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ALCOHOL & THE BODY.
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Research proposal to define effects excessive alcohol consumption has on body fat & body composition.... More...
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Paper Abstract:
Research proposal to define effects excessive alcohol consumption has on body fat & body composition.
Paper Introduction:
Introduction
Over the years, attempts have been made to define the contribution of excessive alcohol consumption to changes in body composition and body fat content. There is no doubt that excessive alcohol consumption leads to destruction of the liver, and thus associated body composition changes, and that many alcoholics appear undernourished, as they drink rather than eat, but the actual contributions of alcohol intake to body composition and body fat have been poorly studied. In the next section, some of the studies on the affect of alcohol on body fat and body composition will be examined. A proposed study to define the effects of excessive alcohol consumption on changes in body fat and body composition will be outlined. Knowing how alcohol affects body composition may give clinicians a clue as to
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Nakamura, Tang, Villanueva, Halsted and Phinney (1 ), in a followupto a study they had previously conducted on micropigs, which had shown thata long-term low-fat and ethanol diet caused a decrease in arachidonic acidlevels in multiple tissues but no significant liver pathology, investigatedfeeding with a diet high in linoleic acid, and looked at tissue fatty acidsand body composition. D.; Roselle, G. The results showed that moderate alcoholconsumption correlates with abdominal distribution of body fat andincreased plasma androgenicity in adult healthy women. The ethanol group showed decreased 2 :4 omega 6and docosahexaenoic acid after one month. Am.J. The diet consisted of 4 percent ethanol and 34percent fat as energy sources, and used pigs fed with corn starch in placeof ethanol as controls. Nutr. Liver biopsies were carried out a baseline andthree other time points in the study. Tremblay, A.; Buemann, B.; Theriault, G.; Bouchard, c. The body composition and lipid metabolic effects oflong term ethanol feeding during a high omega 6 polyunsaturated fattyacid diet in micropigs. Three months of abstinence from alcohol mormalizesenergy expenditure and substrate oxidation in alcoholics: a longitudinalstudy. J.; Longcope, C.; Speizer, F. Addolorato, G.; Capristo, E.; Greco, A. Energy value of moderate alcohol consumption by humans. Res. Nutr. A.; Giovannucci, F.; Rimon, E. The consumption of candy and sugar isinversely related to alcohol intake, suggesting that it is related toappetite for alcohol. B.; Villanueva, J.; Halsted, C. Recent Dev. He believes that variations in alcohol metabolic ratesbetween individuals of the same gender make assessment of genderdifferences difficult. E.; Hunter, D. Metabol. C.; Manson, J. There was aprevalence of fat distribution in the abdominal region in alcoholics.Daily energy expenditure was significantly higher in alcoholics. With any longterm study there are factors inthe participants lives which cannot be predicted, such as medical problemsor job relocation, which will cause them to drop out of the study. E. The best prediction with the least bias is from waistcircumference adjusted for age.Effect of Alcohol on Body Composition A study was carried out at a university hospital in Italy to evaluatethe influence of chronic alcohol abuse on body composition and energymetabolism in patients with chronic alcoholism, without evidence of livercirrhosis or malabsorption, compared with a group of social drinkers (1).Body composition was assessed by anthropometric measurements. This may also prove a problem in a longterm study sincedrinking habits may vary over time in either group.Setting Parameters It will be necessary to set parameters for what is to be considered asignificant change in body fat and body composition. Theauthors believe that these results suggest that the association of alcoholconsumption and postmenopausal obesity with subsequent breast cancer riskmight be mediated in part through an influence on postmenopausal plasmaestrogen levels.Difference of Effect of Alcohol on Men and Women Colditz et al (5) looked at the relation between alcohol intake, bodymass index, and diet in 89,538 women and 48,493 men. In each session the subjects had freeaccess to either high- or low-fat foods, with alcohol or placebo. D. V.; Rhodes, D. 62:639644; 1995.