Patterns of Alcohol Consumption in the Older Population of Spain, 2008-2010

doi:10.1016/j.jand.2014.08.017

Journal of the Academy of Nutrition and Dietetics

Volume 115, Issue 2, February 2015, Pages 213-224

https://doi.org/10.1016/j.jand.2014.08.017 Get rights and content

Abstract

Background

Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe.

Objective

The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain.

Design

This was a cross-sectional study.

Participants/setting

The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010.

Main outcome measure

Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2.

Statistical analysis performed

The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design.

Results

The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake.

Conclusions

Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

Section snippets

Study Design and Population

The data for our analysis were taken from the Study on Nutrition and Cardiovascular Risk in Spain, a cross-sectional study conducted from 2008 to 2010 among 12,948 persons representative of the Spanish population aged ≥18 years.8, 9 Study participants were selected by multistage clustered random sampling. First, the sample was stratified by province and size of municipality. Second, clusters were selected randomly in two stages: municipalities and census sections. Finally, the households within

Results

In the Spanish population aged ≥60 years during 2008-2010, the prevalence of moderate drinking was 44.3% (95% CI 42.0 to 46.6) and of heavy drinking was 7.8% (95% CI 6.7 to 8.9). Corresponding figures for men were 60% (95% CI 57.1 to 63.0) and 11.8% (95% CI 9.8 to 13.8), and for women were 31.2% (95% CI 28.0 to 34.4) and 4.5% (95% CI 3.3 to 5.7). Of note is that 5% to 10% of older adults with diagnosed hypertension, diabetes mellitus, or cardiovascular disease showed heavy alcohol consumption;

Discussion

Our results show that almost half of adults aged ≥60 years in Spain are moderate alcohol drinkers. In addition, nearly two-thirds of alcohol drinkers had a preference for wine and drank mostly during meals. Consumption is more frequent in men than in women, and moderate alcohol consumption was found to decrease with suboptimal health status, diabetes diagnosis, and receiving drug treatment for diabetes. Although not achieving statistical significance, alcohol consumption tended to decrease with

Conclusions

Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a notable proportion of individuals had heavy drinking and concomitant use of medication that may interact with alcohol.

L. M. León-Muñoz is a research associate, CIBER of Epidemiology and Public Health, Madrid, Spain, and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz; Madrid, Spain.

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The Clinical Research Ethics Committee of ‘La Paz’ University Hospital in Madrid approved the study and all participants provided written informed consent. At baseline, study participants were asked about the amount and frequency of the main types of alcoholic beverages that they had consumed during each decade of their lives, and alcohol content of each drink was estimated using standard composition tables (León-Muñoz et al., 2015; Rodríguez-Artalejo et al., 2011). They were also asked if they had drunk ≥ 8 for men or ≥ 6 standard units (SU) for women during any drinking session in the preceding 30 days (León-Muñoz et al., 2015), and if so, they were considered as binge drinkers.
The protective health effects of light alcohol consumption are debated due to potential selection biases, reverse causation and confounding. We examined cross-sectional and prospective associations of alcohol consumption patterns with unhealthy aging among older drinkers addressing these methodological issues.
2081 lifetime drinkers aged 65 + years from the Seniors-ENRICA-2 cohort followed-up for 2.4 years were classified as occasional (average lifetime alcohol intake [g/day] ≤1.43), low-risk (men: >1.43–20; women: >1.43–10), moderate-risk (men: >20–40; women: >10–20) and high-risk drinkers (men: >40; women: >20; or binge drinkers). A Mediterranean drinking pattern (MDP) was defined as occasional/low-risk drinking, wine preference and drinking only with meals. Unhealthy aging was measured with a 52-item health deficit accumulation index (DAI), with higher values indicating more health deficits.
A 10-g/day increment in lifetime average alcohol intake was cross-sectionally associated with a higher DAI among all drinkers (mean difference [95% confidence interval] = 0.35 [0.16, 0.53]) and moderate-/high-risk drinkers (0.41 [0.17, 0.65]), but not among occasional/low-risk drinkers. Also, the DAI was 1.35 (0.06, 2.65) points higher in high-risk versus low-risk drinkers and 2.07 (0.59, 3.60) points higher in non-adherers versus adherers to the MDP. Most associations strengthened when restricting analyses to individuals with lower disease burden and did not generally remain after 2.4 years.
We found no evidence of a beneficial association between low-risk alcohol consumption and unhealthy aging, but a detrimental one for high-risk drinking, which strengthened when accounting for reverse causation, although attenuated over the follow-up likely due to selective attrition of those less resilient to the harmful effects of alcohol.
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Alcohol consumption is related to several diseases and injuries that accelerate the ageing process and increase the mortality and morbidity risk. The soluble form of the α-Klotho gene (called S-Klotho) is widely considered as a powerful anti-ageing biomarker.
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74 (39 women) middle-aged sedentary adults (40–65 years old) participated in the present study. Alcohol consumption was assessed with a food frequency questionnaire previously validated and with three non-consecutive 24-hours recall. The S-Klotho plasma levels were measured by ELISA using a soluble α-Klotho ELISA assay kit.
Total alcoholic drinks consumption was negatively associated with S-Klotho plasma levels (β=-17.031; R² = 0.096, P = 0.013). Furthermore, we observed that higher consumption of total alcoholic drinks is associated with lower S-Klotho plasma levels in middle-aged sedentary adults controlling for BMI (β=-16.372; R² = 0.201, P = 0.011), LMI (β=-31.854; R² = 0.305, P = 0.010) and for FMI β=-13.337; R² = 0.075, P = 0.049).
Conclusion: In conclusion, our study shows that total alcoholic drinks consumption is negatively associated with the S-Klotho plasma levels in middle-aged sedentary adults.
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As Garcia et al. (2013) reported, a vast majority of younger Spanish people consume wine only in special occasions and, as a consequence, they prefer to spend more money on high quality wines. In the same line, León-Muñoz et al. (2015) found that alcohol consumption among older adults in Spain is consistent with the traditional Mediterranean drinking pattern (moderate alcohol intake, mainly from wine and during meals), which decreases with age (MSSSI, 2011). Another important factor to mention is that in comparison to the Italian elderly people who are willing to pay premium prices for NAS wine, in Spain one of the most important attribute, beside price, is the origin and more specifically the protected designation of origin quality certification and organic (Brugarolas et al., 2005; De Magistris et al., 2014).
Although scientific literature is still uncertain towards the real causes that can link headache episodes with moderate wine consumption, a growing proportion of consumers seems to address sulphites as possible culprits. Hence, the objective of this study is to assess consumers` willingness to pay for wine bearing a sulphites-free label in two traditional wine producing countries, Italy and Spain. The methodological framework is based on the specification of the Becker-DeGroot-Marschak (BDM) type of auction applied to consumers purchasing wine in the supermarket stores of both countries. A left censored Tobit model is used to analyse the bidding behaviour for conventional and "Non-Added Sulphite" (NAS) wine. Results in both countries show that consumers who link the headaches with the consumption of sulphite are willing to exchange the habitually consumed bottle of wine with a NAS wine and pay extra premium prices.
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Several studies have found that moderate alcohol intake is associated with lower risk of functional limitations in older adults. However, no previous investigation has assessed this association in older adults from Mediterranean countries, who show characteristic drinking patterns.
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Study participants were classified as non-drinkers (including also occasional drinkers), ex-drinkers, moderate drinkers and heavy drinkers. The threshold between moderate and heavy drinking was set at ≥40 g/day in men and ≥24 g/day in women (León-Muñoz et al., 2015). A preference for wine or other alcoholic beverage was considered when it accounted for more than 80% of alcohol consumed (Valencia-Martín et al., 2011).
Health-related quality of life (HRQOL) is a more powerful predictor of health services use and mortality than many objective measures of health. However, in older adults the association between main alcohol drinking patterns and HRQOL is uncertain.
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E. López-García is an associate professor, CIBER of Epidemiology and Public Health, Madrid, Spain, and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz; Madrid, Spain.

