Modifiable risk factors as predictors of all-cause mortality: the roles of genetics and childhood environment

The authors studied familial aggregation of mortality risk factors and their association with future deaths in the Finnish Twin Cohort. Cohort members (n = 15,904) aged 24-60 years and healthy at the end of 1981 who had responded to questionnaires in 1975 and 1981 were followed up for death through June 30, 2001. In individual-based analyses, the age- and sex-adjusted risk of death was higher among persons who were not participating in vigorous leisure physical activity in 1975 and 1981 than in those who were (p < 0.001), and risk was increased among smokers (p < 0.001) and heavy users of alcohol (p < 0.001). The study sample included data on both members of 3,551 dizygotic same-sex twin pairs and 1,772 monozygotic same-sex twin pairs. In pairwise analyses of discordant dizygotic pairs, risks of death were increased among co-twins who were not participating in vigorous activity (p = 0.05), co-twins who were smokers (p < 0.001), and co-twins who were heavy alcohol users (p < 0.001). Correspondingly, among monozygotic twin pairs, a difference in risk was seen only for smoking (p = 0.03). The authors conclude that, after adjustment for childhood environment, a low level of leisure physical activity, smoking, and heavy use of alcohol are associated with increased risks of death, but genetic selection may account for some of the association concerning physical activity and heavy use of alcohol.     

Genetic and environmental influences on the tracking of body size from birth to early adulthood

OBJECTIVE: This study identified genetic and environmental influences on the tracking of body size from birth to 16 to 18.5 years of age. RESEARCH METHODS AND PROCEDURES: Longitudinal information was collected from a nationally representative sample of Finnish twin adolescents (birth cohorts 1975 to 1979) and their parents through questionnaires mailed when the twins were ages 16 and 18.5 years old. The sample included 702 monozygotic, 724 same-sex dizygotic, and 762 opposite-sex dizygotic sets of twins. The measures used were length, weight, ponderal index (kilograms per cubic meters), and gestational age at birth, and height, weight, and body mass index (kilograms per square meters) at 16 to 18.5 years of age. The changes in genetic and environmental influences on body size from birth to early adulthood were analyzed by quantitative genetic modeling. RESULTS: The twins who had a higher weight or ponderal index at birth were taller and heavier in early adulthood, whereas those who were longer at birth were taller, but not heavier, later in life. Adult height was affected more by the birth size than body mass index. In the genetic modeling analyses, the genetic factors accounting for the variation of body size became more apparent with age, and both genetic and environmental influences on stature had a sizable carry-over effect from birth to late adolescence, whereas for relative weight, the influences were more age-specific. DISCUSSION: The genetic and environmental architecture of body size changes from birth to adulthood. Even in monozygotic twins who share their genetic background, the initially larger twin tended to remain larger, demonstrating the long-lasting effects of fetal environment on final body size.     

Snoring,sympathetic activity and cardiovascular risk factors in a 70 year old population

In order to describe the relation between snoring, cardiovascular risk factors, metabolic factors and sympathetitic activity, 804 70-year-old males and females were classified according to snoring habits and life-style factors (alcohol and tobacco consumption), blood pressure, body mass index (BMI), plasma lipids (triglycerides, cholesterol, high density lipoprotein), plasma catecholamines (epinephrine, norepinephrine), fasting blood glucose and glucose tolerance test (1 gram glucose per kg body weight given and blood glucose was measured 1 and 2 hours thereafter) were evaluated in all participants.Self-reported snoring was associated with gender (males showed higher prevalence than females, p < 0.05), alcohol consumption (p < 0.01), BMI (p < 0.001), systolic (p < 0.01) and diastolic (p < 0.05) blood pressure, glucose tolerance test (p < 0.01), plasma norepinephrine (p < 0.05) and partly with tobacco consumption (p = 0.08). No associations were found between snoring and fasting glucose, plasma lipids, plasma epinephrine or in the use of antihypertensive medication.In multivariate analysis, with forced entry of gender, BMI, physical activity, alcohol and tobacco consumption, the relation between snoring and blood pressure ceased; only systolic blood pressure was associated with snoring (p < 0.05). Snoring was still associated with plasma norepinephrine (p < 0.001) and abnormal glucose tolerance (p < 0.001).We conclude that, in a 70-year-old population, snoring is associated with gender, BMI and alcohol consumption. Snores showed higher plasma norepinephrine and abnormal glucose tolerance.     

