Alcohol Consumption Pattern and Nutritional Intake: Analysis of the 2017‐2018 National Health and Nutrition Examination Survey

Background Poor nutrition is often considered a component of alcohol use disorder as heavy drinkers substitute calories from macronutrients with ‘empty’ calories from ethanol. Indeed, the relationship between alcohol use and nutrition has long been of research interest due to the key role of diet in modifying individual susceptibility to alcohol‐induced multi‐organ pathology, such as alcohol‐associated liver disease. The goal of the current study was to evaluate nutritional intake among individuals with various drinking patterns through analysis of the 2017‐2018 National Health and Nutrition Examination Survey (NHANES). We hypothesized that individuals with the greatest alcohol intake would have the highest total caloric consumption, but that these individuals would have the lowest nutrient density in their overall diet. Methods Using the 2017‐2018 NHANES, we divided survey participants into the following four drinking categories based on guidelines from the National Institute on Alcohol Abuse and Alcoholism and the United States Department of Agriculture: never drinkers (n=500), non‐drinkers (past‐year abstainers, n=874), moderate drinkers (1 or 2 drinks per day for females or males, respectively, with no binge drinking, n=2658), and heavy drinkers (>1 or >2 drinks per day for females or males, respectively, or binge drinking, n=393). We analyzed 24‐hour dietary recall variables including macro‐ and micronutrient intake, as well as anthropometric measurements. One‐way ANOVA was used to determine significance by p values <0.05. Results Compared to never, non‐, and moderate drinkers, heavy drinkers consumed the highest total calories (by roughly 500 calories), coming from higher intake of carbohydrates, protein, fat, and alcohol. Further, heavy drinkers also consumed more of most micronutrients reported by the NHANES (apart from several antioxidant carotenoids such as alpha‐ and beta‐carotene and lutein/zeaxanthin). Interestingly, despite increased alcohol consumption and macro‐/micronutrient intake, heavy drinkers did not have an increased body mass index or waist circumference compared to other drinking groups. Conclusion Though poor nutrition has often been associated with excessive alcohol consumption, the results of this study showed that heavy drinkers consumed the most nutrient‐dense diet overall. Despite significant differences in total energy intake in heavy drinkers, anthropometric measurements were comparable across drinking groups. Future research should further investigate the relationship between alcohol use and nutrition in the NHANES and other sources.