Does beer consumption cause beer belly_

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					                                                     11-4-2011




                    Does beer consumption
                    cause beer belly?
                    Nathalie Tommerup Bendsen, PhD
                    Department of Human Nutrition
                    Faculty of Life Sciences
                    University of Copenhagen




8 April 2011 [1]




                    Beer belly – myth or fact?




            Does beer intake increase
            the risk of
               ▪ overweight / obesity?
               ▪ abdominal fatness?

            Does intake level matter?




8 April 2011 [2]




                                                            1
                                                                                  11-4-2011




                                What is beer?


            Main ingredients of most beers are:
            Water, Barley, Hops and Yeast.

            Nutrient content of beer (per 100 g, pilsner type):
            - Energy : ~45 kcal                                Sweet
                                     7.4 kcal per gram
            - Alcohol: ~4-5 g                                  taste
            - Several carbohydrates (sugars and dextrins): ~3 g
            - Small amount of protein: <0.1 g
            - Fiber: ~0.6 g
            - B-vitamins, especially B6 (pyridoxine) & B9 (folate)   Bitter
            - Minerals: magnesium, potassium & silicon               taste
            - Numerous trace compounds:
                          polyphenols, flavonoids and isohumulones
8 April 2011 [3]




                                What is beer?
                                                                     Per 100 ml


            Main ingredients of most beers are:
            Water, Barley, Hops and Yeast.

            Nutrient content of beer (per 100 g, pilsner type):
            - Energy : ~45 kcal                                Sweet
                                   7.4 kcal per gram
            - Alcohol: ~4-5 g                                  taste
            - Several carbohydrates (sugars and dextrins): ~3 g
            - Small amount of protein: <0.1 g
                                ~350 ml
            - Fiber: ~0.6 g
            - B-vitamins, especially B6 (pyridoxine) & B9 (folate)
                               ~150 ml                               Bitter
            - Minerals: magnesium, potassium & silicon               taste
                                 ~40 ml
            - Numerous trace compounds:
                          polyphenols, flavonoids and isohumulones
                                                       Wannamethee, Beer in
                                                       health and disease
8 April 2011 [4]                                       prevention, 2009




                                                                                         2
                                                11-4-2011




                     Why should beer intake
                       promote fatness?


            • Alcohol metabolism &
              fat oxidation

            • Liquid energy &
              satiety

            • Alcohol & appetite




8 April 2011 [5]




                   Do alcohol calories count?




8 April 2011 [6]




                                                       3
                                                                                  11-4-2011




                   Alcohol intake decreases fat oxidation




                                                  Suter et al. NEJM 1992

8 April 2011 [7]




                          Liquid energy & satiety

                              Meal-replacement
                            shake vs. nutrition bar




                                                      Leidy et al. Obesity 2010

8 April 2011 [8]




                                                                                         4
                                                                                             11-4-2011




                     Beer (& wine) increases appetite
                            and energy intake




                                                                    Westerterp-Plantenga &
                                                                    Verwegen, AJCN 1999


8 April 2011 [9]




                    Are alcohol calories compensated for?




                            Mattes. Physiololy and Behaviour 1996

8 April 2011 [10]




                                                                                                    5
                                                                                                                  11-4-2011




                                  Why should beer intake
                               promote abdominal fatness?




                                   Alcohol stimulates production of
                                                cortisol
                                                   +
                                  Alcohol decreases lipid oxidation

                                                     Central obesity


                                                                                  Adinoff et al. Alcoholism:
                                                                                  Clin Exp Res 2005
                                                                                  Suter et al. NEJM 1992
                                                                                  Purnell et al. AJP 2009

8 April 2011 [11]




                             Systematic review: What is the
                          evidence for a fattening effect of beer?