Leisure time and occupational physical activity: risk of death from ischemic heart disease

The relation of leisure time and occupational physical activity to the risk of death from ischemic heart disease was investigated in a cohort of 15,088 persons aged 30-59 years who had no history of cardiovascular disease or other condition which hindered physical activity. Two population samples were randomly chosen from eastern Finland. During a six-year follow-up, persons who were sedentary in leisure time (relative risk = 1.3, 95% confidence interval (CI) = 1.1-1.6) or at work (relative risk = 1.3, 95% CI = 1.1-1.6) had an excess risk of ischemic heart disease death when adjusted for age, health status, family history, and body mass index in multivariate logistic models. Adjustment for years of education, social network participation, cigarette consumption, serum cholesterol level, and blood pressure level weakened the residual association of low leisure time physical activity with the risk of ischemic heart disease death (relative risk = 1.2, 95% CI = 1.0-1.5), whereas the association for low occupational physical activity remained unchanged. The lack of leisure time physical activity and a sedentary occupation are associated with an increased risk of ischemic heart disease death, and the excess risk due to lack of leisure time physical activity is, in part, accounted for by other ischemic heart disease risk factors.     

Determinants of weight gain and overweight in adult Finns

We studied sociodemographic and behavioural factors as predictors of weight gain in 12,669 adult Finns examined twice with a median interval of 5.7 years. The association of these factors with the prevalence of obesity (body mass index greater than or equal to 30 kg/m2) was also studied in a subsequent cross-sectional survey of 5673 Finns. In uni- and multivariate analyses, the risk of substantial weight gain (greater than or equal to 5 kg/5 years) was greatest for persons with a low level of education, chronic diseases, little physical activity at leisure or heavy alcohol consumption, and for those who got married or quit smoking between the examinations. Parity and energy intake predicted weight gain in women. The prevalence of obesity was inversely associated with the level of education and physical activity, and positively associated with alcohol consumption in men and parity in women. There were no significant differences in the prevalence of obesity by smoking or marital status. The recognition of socioeconomic and behavioural factors as important determinants of weight gain and overweight helps the planning of effective treatment and preventive programmes tailored for subjects at highest risk of obesity.     

Contribution of genetic and environmental influences to ankle-brachial blood pressure index in the NHLBI Twin Study. National Heart, Lung, and Blood Institute

The ankle-brachial index (ABI) is widely used in the clinical diagnosis of peripheral arterial disease. The contributions of genetic and environmental influences to normal and abnormal ABI values are unknown. In this study, the authors used available data on 94 monozygotic pairs and 90 dizygotic pairs of elderly, White, male twins examined in 1995-1997 to investigate the contributions of genetic and environmental influences to normative ABI values. Within-twin-pair correlations for normative ABI values were statistically significant, and the correlation in monozygotic twin pairs was significantly greater than that in dizygotic pairs. Structural equation modeling of the variance-covariance matrices of monozygotic and dizygotic twins indicated that 48% of the observed variability in ABI values could be attributed to additive genetic effects. In contrast, concordance rates for low ABI values (ABI< or =0.9) for both monozygotic and dizygotic twins were significantly greater than would be expected by chance alone, but within-pair monozygotic similarity was not significantly greater than dizygotic similarity. A matched-cotwin analysis in 21 pairs that were discordant for low ABI values found that twins with low ABI values were physically less active and more likely to be persistent smokers than their normal-control brothers. These findings reinforce the role of individual health practices (e.g., physical activity, smoking) in the manifestation of peripheral arterial disease among subjects matched for age, genetics, and early shared environment.     

The relation of physical activity to cardiovascular disease risk factors in Mauritians. Mauritius Noncommunicable Disease Study Group

