have a very high tHcy4 and moderate alcohol consumers (4 glasses/ day) have a lower tHcy as compared to non-drinkers.3,5 In our study population, a random sample (n = 3025) of a population-based cohort of Dutch men and women (2065 years),6 we cross-sectionally observed a lower tHcy at higher levels of alcohol consumption (assessed with a food frequency questionnaire). This trend was statistically significant in men (P < 0.001); non-drinkers (n = 132) had a (geometric) mean tHcy of 14.2 µmol/L, compared to 13.9 µmol/L in drinkers of
2 glasses/day (n = 838), 12.5 µmol/L in drinkers of >2 to <4 glasses/day (n = 306) and 13.1 µmol/L in drinkers of
4 glasses/day (n = 214). An overall statistically significant inverse trend (P < 0.05) remained after correction for age, smoking, physical activity, coffee and tea consumption, dietary folate intake and vitamin B supplements use.
An intriguing question is whether the inverse relation can be ascribed to ethanol intake or that the type of alcoholic beverages consumed is important, as the recent intervention trial of Van der Gaag et al.7 suggests. They showed, in a 3-week randomized cross-over trial, that despite the equally administered amount of ethanol (4 glasses/day = 40 g/day) beer does not affect tHcy, whereas wine and spirits induce an increase. Motivated by these results7 we studied whether different types of alcoholic beverage were differently related to tHcy in males (Table 1) we found that higher beer consumption was inversely associated to tHcy, whereas wine (red and white) and spirits showed no relation to tHcy. Thus, like Van der Gaag et al.,7 we showed that beer drinking does not have an adverse effect on tHcy. In fact, we observed a favourable effect, which may seem inconsistent. However, as the relation between alcohol consumption and tHcy might be J-shaped3 and our study contained few heavy drinkers (16% of the male drinkers drank >4 glasses/day) we were probably measuring an effect in the descending part of the J-curve. The intervention trial provided relatively high alcohol doses7 and might have measured an effect at or beyond the nadir of the curve.
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Acknowledgments
This work was financially supported by a grant of the Netherlands Heart Foundation (grant no. 96.147). HJ Blom is established investigator of the Netherlands Heart Foundation (grant no. D97.021).
References
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