                    Records identified through databases (n = 2811)
                                                                           Records identified through
                                                                           other sources (n = 11)
                    Full-text articles assessed for eligibility (n = 70)

                                                                           Full-text articles excluded (n = 25)
                    Studies included in qualitative review (n = 45)
                    Observational studies (n = 34)
                    Intervention studies (n = 11)
                                                                           Not included in syntheses (n = 22)

                Studies included in quantitative synthesis
                Intervention studies (n = 10)
                     •Beer vs non-alcoholic beer (n = 6)
                     •Beer vs. control (n = 4)
                Studies included in dose-response graphs:
                Observational studies (n = 14)
                    •Prospective analyses (n = 5)
                    •Cross-sectional analyses (n = 10)
8 April 2011 [12]




                                                                                                                         6
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                               Observational studies:
                    Association between beer intake and fatness

                                                        Women                         Men
                                                Overall       Abdominal     Overall       Abdominal
                                                fatness        fatness      fatness        fatness
                                              (BMI/weight)   (WC/WHR)     (BMI/weight)   (WC/WHR)
              ↑ positive association

                    Cross-sectional studies                      ••          ••••        •••••••••
                    Prospective studies                         •••            •              •••
              ↔ no association
                    Cross-sectional studies      ••••        ••••••••      ••••••••         •••••••
                    Prospective studies            •             ••            •              ••

              ↓ negative association
                    Cross-sectional studies      ••••            •
                    Prospective studies            •             ••            •              ••



8 April 2011 [13]




                         Is there a dose-response relationship?

                                               Our expectation

         Waist circumference




8 April 2011 [14]




                                                                                                             7
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                             Cross-sectional studies:
                             Are beer-drinkers fatter?

                                    Body mass index




                      Waist-hip ratio              Waist circumference




      16 glasses/wk
8 April 2011 [15]




                               Prospective studies:
                    Does beer consumption increase the risk of
                           future weight or waist gain?

                                  Body weight change




                                        Waist change




8 April 2011 [16]




                                                                                8
                                                                                                                                                    11-4-2011




                                   Intervention studies:
                            Alcoholic beer vs low-alcoholic beer


                                                                                               - 3-6 wk
                                                     vs                                        - 40-64 g/day ethanol
                                                                                                 ~1.1-1.8 L alcoholic beer


                                                                       Mean Difference                           Mean Difference
        Study or Subgroup       Mean Difference         SE Weight      IV, Random, 95% CI                       IV, Random, 95% CI
        Beulens_2008                           0.7    0.276   12.7%        0.70 [0.16, 1.24]
        Cox_1990                              0.42    0.225   19.1%       0.42 [-0.02, 0.86]
        Masarei_1986                           0.7    0.165   35.5%        0.70 [0.38, 1.02]
        Puddey_1987                            0.9    0.255   14.9%        0.90 [0.40, 1.40]
        Puddey_1992                            1.7    0.752    1.7%        1.70 [0.23, 3.17]
        Zilkens_2003                           0.9    0.244   16.2%        0.90 [0.42, 1.38]

        Total (95% CI)                                        100.0%      0.73 [0.53, 0.92]
        Heterogeneity: Tau² = 0.00; Chi² = 4.54, df = 5 (P = 0.48); I² = 0%
                                                                                               -4           -2          0          2           4
        Test for overall effect: Z = 7.39 (P < 0.00001)                                             Favours alcohol Beer Favours low-alcohol Beer



                                                                         A 0.7 kg higher body weight after
                                                                         alcoholic beer compared to low- or
                                                                                  non-alcoholic beer
8 April 2011 [17]




                                           Intervention studies:
                                        Alcoholic beer vs no alcohol


                                                                                               - 3-9 wk
                                                      vs                                       - 24-40 g/day ethanol
                                                                                                 ~0.6-1.0 L alcoholic beer


                                                                              Mean Difference                      Mean Difference
       Study or Subgroup            Mean Difference           SE Weight       IV, Random, 95% CI                  IV, Random, 95% CI
       Addolorato_2008                                  0       0                   Not estimable
       Hartung_1983_inactive                          0.8   2.427   10.5%        0.80 [-3.96, 5.56]
       Hartung_1983_joggers                           0.5    2.66    8.7%        0.50 [-4.71, 5.71]
       Hartung_1983_runners                           0.6   2.865    7.5%        0.60 [-5.02, 6.22]
       Ka_2005_high_drinkers                         -0.1   4.661    2.8%       -0.10 [-9.24, 9.04]
       Ka_2005_low_drinkers                           0.7   3.005    6.9%        0.70 [-5.19, 6.59]
       Romeo_2008_men                                 0.4   1.617   23.7%        0.40 [-2.77, 3.57]
       Romeo_2008_women                               0.5   1.616   23.7%        0.50 [-2.67, 3.67]
       Zilkens_2005                                  0.66    1.96   16.1%        0.66 [-3.18, 4.50]