The authors investigated the relation between physical activity and cardiovascular disease risk factors in a random sample of 4,658 Asian Indian, Creole, and Chinese adults aged 25-74 years from the island nation of Mauritius. Subjects known to have diabetes were excluded from analyses. Subjects were divided into "active" and "inactive" groups on the basis of a combined leisure and occupational physical activity score determined at interview (April 1987). Two-hour plasma glucose concentration and fasting and 2-hour serum insulin concentrations were significantly lower and high density lipoprotein (HDL) cholesterol was significantly higher in active subjects of both sexes. Plasma uric acid and fasting triglyceride levels were also lower among active subjects, but significantly so only in females. Systolic and diastolic blood pressure levels, body mass index (weight (kg)/height (m)2), and waist:hip ratio varied little between the two activity groups. In multiple linear regression analyses, physical activity made an independent negative contribution to the models for 2-hour glucose and insulin in both males and females, as well as for fasting insulin in males. When glucose and insulin were not included, physical activity also made an independent contribution to the models for plasma triglycerides (inversely) in females and HDL cholesterol and HDL cholesterol as a proportion of total cholesterol (positively) in males. The authors have demonstrated improved cardiovascular disease profiles associated with physical activity in Mauritians. The data suggest that much of the effect is modulated via an effect on insulin-glucose metabolism. Promotion of exercise should become an important strategy in the prevention of cardiovascular disease and glucose intolerance in this population.     

Interdependence of associations of physical activity, smoking, and alcohol and coffee consumption with serum high-density lipoprotein and non-high-density lipoprotein cholesterol--a population study in eastern Finland

The interdependence of the associations of physical activity, smoking, and consumption of alcohol and coffee with serum high-density lipoprotein and non-high-density lipoprotein cholesterol concentrations was studied in 9,347 persons ages 25-64 years from east and southwest Finland. In covariance analyses with corrections for age, body mass index, saturated fat index, and fasting time, the mean adjusted serum high-density lipoprotein to non-high-density lipoprotein cholesterol ratio was high among physically active male non-smokers but not among smokers (P = 0.024 for two-way interaction). The cholesterol ratio was lower among both men (P = 0.010 for two-way interaction) and women (P = 0.030 for two-way interaction) reporting no or very little use of alcohol, and this association was stronger among smokers and women with high coffee consumption (P less than 0.001 for two-way interaction). Our data suggest that the elevating effect of regular physical exercise on serum high-density lipoprotein cholesterol may be absent in smokers, whereas that of alcohol is greater in smokers than nonsmokers. High coffee consumption associates with decreased serum high-density lipoprotein cholesterol levels in smokers but increased levels in non-smokers.     

昆明市城乡居民劳动强度与高血压患病关系研究

目的探讨城乡居民劳动强度与高血压的关系,为高血压防治提供基础数据。方法于2008年1—4月采用多阶段随机抽样方法,抽取昆明市20岁及以上常住城乡居民5191人,进行问卷调查、人体测量及生化指标检测和劳动强度分级。结果调查对象中轻体力劳动、中等体力劳动和重体力劳动的高血压患病率分别为33．8％、24．9％和18．1％,糖尿病患病率分别为8．1％、4．5％和1．9％,各劳动强度级别患病率两两比较,差异均有统计学意义（P〈0．05）;收缩压、舒张压、体质指数（BMI）、腰围、空腹血糖（FPG）、餐后2h口服75g葡萄糖耐量实验（2h-OGTT）、高血压患病率均随劳动强度的增加而下降,且各劳动强度级别均数两两比较,差别均有统计学意义（P〈0．05）。多因素Logistic回归分析,在调整了年龄、性别、肥胖等多种混杂因素之后,中等体力劳动组和重体力劳动组高血压的OR值分别为0．74（95％CI：0．43～1．31）、0．58（95％CI：0．36～0．93）,趋势分析P=0．03。结论体力劳动强度对高血压的患病率有保护作用,经常性的适度体力劳动有助于降低居民高血压患病风险。     

Physical activity and its association with other lifestyle factors

The association of several lifestyle factors with leisure-time physical activity was examined from 1990 to 1991 in a representative sample of 2623 men and 2688 women, ages 25–69, in Germany. Active persons during leisure time were less likely to live in small villages, to smoke and generally had a lower body mass index as compared to sedentary. Men and women with high socioeconomic status were, respectively, four and three times more likely to have an active leisure time than those with low socioeconomic status. After adjustment for age, body mass index, urbanization, socioeconomic status, smoking and average monthly temperature, they less often felt the need to sleep early, consumed more often fruit, salad, whole grain bread and vitamin supplements, less often white bread and meat and a higher amount of fluids as compared to sedentary persons. They were more likely to be single and to eat breakfast regularly. Higher levels of leisure-time physical activity were associated with a general healthier lifestyle.     

Devil in disguise: Does drinking lead to a disability pension?

