Among consumers of different types of alcohol, those who consume beer only have the lowest dietary quality compared with those confined to wine or liquor intake or those who consume multiple types of alcohol, according to data presented at TLM 2024.

In the study, dietary quality was assessed by the Healthy Eating Index (HEI) score, where a higher HEI score indicates better adherence to dietary guidelines and improved dietary quality, noted lead study author Madeline Novack, chief resident at Tulane School of Medicine’s internal medicine residency programme, New Orleans, Louisiana, US.

In the 100-point HEI, a score of 80 points was considered an adequate diet. “[Our results showed that] beer-only consumers had the lowest HEI-2015 score (49.3), while wine-only consumers had the highest (55.1),” Novack said. “After adjusting for confounders such as gender, age, income level, and race, we found a higher HEI in wine-only drinkers (β=3.19) and liquor/cocktail-only drinkers (β=3.01) compared with beer-only drinkers.”

For the respective liquor-only and mixed-intake groups, the total HEI-2015 scores were 52.8 and 52.6. [The Liver Meeting 2024, abstract 3019]

Stratifying by alcohol consumption level, those who consumed light wine only and liquor/cocktail only had higher HEIs than those who drank light beer only (β=3.69 and β=3.91, respectively).

Beer-only drinkers had the highest total daily caloric intake after adjusting for body weight (29.6 kcal/kg) and the lowest prevalence of sufficient physical activity (defined according to the WHO guidelines for adults; 42.2 percent) compared with the other three groups.

Driving factors

The investigators attributed the low HEI score among beer-only drinkers to a decreased intake of healthy foods such as whole fruits, vegetables, and proteins rather than an increase in the consumption of unhealthy foods such as unsaturated fats and added sugars.

One possible reason is that beer is often a staple accompaniment to meals laden with carbs and processed meat instead of fibre, whereas wine is typically paired with meals consisting of meat and vegetables, Novack pointed out.

Apart from the partnering context, the food choice may also drive the alcohol choice. For instance, salty or fried foods may trigger beer cravings, she added.

Lifestyle change key to liver disease prevention

“Alcohol overuse is the leading cause of cirrhosis in the US, and metabolic dysfunction-associated steatotic liver disease is rapidly increasing,” noted Novack in an accompanying press release. “Both types of liver disease often coexist, and lifestyle changes are key to managing and preventing these conditions, starting with understanding the link between alcohol use and poor nutrition.” [J Hepatol 2023;78:191-206]

Novack and colleagues retrospectively evaluated data from 1,917 alcohol drinkers from the National Health and Nutrition Examination Survey 2017-2020 cycle. Nearly 40 percent of participants were beer-only drinkers, 21.8 percent consumed wine only, 21 percent drank multiple* types of alcohol, while 18.2 percent had liquor/cocktail only.

Beer-only drinkers were younger (mean age 44.8 years) and mostly men (73.4 percent), while wine-only drinkers were older (mean age 53.4 years) and mostly women (72.4 percent). Wine-only drinkers were more likely to have high food security and less likely to live below poverty level compared with the other groups.

The HEI-2015 score had two components: Moderation and adequacy components. For the former, the dietary components were sodium, refined grains, saturated fats, and added sugar. For the latter, the components were total vegetables, greens and beans, total fruits, whole fruits, whole grains, total dairy, total protein foods, seafood and plant proteins, and fatty acids.

“Clinicians and health policy officials should focus on promoting healthier dietary patterns by recommending an increased consumption of healthy foods among beer-only drinkers to mitigate the combined impact of alcohol consumption and poor dietary quality,” Novack and colleagues concluded.

*The multiple types of alcoholic beverage included during the 24-hour dietary survey were beer and wine, beer and liquor, wine and liquor, or beer, wine, and liquor