       Total (95% CI)                                               100.0%      0.54 [-1.00, 2.08]
       Heterogeneity: Tau² = 0.00; Chi² = 0.05, df = 7 (P = 1.00); I² = 0%
                                                                                                         -10      -5       0       5      10
       Test for overall effect: Z = 0.68 (P = 0.49)                                                            Favours Beer Favours Control




8 April 2011 [18]




                                                                                                                                                           9
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                                        Conclusions


                    •    Few studies have been conducted with the
                         objective to assess whether beer intake is
                         associated with body fatness
                    •    Results are inconsistently presented across
                         studies
                    •    Most studies are of low quality
                    •    Limited scientific evidence to support that beer
                         intake is responsible for the beer belly
                    •    High beer intakes (>4 L or 16 gl/wk) may be
                         associated with a higher degree of abdominal
                         adiposity

8 April 2011 [19]




                    Possible explanations for inconsistent
                                   findings



                        • Underreporting of beer intake
                        • Are excessive drinkers included in
                          research studies?
                        • Drinking pattern
                        • Lifestyle
                          •   Physical activity
                          •   Diet
                          •   Smoking
                          •   Education



8 April 2011 [20]




                                                                                  10
                                                                              11-4-2011




                    Beer-drinking and lifestyle I




                                                            Johansen et al.
                                                            BMJ 2006




8 April 2011 [21]




                    Beer-drinking and lifestyle II


          Germany
          7876 men




                                          Schütze et al. EJCN 2009

8 April 2011 [22]




                                                                                    11
                                                                                                   11-4-2011




                               Beer goggles




               •    80 university students were asked to rate
                    the attractiveness of unfamiliar faces
                    (photos) of the opposite sex

               •    Results:
                    Attractiveness ratings were positively
                    correlated with blood alcohol concentration

               •    Conclusion:
                    Beer increases attractiveness ratings for
                    opposite sex faces

                                                                               Lyvers et al. Soc
                                                                               Psychol. 2011.
8 April 2011 [23]




                             Thank you for your
                                 attention.

                                      Questions?

                                   nathalie@life.ku.dk
                            The Dutch Beer Knowledge Institute provided
                           financial support for the execution of this work.




8 April 2011 [24]




                                                                                                         12
                                                                                                 11-4-2011




                                      Beer and mortality




                                                                           Castelnuovo et al.,
                                                                           Arch Int Med 2006




          22% CHD risk reduction                           HDL-cholesterol ↑
          among beer drinkers                              Adiponectin ↑
                                                           Fibrinogen ↓
          (95% CI: 14 - 30%)                                           Brien et al., BMJ 2011
                    Castelnuovo et al., Circulation 2002   Insulin sensitivity ↑
                                                           Blood pressure ↓
8 April 2011 [25]




                    Alcohol and risk of type 2 diabetes
       A meta-analysis: ~370.000 subjects followed for 12 y


   RR of T2D




                                                                         Koppes et al.
                                                                         Diabetes Care 2005

8 April 2011 [26]




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Description: Some friends worried that drunk beer make you fat, produce beer belly. In fact the beer together with the fat does not make sense. Beer can result in higher heating value, which comes mainly from the alcohol extract and other nutrients. Because different types of beer, how many calories there are differences, such as large bottle of good beer, about 160 kilocalories Phoenix, extract ingredients into a 90 kilo-calories, these calories for normal day is about 1 / 5 of the heat. Beer does not contain the body fat of high-fat, so the beer itself does not make people fat. But it is worth mentioning that the beer has to promote the role of the human body the secretion of gastric juice, can increase appetite, plus drink, eat high-calorie dishes with increased fat absorption, it is hard to say. So without restraint to binge eating is causing the real reason for the body fat.