ObjectivesTo examine whether alcohol consumption in adulthood is related to the incidence of receiving a disability pension later in life.MethodsTwin data for Finnish men and women born before 1958 were matched to register-based individual information on disability pensions. Twin differences were used to eliminate both shared environmental and genetic factors. The quantity of alcohol consumption was measured as the weekly average consumption using self-reported data from three surveys (1975, 1981 and 1990). The disability pension data were evaluated from 1990–2004.ResultsThe models that account for shared environmental and genetic factors reveal that heavy drinkers are significantly more likely to receive a disability pension than moderate drinkers or constant abstainers. Heavy drinking that leads to passing out is also positively related to receiving a disability pension. The results were robust to the use of potential confounders that twins do not share, such as education years, the number of chronic diseases, physical activity at work and leisure, and stressful life events.ConclusionDrinking profiles in early adulthood are an important predictor of receiving a disability pension later in life.     

Correlates of high density lipoprotein cholesterol in women studied by the method of co-twin control

This study examines the relation between each of the following risk variables and high density lipoprotein (HDL) cholesterol: cigarette smoking, alcohol use, leisure exercise, postmenopausal estrogen use, and body mass, before and after adjustment for genetic and nongenetic variables shared by monozygous and dizygous co-twins. Subjects were 179 dizygous and 255 monozygous twin pairs from the Kaiser Permanente Twin Registry who participated in a special examination in 1978-1979 in Oakland, California. A multivariate co-twin analysis made it possible to adjust for measured covariables and also to adjust for unmeasured familial variables shared by co-twins. After adjustment for measured covariables, further adjustment for the unmeasured familial variables shared by monozygous co-twins reduced a positive association between alcohol and HDL cholesterol and eliminated a positive association between exercise and HDL cholesterol. On the other hand, adjustment for unmeasured familial variables shared by monozygous co-twins had little effect on significant associations between smoking and HDL cholesterol, postmenopausal estrogen use and HDL cholesterol, and body mass and HDL cholesterol. Although an important role for random error was not ruled out in the sample size available, findings are consistent with the following interpretations: 1) alcohol consumption and leisure exercise may have smaller effects on HDL cholesterol than predicted by studies unadjusted for familial factors because effects of these variables are confounded by familial factors; and 2) smoking, postmenopausal estrogen, and body mass have effects predicted by studies unadjusted for familial factors and may therefore be good targets for interventions to raise HDL cholesterol.     

The relationship between education and risk factors for coronary heart disease

In nine samples of adult populations (2707 males and 2871 females, aged 20–59 years) we studied the relationship between educational level and several lifestyle factors at risk for coronary heart disease (CHD), (i.e., smoking, alcohol consumption, dietary fat intake, sedentary behaviour at work and leisure) and the association between education and certain CHD risk factors (i.e., total cholesterol, HDL-cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index). The data were analyzed separately in samples from North, Central and Southern Italy. The results show that educational level is often associated to the lifestyle factors considered here. This association was positive for both men and women for physical activity at leisure and work stress and only for women with respect to smoking. It was negative for both men and women for alcohol consumption and physical activity at work and for men only for cigarette smoking. The age-adjusted mean levels of the CHD risk factors show some significant differences among subjects with different educational levels, which were not always the same for the three geographical areas. This was with the exception of BMI in females, which appears negatively associated to education in all areas. These differences decreased after adjustments were made for daily cigarette smoking, wine consumption and dietary fat intake. Education seems to play a determining role in lifestyle, however its direct and indirect effects on some major CHD risk factors are somewhat different in areas at different socio-economic conditions.     

Genetic effects on weight change and food intake in Swedish adult twins

BACKGROUND: Obesity is influenced by genetic and environmental factors. Additionally, synergistic effects of genes and environments may be important in the development of obesity. OBJECTIVE: The aim of this study was to test for genetic effects on food consumption frequency, food preferences, and their interaction with subsequent weight gain. DESIGN: Complete data on the frequencies of consumption of 11 foods typical of the Swedish diet were available for 98 monozygotic and 176 dizygotic twin pairs aged 25-59 y who are part of the Swedish Twin Registry. The data were collected in 1973 as part of a questionnaire study. Body mass index was measured in 1973 and again in 1984. RESULTS: There was some evidence that genetic effects influenced the frequency of intake of some foods. Similarity among monozygotic twins exceeded that among dizygotic twins for intake of flour and grain products and fruit in men and women, intake of milk in men, and intake of vegetables and rice in women, suggesting that genes influence preferences for these foods. Analyses conducted for twins reared together and apart also suggested greater monozygotic than dizygotic correlations, but cross-twin, cross-trait correlations were all insignificant, suggesting that the genes that affect consumption frequencies are not responsible for mediating the relation between the frequency of intake and weight change. CONCLUSIONS: Genetic effects and the frequency of intake are independently related to change in body mass index. However, there was no suggestion of differential genetic effects on weight gain that were dependent on the consumption frequency of the foods studied.     