----------------------- 16 Analysisof the results of the study will take these factors into account and makecomparisons between and within these groups - men, women, lean women, heavywomen, premenopausal women, postmenopausal women - to avoid any bias.Monitoring of Participants The population will have to be monitored regularly to make sure thatthere are no changes in their alcohol intake during the course of thestudy. 8. In addition to this group, the effects of alcohol on energy andmacronutrient intake was studied in 352 men and 36 women.The results showed that a high alcohol intake was associated with a highdaily energy intake and had no inhibitory effect on lipid intake. E. Leibel, Dufour, Hubbard and Lands are in agreement with Thomasson(8). 12:163-179;1995.14. Hankinson et al looked at plasma hormone levels and assessed them inrelation to alcohol consumption, height, and adiposity among postmenopausalwomen (6). Suter, P. A study of the adverse effects ofchronic alcohol consumption in 15 male rats over their 25-month lifespanwas carried out. Literature ReviewMeasurement of Body Fat Body fat percentages can be predicted from body density measured byunderwater weighing using simple anthropometric measurements (7). Am. This study suggests thatalcoholics have a lower fat mass than non-alcoholics due to an alterationin substrate oxidation. S.; Lands, W. They say that many epidemiological studies show that alcohol-derivedcalories add to the food intake of men and women in amounts of zero to 25percent of total energy, but do not appreciably alter the average dailyintake of macronutrients (carbohydrate, fat, and protein). E. Methods of assessing bodycomposition changes and body fat changes also need to be well-defined.Proposed Study A study is proposed to look at the effects of excessive alcoholconsumption on body composition changes and body fat changes. 3. Evaluations at two, three, eight, 13, 19, and 25 monthsof age (9) included changes in nutrition status, biochemical tests forliver injury, compositional changes in the liver, and hepatic regenerativecapacity. F.;Gasbarrini, G. Subjects classified aslow-fat consumers displayed significantly lower levels of fat mass andsubcutaneous adiposity compared to high-fat consumers. 4. V.; Stefanini. Stepwise-multiple-regression analysis can be used. Skinfold-thickness measurements continue to give goodpredictions of measured body density, but with significant bias at extremesof body fat and age. Gastroenterol. The subjects were given alcoholand no alcohol for three months each in a crossover design. Alcohol-induced suppression of lipid oxidation can enhancepositive energy balance, leading to weight gain.Use of energy from alcohol: body weight factor A study was conducted which looked at the difference in use of energyfrom alcohol in lean and heavy women (4). Body composition will be calculated byusing their height and weight measurements.Selection Criteria for Population to be Studied The test and control populations will be matched for age, gender,height, weight, hormonal status of females (pre- or post-menopausal),length of time for which subjects have been using alcohol at time of entryinto the study, and baseline body fat and body composition measures. In the next section, some of the studies onthe affect of alcohol on body fat and body composition will be examined. R. Alcoholand calories: a matter of balance. Alcoholics showed a significantly lower body weight and asignificantly lower fat mass compared with controls. The effects of alcohol and dietary fat on spontaneous energy andmacronutrient intake were investigated in eight male subjects whoparticipated in a protocol including four randomly assigned sessions inwhich they ate ad libitum (15). 125:2536-254 ; 1995. B.; Stampfer, M. Fatty compositional changes occurred early (a five-fold increasesafter one month of treatment), then declined to levels only slightly abovecontrols. J.Clin. C. They found that although metabolic parameters hadimproved after one and two months, it took three months of abstinence foralcoholics to exhibit body mass indices, fat mass, basal metabolic rate/fat-free mass, and lipid and carbohydrate oxidation levels equal to those ofcontrols.Effect of Alcohol on Body Fat Tremblay, Buemann, Theriault and Bouchard (14) looked at bodyfatness in active individuals in relation to fat and alcohol intake.Significant positive correlations were observed between the percentage ofdietary energy as lipids and adiposity indicators. Nakamura, M. Tremblay, A.; Wouters, E.; Wenker, M.; St-Pierre, S.; Bouchard, C.;Despres, J-P. Nutr. Phospholipid levels were measured bythin-layer and gas chromatography. Bodycomposition results indicated marked wasting of energy in