Alcohol Consumption and Risk of Chronic Obstructive Pulmonary Disease

Abbreviations: MET, metabolic equivalent of task; SD, standard deviation.
^a P values, calculated across categories of alcohol consumption using an age-adjusted linear model for continuous variables and Pearson's χ² test for categorized variables, were statistically significant (all P's < 0.001).
^b1 standard drink (approximately 12 g of ethanol) was defined as 40 mL of liquor, 80 mL of strong wine (>18% alcohol), 150 mL of regular wine, 330 mL of class III beer (>3.50% ethanol by volume), 500 mL of class II beer (2.80%–3.50%), and 660 mL of class I beer (<2.25%).
^cMedian alcohol consumption ranged from 0.6 standard drinks/week to 27.5 standard drinks/week for the alcohol consumption categories 0.1–0.9 standard drinks/week and >20.0 standard drinks/week, respectively.
^dWeight (kg)/height (m)².
^eTotal physical activity is given as the metabolic equivalent of energy expenditure per day (kcal/kg × hours).
^fPercentages do not sum to 100 because of missing data for smoking status (576 men).
^gRecommended food score (range of possible scores, 0–36) included 36 food items: 13 vegetables, 6 fruits, 7 cereal products, 5 types of fish and seafood, 3 low-fat dairy products, nuts/almonds, and olive oil. When a recommended food item was consumed at least 1–3 times/month, 1 point was assigned (22).
^hNonrecommended food score (range of possible scores, 0–16) included 16 food items: 3 unprocessed red meats, 4 processed red meats, 3 high-fat dairy products, white bread, sweets, potato chips/popcorn and fried potatoes/French fries, unprocessed offal, mayonnaise, and ice cream. Consumption of any of these nonrecommended food items at least 3 times/week was assigned 1 point (22).

Abbreviations: CI, confidence interval; HR, hazard ratio; MET, metabolic equivalent of task.
^aAdjusted for age (years; continuous), cigarette smoking status and pack-years of smoking (never smoker; past smoker of <20, 20–39, or ≥40 pack-years; or current smoker of <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (weight (kg)/height (m)²; <18.5, 18.5–24.9, 25–29.9, or ≥30.0), total physical activity (MET-hours/day; quintiles), intake of energy (kcal/day; quintiles), recommended food score (range of possible scores, 0–36; continuous), and nonrecommended food score (range of possible scores, 0–16; continuous).
^bMissing data on educational level (0.7%), smoking status (1.3%), body mass index (4.9%), and total physical activity score (22.7%) were included in the models as separate categories.
^c1 standard drink (approximately 12 g of ethanol) was defined as 40 mL of liquor, 80 mL of strong wine (>18% alcohol), 150 mL of regular wine, 330 mL of class III beer (>3.50% ethanol by volume), 500 mL of class II beer (2.80%–3.50%), and 660 mL of class I beer (<2.25%).

Abbreviations: CI, confidence interval; HR, hazard ratio; MET, metabolic equivalent of task.
^aResults were mutually adjusted for beer consumption, wine consumption, and liquor consumption in the model.
^b1 standard drink (approximately 12 g of ethanol) was defined as 40 mL of liquor, 80 mL of strong wine (>18% alcohol), 150 mL of regular wine, 330 mL of class III beer (>3.50% ethanol by volume), 500 mL of class II beer (2.80%–3.50%), and 660 mL of class I beer (<2.25%).
^cAdjusted for age (years; continuous), cigarette smoking status and pack-years of smoking (never smoker; past smoker of <20, 20–39, or ≥40 pack-years; or current smoker of <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (weight (kg)/height (m)²; <18.5, 18.5–24.9, 25–29.9, or ≥30.0), total physical activity (MET-hours/day; quintiles), intake of energy (kcal/day; quintiles), recommended food score (range of possible scores, 0–36; continuous), and nonrecommended food score (range of possible scores, 0–16; continuous).
^dMissing data on educational level (0.7%), smoking status (1.3%), body mass index (4.9%), and total physical activity score (22.7%) were included in the models as separate categories.