Waist-to-hip ratio and dietary factors in adults

OBJECTIVES: To assess the association between diet factors and abdominal fat accumulation. METHODS: A household survey carried out in the city of Rio de Janeiro during 1995-1996. The usual diet of a sample of 2,441 individuals (42.8% men and 57.2% women), aged 20 to 60 years, was investigated using a food frequency questionnaire and data about height, weight, waist and hip perimeter was collected. The cut-off points for inadequate waist-to-hip ratio (WHR) for men and women were 0.95 and 0.80, respectively. RESULTS: Inadequate WHR was positively associated with age, cigarette smoking, body mass index, and inversely associated with education level, income and leisure physical activity in both men and women (p<0.05). Inadequate WHR was not associated with lipids, carbohydrates and total fiber intake. Positive association was found with inadequate WHR and spirits consumption among menopause women (p<0.001), and the consumption of four or more glasses of beer per day in men (p<0.001). CONCLUSION: In agreement with other studies, alcohol intake was associated with abdominal fat accumulation.     

Correlates of high-density lipoprotein cholesterol in a sample of healthy workers

METHODS. Correlates of high-density lipoprotein cholesterol are analyzed in a sample of 797 male workers in southern Italy participating in the Olivetti Heart Study. At the univariate level high-density lipoprotein cholesterol concentrations are positively related to alcohol consumption (r = 0.127; P less than or equal to 0.001) and sport activity (r = 0.074; P less than or equal to 0.05) and inversely related to body mass index (r = -0.160; P less than or equal to 0.001), serum triglycerides (r = -0.349; P less than or equal to 0.001), cigarette smoking (r = -0.227; P less than or equal to 0.001), and coffee consumption (r = -0.153; P less than or equal to 0.001). RESULTS. In the group as a whole, body mass index, alcohol consumption, cigarette smoking, and serum triglycerides remain significantly related to high-density lipoprotein cholesterol in the multivariate model, while the association with coffee intake and sport activity loses statistical significance. A significant negative interaction is reported between physical activity and cigarette smoking, and a positive significant linear trend between high-density lipoprotein cholesterol and sport activity is observed only in nonsmokers. CONCLUSION. These findings suggest that body mass index, alcohol consumption, cigarette smoking, serum triglycerides, and sport activity are important correlates of high-density lipoprotein cholesterol but that the positive significant association between sport activity and high-density lipoprotein cholesterol is absent in smokers.     

The relationship between body mass index and lifestyle in a Brazilian adult population: a cross-sectional survey

This study focused on adult obesity prevalence in Goiania, Goiás State, Brazil, and the association between socio-demographic variables, lifestyle, physical activity, eating habits, and food consumption frequency and body mass index (BMI). A cross-sectional study was conducted in 2001 with a sample of 1,252 individuals from 20 to 64 years of age. The association between socio-demographic variables, lifestyle, food consumption, and physical activity and BMI was evaluated by hierarchical multiple linear regression analysis. Obesity prevalence was 10.7% in men and 13.9% in women. In males, age, income, and meat consumption showed a positive association with BMI, while physical activity during leisure time and commuting and the habit of eating > 4 meals per day were inversely associated with BMI. In women, positively associated factors were age, no smoking, and no meat consumption; in contrast, consumption of grains was inversely associated with BMI. High obesity prevalence was observed; active lifestyle coupled with ingestion of more grains and less meat appeared to protect against increased BMI.     

Association between baseline risk factors, cigarette smoking, and CHD mortality after 10.5 years. MRFIT Research Group.