the ethanolgroup.Literature Reviews and Critiques Thomasson points out that gender differences in alcoholpharmacokinetics may explain why women are more vulnerable to ethanol'stoxic effects (13). After adjusting for other covariates, thegroup found a strong correlation between BMI and plasma estrogens. Incontrol animals, an age-related decline was also seen, but occurred onlybeyond 12 months of age. The [Log sub 1 ] sum of fourskinfold thicknesses, and equations using limb lengths instead of heightmay be valuable for epidemiologic and clinical work. 2 :2 6-212; 1996. Energy expenditure, measuredfor a 24-hour period in a room calorimeter at the end of each eight-weekperiod was the same for both periods. The group considered heavy drinkers will be selected so that theyare matched as to how many drinks they have each week so that they can becompared as a group, and individual differences in alcohol do not affectthe results. The difference wasfound mainly in truncal subcutaneous adiposity. 5. S. 54:49-55; 1991. Alcohol intake inrelation to diet and obesity in women and men. The feeding period was divided into two eight-weekcrossover periods in which alcohol or carbohydrate was added to the diet.The metabolized energy content of the diets was determined for all subjectsthrough measurement of total food intake and fecal and urinary losses forseven days during both eight-week periods. Energy intake excluding alcoholvaried little with alcohol intake, but sucrose intake decreased with higheralcohol intake. Rev. 55:157-171; 1997.13. Med. Mendenhall, C. Introduction Over the years, attempts have been made to define the contribution ofexcessive alcohol consumption to changes in body composition and body fatcontent. The enhancingeffect of alcohol and dietary fat on daily energy intake were additive,leading to maximal overfeeding in the high- fat plus alcohol condition. The 16 men and 32 womenwere divided equally into two groups and consumed either a high- or low-fatdiet for 16 weeks. Literature Cited 1. Clevidence, B. The proposedpopulation for the study includes 25 subjects who consume more than sixdrinks per week and 25 control subjects who consume less than two drinksper week. Maximal changes were observed at the two extremes of age, two tofive months and 19 to 25 months, which meant that a nutritionalcontribution to other adverse changes could not be excluded. A.; Stampfer, M. J. This slowly progressive decrease in the omega 3/omega 6 ratioin liver phospholipids with ethanol feeding may have enhanced theinflammatory response in the liver, contributing to liver pathology. Body fatnessin active individuals reporting low lipid and alcohol intake. An investigation of the effects of an equal-energetic substitution ofethanol for dietary carbohydrate in high- and low-fat diets looked atenergy expenditure and body composition (11). It may alsoindicate what chemical interventions could be used to reduce the cravingsfor alcohol and prevent its destructive effects on the body. The most powerful predictor appears to be waist circumference and triceps-skinfold thickness. Sincethe study wishes to determine changes in body fat and body composition, itwill be a longterm study, as these changes do not take place rapidly. 7. J.; Han, T. The results of animal experiments suggest that femalesexhibit higher alcohol metabolic rates than males as a result of hormonaldifferences, but experiments looking at gender differences in humans areinconclusive. Afteradjustment for BMI, cigarette smoking and physical activity, significantdifferences were found in waist circumferences and waist-hip ratios, aswell as in plasma androgens, with increasing daily alcohol intake.Abdominal visceral fat area correlated positively with plasma freetestosterone and alcohol intake. This means that sixdrinks a week may not be considered excessive by some, so the study mayactually be looking at the effects of moderate alcohol intake on body fatand body composition changes. 6. R.; Campbell, W. M.; Hasler, E.; Vetter, W. Relat. T.; Tang, A. Alcohol. Body composition analysis demonstrated a marked reduction of carcassfat in the ethanol group, but no significant reduction of carcass leanweight after 12 months. J. J. Clin. Anthropometric and computertomography measurements of body fatness and adipose tissue distribution,main behavioral factors, and plasma androgens were recorded. Ethanol diet survival was poorer than the pair-fed control groups by 15 percent, with a median survival of 17 months foralcoholics and 2 months for controls. J.; Conway, J. This conclusion isin conflict with some of the studies above which indicate alcohol isresponsible for excessive fat, particularly in the abdominal region (3, 12,14).Rationale for Proposed Study From the above studies, it is obvious that there is stillconsiderable variation in the assessment of the contribution of excessivealcohol intake on changes in body fat and body composition. L.; Dufour, M.; Hubbard, V. Obes. I.; Rouster, S. Nutr. J.Clin. V.; Caputo, F.; Stefanini, G.F.; Gasbarrini, G. Effects of alcohol on energymetabolism and body weight regulation: is alcohol a risk factor forobesity? 