P. Guallar-Castillón is a professor, CIBER of Epidemiology and Public Health, Madrid, Spain, and Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz; Madrid, Spain.

I. Galán is principal researcher and adjunct professor, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain, and National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.

J. Donado-Campos is an adjunct professor, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz; Madrid, Spain.

F. Sánchez-Alonso is a research associate, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz; Madrid, Spain.

J. L. Valencia-Martín is a research fellow and attending physician, CIBER of Epidemiology and Public Health, Madrid, Spain, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain, and Department of Preventive Medicine, Móstoles University Hospital, Móstoles, Spain.

F. Rodríguez-Artalejo is a professor, Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain.

: STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

: FUNDING/SUPPORT This work was supported by grant no. 06/2010 from the Plan Nacional sobre Drogas (Ministry of Health of Spain), FIS (Fondo de Investigación Sanitaria) grant no. 12/1166 (Ministry of Health of Spain), and FP7-HEALTH-2012-Proposal no. 305483-2 (FRAILOMIC Initiative).

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ResearchOriginal ResearchPatterns of Alcohol Consumption in the Older Population of Spain, 2008-2010

Abstract

Background

Objective

Design

Participants/setting

Main outcome measure

Statistical analysis performed

Results

Conclusions

Section snippets

Study Design and Population

Results

Discussion

Conclusions

Lancet

Rev Esp Cardiol

Med Clin (Barc)

Am J Clin Nutr

J Am Diet Assoc

Ann Epidemiol

Diabetes Res Clin Pract

Lancet

Am J Geriatr Pharmacother

Geriatr Nurs

J Nutr Health Aging

Ethanol metabolism and aging: the role of “first pass metabolism” and gastric alcohol dehydrogenase activity

J Gerontol A Biol Sci Med Sci

The influences of age and gender on blood ethanol concentrations in healthy humans

J Stud Alcohol

VINTAGE project Working Group. Alcohol and older people from a public health perspective

Ann Ist Super Sanita

Binge drinking in Spain, 2008-2010

Alcohol Clin Exp Res

Evaluation of health interview surveys and health examination surveys in the European Union

Eur J Public Health

Relative validity and reproducibility of a diet history questionnaire in Spain. I. Foods. EPIC Group of Spain. European Prospective Investigation into Cancer and Nutrition

Int J Epidemiol

Validity and reproducibility of a Spanish dietary history

PLoS One

Centre d’Ensenyament Superior de Nutrició i Dietética (CESNID)

Tablas de composición de alimentos. 11ª Edición

The association between alcohol consumption patterns and adherence to food consumption guidelines

Alcohol Clin Exp Res

The “standard drink unit” as a simplified record of alcoholic drink consumption and its measurement in Spain

Med Clin (Barc)

Research
Original Research
Patterns of Alcohol Consumption in the Older Population of Spain, 2008-2010

Tablas de composición de alimentos. 11^ª Edición