METHODS. The association between baseline risk factors and death from coronary heart disease (CHD) after 10.5 years was investigated for cigarette smokers and nonsmokers who entered the Multiple Risk Factor Intervention Trial (MRFIT). RESULTS. Rates per thousand person-years of CHD mortality were higher for smokers than for nonsmokers at every level of baseline risk factors examined. There were significant associations between CHD mortality and plasma low-density lipoprotein and high-density lipoprotein cholesterol for smokers and nonsmokers. The inverse association between CHD mortality and high-density lipoprotein cholesterol was significantly stronger among nonsmokers compared with that among smokers and was attributable to a very strong association for former smokers. An inverse relationship between CHD and body mass index was evident for smokers and nonsmokers. Rates of CHD death rose sharply when levels of fasting glucose exceeded 140 mg/dl, and there was a significant association between CHD mortality and blood sugar levels for nonsmokers but not for smokers. For both smokers and nonsmokers, an inverse univariate association between alcohol consumption and CHD mortality was evident. This association, however, did not persist after adjustment for plasma high-density lipoprotein cholesterol. CONCLUSION. Intervention on blood pressure and blood lipids is particularly important among cigarette smokers because of their increased risk of CHD death. The different associations between high-density lipoprotein cholesterol, fasting serum glucose, and CHD mortality for smokers and nonsmokers requires further investigation.     

Alcohol consumption and blood pressure in Japanese men.

In a study of Japanese men, a nonlinear association of alcohol consumption and blood pressure was not observed. This cross-sectional study was conducted to clarify the effect of infrequent or light alcohol consumption on blood pressure in normotensive Japanese men. The subjects were 2,179 male workers ranging in age from 40 to 54 years. Drinking habits were represented by three indices: episodic alcohol consumption, frequency of drinking, and monthly alcohol consumption. Seven items were analyzed as covariates: age, body mass index, salt intake, physical activity, and levels of gamma-glutamyl transpeptidase, uric acid, and plasma glucose. The association between drinking habits and blood pressure was evaluated by using analysis of covariance. Both episodic alcohol consumption and frequency of drinking were significantly associated with blood pressure in subjects aged 45 to 54 years. In those aged 40 to 44 years, there was a significant association between frequency of drinking and diastolic blood pressure. Significant associations of monthly alcohol consumption with blood pressure in every age group also were found. In subjects aged 45 to 54 years, linear associations between episodic alcohol consumption, frequency of drinking, monthly alcohol consumption, and adjusted blood pressure were observed. In those aged 40 to 44 years, nonlinear associations of monthly alcohol consumption and frequency of drinking with adjusted blood pressure were observed, and threshold effects of 540 ml of alcohol per month and a frequency of 1 to 12 days per month were found. In conclusion, habitual alcohol consumption increases blood pressure linearly in normotensive workers aged 45 to 54 years, although light consumption does not affect blood pressure in those aged 40 to 44 years.     

Alcohol consumption in the severely obese: relationship with the metabolic syndrome

OBJECTIVE: The aim of this study was to examine the association between the clinical and biochemical features of the metabolic syndrome and quantity and type of alcohol intake in the severely obese. RESEARCH METHODS AND PROCEDURES: A cross-sectional study was performed in 486 consecutive severely obese subjects. Data on alcohol consumption was collected by serial clinical interviews and a questionnaire. The relationship between alcohol intake and the clinical and serum chemistry features of the metabolic syndrome was analyzed by multiple statistical techniques. Laboratory measures included lipid profile, fasting blood glucose, hemoglobin A1c, and fasting serum insulin. An indirect index of insulin resistance was calculated using the log-transformed fasting insulin and glucose product. RESULTS: There were 486 subjects, 84% women, with a mean age of 40.6 +/- 10 years (range, 16 to 71 years) and a body mass index of 45.3 +/- 7 kg/m(2) (range, 34 to 77 kg/m(2)). Alcohol consumers (N = 276) showed a marked reduction in the adjusted odds ratio of type 2 diabetes (odds ratio = 0.29; 95% confidence interval, 0.16 to 0.55) compared with rare or nonconsumers (N = 210). There was a U-shaped relationship between the amount and frequency of alcohol consumption and fasting triglyceride, fasting glucose, hemoglobin A1c, and index of insulin resistance measurements. Consumers of < 100 g/wk had more favorable measures. The effect was attenuated when diabetics were excluded from the analysis. Timing of alcohol consumption did not influence outcome measures. DISCUSSION: Light-to-moderate alcohol consumption is associated with a lower prevalence of type 2 diabetes, reduced insulin resistance, and more favorable vascular risk profile in the severely obese. We would propose that light to moderate alcohol consumption should not be discouraged in the severely obese.