2. Body composition, genetic factors, gastric andhepatic dehydrogenase activity, and gastric absorption all may play a rolein creating gender differences in alcohol metabolism. Alcoholics showeda higher lipid utilization than controls. Metab. The high-fat diet was associated with a substantial increase in daily energy intake. While wastingis a common feature of excessive alcohol consumption (1, 1 ), withalcoholics exhibiting a lower body mass, many studies show that alcoholconsumption leads to the deposition of body fat, particularly in theabdominal region, and does not inhibit food intake (3, 12, 14). J.;Ghosn, S.; Gartside, P. J. One drawback of this study is that there is no cleardefinition as to what "excessive alcohol intake" is. This will not nullify the results, but theywill have to be considered in this light, and not compared with studies ofexcessive alcohol intake involving much higher levels of alcoholconsumption.Measurement of Body Fat All individuals in the study will be tested for body fat percentagesby underwater weighing and simple anthropometric measurements using waistcircumference adjusted for age. Moderate alcohol consumption andits relation to visceral fat and plasma androgens in healthy women.Int. 87:1297-13 1; 1995. Nutr. Am. Am. These datashow clearly that, on an energy basis, ethanol and carbohydrate areutilized in the diet with the same efficiency.Animal Studies Studies in animals have looked at the effects of chronic alcoholintake on body composition (9, 1 ). S.; Judd, J. Biochemical serological tests for liver injury were consistentlyhigher with alcohol treatment. Itwill also select excessive alcohol consumers very early in their drinkingcareer so that baseline values can be established before such changes havetaken place. Department of Agriculture Beltsville HumanNutrition Research Center's Diet Study Facility. Eur. 9. S.; Deurenberg, P. The totalenergy intake from food was higher in the control group. 17:847-853; 1993.1 . L. G. Theconclusions from the studies are that a diet high in fat and alcoholincreases the risk for a positive energy balance and thus weight gain.This correlates with a study by Suter, Hasler and Vetter (12) whichconcluded that moderate alcohol consumption appears to be a risk factor forobesity. Subcutaneousadiposity was doubled when subjects with high lipid and alcohol intake werecompared to subjects with low lipid and alcohol intake. Leibel, R. The study considersmore than six drinks per week excessive, yet many doctors now advise that aglass of wine a day can help prevent heart disease. Clin. Alcohol appears to have caused abody composition change in these animals. 64:1 8-114; 1996.12. 49:824-831; 1995.15. In spite of nearly identical caloric intake, alcohol treatmentwas associated with nutritional levels 1 to 3 percent lower thancontrols. Cancer Inst. 93:2476-2481; 1993. Lean, M. G.; Baer, D. Predicting bodycomposition by densitometry from simple anthropometric measurements. pre- or post-menopausal women), body type at onset of drinking, and individualvariations in response to alcohol intake. The study suggeststhat the relation between alcohol intake and fat distribution may bemediated, at least in part, by plasma androgens. During the controlledfeeding study, subjects maintained their weights and consumed only food anddrink provided by the U. There isobviously a need for more controlled studies which take into accountvarious factors such as gender, age, hormonal status (i.e. Alcohol 1 :427- 434; 1993. A.; Taylor, P. Gender differences in alcohol metabolism.Physiological responses to ethanol. Colditz, G. Alcohol and fat diet: a combination favoring overfeeding.Am. 63:4-14; 1996. In choosing the population for this longterm study, it may benecessary to start with a higher number of participants due to anunavoidable dropout problem. M.; Seale,J. Impact of chronic alcoholism on the aging rat:changes in nutrition, liver composition, and mortality. With such lackof evidence for caloric compensation, they say, alcohol and its caloriesseem to make little contribution to metabolic energy, body weight, or bodycomposition as indicated by the body mass index, BMI. J.;Colditz, G. Alcohol,height, and