Abbreviations: CI, confidence interval; HR, hazard ratio; MET, metabolic equivalent of task.
^aAdjusted for age (years; continuous), pack-years of smoking (past smoker of <20, 20–39, or ≥40 pack-years or current smoker of <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (weight (kg)/height (m)²; <18.5, 18.5–24.9, 25–29.9, or ≥30.0), total physical activity (MET-hours/day; quintiles), intake of energy (kcal/day; quintiles), recommended food score (range of possible scores, 0–36; continuous), and nonrecommended food score (range of possible scores, 0–16; continuous).
^bMissing data on educational level (0.7%), smoking status (1.3%), body mass index (4.9%), and total physical activity score (22.7%) were included in the models as separate categories.
^cData on smoking status were missing for 576 men.
^d1 standard drink (approximately 12 g of ethanol) was defined as 40 mL of liquor, 80 mL of strong wine (>18% alcohol), 150 mL of regular wine, 330 mL of class III beer (>3.50% ethanol by volume), 500 mL of class II beer (2.80%–3.50%), and 660 mL of class I beer (<2.25%).

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, hazard ratio.
^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.
^bAdjusted for age (continuous), smoking status and pack-years of smoking (never; past <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (<18.5, 18.5–24.9, 25–29.9, or ≥30 kg/m2), total physical activity (MET×h/d, quintiles), intake of energy (kcal/day, quintiles), and Recommended Food Score (scores, continuous) and Non- Recommended Food Score (scores, continuous).

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, hazard ratio.
^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.
^bAdjusted for age (continuous), smoking status and pack-years of smoking (never; past <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (<18.5, 18.5–24.9, 25–29.9, or ≥30 kg/m2), total physical activity (MET×h/d, quintiles), intake of energy (kcal/day, quintiles), and Recommended Food Score (scores, continuous) and Non- Recommended Food Score (scores, continuous).

^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, hazard ratio.
^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.
^bAdjusted for pack-years of smoking (never; past <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (<18.5, 18.5–24.9, 25–29.9, or ≥30 kg/m2), total physical activity (MET×h/d, quintiles), intake of energy (kcal/day, quintiles), and Recommended Food Score (scores, continuous) and Non-Recommended Food Score (scores, continuous).
^cMissing data on educational level (0.7%), smoking status (1.3%), body mass index (4.9%) and total physical activity score (22.7%) were included in the models as separate categories.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, hazard ratio.
^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.
^bAdjusted for age (continuous), pack-years of smoking (never; past <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), body mass index (<18.5, 18.5–24.9, 25–29.9, or ≥30 kg/m2), total physical activity (MET×h/d, quintiles), intake of energy (kcal/day, quintiles), and Recommended Food Score (scores, continuous) and Non-Recommended Food Score (scores, continuous).
^cMissing data on smoking status (1.3%), body mass index (4.9%) and total physical activity score (22.7%) were included in the models as separate categories.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, hazard ratio.
^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.
^bAdjusted for age (continuous), pack-years of smoking (never; past <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), total physical activity (MET×h/d, quintiles), intake of energy (kcal/day, quintiles), and Recommended Food Score (scores, continuous) and Non-Recommended Food Score (scores, continuous).
^cMissing data on educational level (0.7%), smoking status (1.3%) and total physical activity score (22.7%) were included in the models as separate categories.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; HR, hazard ratio; MET, metabolic equivalent of energy expenditure (kcal/kg x h).
^aStandard drink (~12 g alcohol) = 40 ml liquor, 80 ml strong wine, 150 ml wine, 330 ml beer >3.5% alcohol, 500 ml beer 2.8 to 3.5%, or 660 ml beer <2.25%.
^bAdjusted for age (continuous), pack-years of smoking (never; past <20, 20–39, or ≥40 pack-years; or current <20, 20–39, or ≥40 pack-years), education (less than high school, high school, or university), body mass index (<18.5, 18.5–24.9, 25–29.9, or ≥30 kg/m2), intake of energy (kcal/day, quintiles), and Recommended Food Score (scores, continuous) and Non-Recommended Food Score (scores, continuous).
^cMissing data on educational level (0.7%), smoking status (1.3%) and body mass index (4.9%) were included in the models as separate categories.

Authors and Disclosures

Joanna Kaluza*, Holly R. Harris, Anders Linden, and Alicja Wolk

Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Joanna Kaluza, Alicja Wolk); Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Warsaw, Poland (Joanna Kaluza); Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (Alicja Wolk); Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington (Holly R. Harris); Unit for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Anders Linden); and Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden (Anders Linden).

* Correspondence to
Dr. Joanna Kaluza, Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, 159C Nowoursynowska Street, 02–776 Warsaw, Poland (e-mail: joanna_kaluza@sggw.pl).

Conflict of interest
none declared.