adiposity in relation to estrogen and prolactin levels inpostmenopausal women. Body composition was analyzed byunderwater weighing of carcasses. Cigolini, M.; Targher, G.; Bergam Andreis, I. In men, totalenergy increased with alcohol consumption. H.;Phinney, S. Knowing howalcohol affects body composition may give clinicians a clue as to how torestore normal body conditions in the treatment of alcoholics. Regenerative capacity measured by[3H]thymidine uptake after partial hepatectomy was initially elevated inthe alcoholic rats, then rapidly declined beyond seven months of age. Combining triceps-skinfold thickness with other anthropometric measurements can also be used. Influence of chronic alcohol abuse on body weight andenergy metabolism: is excess ethanol consumption a risk factor forobesity or malnutrition? Nutr. While this value remainedconstant after a month, 22:6 omega 3 showed a progressive decrease up to 12months, resulting in a continuous decrease of the omega 3/omega 6 fattyacids ratio. Alcohol. J.;Rosner, B.; Speizer, F. With only25 subjects to start with, this may leave too few participants to drawmeaningful conclusions at the end of the study.Analysis of Results Studies cited above have shown difference between the way men andwomen process alcohol and how it affects their dietary intake (5, 13).They have also shown differences in the way lean and heavy women processalcohol and its effect on their diet (4), and the difference betweenalcohol and body changes in pre- and postmenopausal women (3, 6). Natl. E.; Gordis, E., Willett, W. Aproposed study to define the effects of excessive alcohol consumption onchanges in body fat and body composition will be outlined. These data suggest that calories from alcohol were addedto energy intake from other sources in men, and that in women, energy fromalcohol intake displaced sucrose. J. A.; Grossman, C. Thomasson, H. E.; Willet, W. Disord. Total energy expenditure was thesame when subjects consumed either ethanol or carbohydrate. Other than alcohol intake, there will be no other dietaryrestrictions. A.; Tonoli, M.;Filippi, F.; Muggeo, M.; Sandre, G. These researchers also looked at the effect of three months ofabstinence from alcohol on 15 alcoholic patients who were able to achievethis abstinence (2). J. 244:387-395; 1998. Restingenergy expenditure and substrate oxidation rate was measured by indirectcalorimetry. This decrease in carbohydrate intake was mainly due todecreased sugar consumption with higher alcohol intake, reflectingdecreased energy consumption from sources excluding alcohol. Nutr. The study will needto be open-ended, as there is no information available at present whichprovides indicates how long it takes for these changes to occur.Participants will be monitored regularly to determine when these changestake place to a significant degree, and the study will continue until allparticipants considered excessive drinkers reach the predeterminedsignificant changes. J. Rumpler, W. Clin.Exp. Addolorato, G.; Capristo, E.; Greco, A. Somesubjects may be willing to commit to a longterm study in the beginning, butmay tire of it after a while and no longer wish to participate. Hankinson, S. Clin. After controlling for age, height, smoking status, and BMI,alcohol consumption was positively associated with estrone sulfateconcentrations; no statistically significant association was noted forother plasma hormone levels. 42:134 -135 ; 1993.11. The averagechange in energy intake associated with the alcohol treatment wasnegligible, but lean women needed a higher carbohydrate supplement tomaintain body weight than did heavier women, suggesting that not allsubjects used energy from alcohol with equal efficiency.Hormones and Alcohol Consumption A study of women by Cigolini et al (3) looked at the relationshipbetween daily alcohol intake, fat distribution, and plasma androgens to seeif daily alcohol intake correlates with abdominal fat, and if thisrelationship is mediated by plasma androgens. There is no doubt that excessive alcohol consumption leads todestruction of the liver, and thus associated body composition changes, andthat many alcoholics appear undernourished, as they drink rather than eat,but the actual contributions of alcohol intake to body composition and bodyfat have been poorly studied. Intern. T.Lean and heavy women may not use energy from alcohol with equalefficiency. In women, totalenergy increased with alcohol consumption, and carbohydrate intakedecreased. Alcohol had no inhibitory effect on food intake and its energy content wasthus associated with an additional increase in energy intake.
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