Abstract
Background
Studies across racial/ethnic groups indicate that physical activity (PA) and alcohol consumption are positively associated, and that alcohol consumption is negatively associated with body mass index (BMI), but this relationship is less often evaluated in Hispanics. The purpose of this study was to assess the relationships between alcohol consumption, PA, and BMI in Hispanic adults.
Methods
In this secondary data analysis of a Mexican-American cohort, we collected self-reported PA, alcohol consumption, and demographics, and measured height and weight. Linear regression assessed the association between PA and alcohol consumption with BMI, controlling for covariates. Total sample for analyses was n = 3897.
Results
We found an inverse relationship between high PA and BMI in the full sample (adjusted estimate = − 0.03, 95% CI − 0.07, − 0.01) and in females, but not males. We also found an inverse relationship between current alcohol use and BMI in the full sample (adjusted estimate = − 0.05, 95% CI − 0.09, − 0.01) and both sexes. There was no significant interaction between PA and alcohol use on BMI.
Conclusions
In this study of Mexican-origin adults, current alcohol use and high PA were associated with lower BMIs, but there was no interaction between PA and alcohol use. These results can be used to inform multiple behavior change interventions in Mexican-origin adults.
Keywords: Mexican Americans, Alcohol use, Exercise, Obesity
Background
Alcohol consumption is associated with severe negative health outcomes, including injuries/accidents [1], mental health [2], cirrhosis [3, 4], hepatocellular carcinoma [5–7], and mortality [8]. Although Hispanics/Latinos have a lower prevalence of current alcohol consumption than non-Hispanic whites [9, 10], they still experience higher incidence of alcohol-related diseases [11–14]. They also have the highest rates of hepatocellular carcinoma incidence in the USA [15], though alcohol consumption is only one of the several contributors to this and other liver-related diseases [16, 17].
Physical activity is typically considered an important cancer and chronic disease prevention behavior [18, 19]. Interestingly, studies from across racial/ethnic groups indicate that greater alcohol consumption is associated with more physical activity [20–22], but the relationship between the two behaviors has been seldom explored in this population. Two studies with Hispanics/Latinos exploring correlates of physical activity have reported a positive association with alcohol consumption among its many findings [23, 24], but no studies with Hispanic/Latinos, or Mexican-Americans more specifically, have focused closely on this relationship.
Physical inactivity and alcohol consumption are both associated with obesity. Physical activity has shown to be protective against obesity [25], including in Hispanic/Latino adults [26], while the relationship between alcohol consumption and obesity is more nuanced. While recent reviews tend to indicate that adults who drink have a lower risk of obesity than those who never use alcohol [27–29], the few studies that have assessed this relationship exclusively among Hispanics/Latinos indicate that alcohol consumption may actually be positively associated with waist circumference [30] and obesity [31] in this population. In addition to needing a better understanding of the relationship between alcohol and obesity in Hispanic/Latinos, and Mexican-Americans more specifically, clarity is also needed on how physical activity may influence the relationship between alcohol and obesity, as it has been suggested to be a potential confounding factor [32].
The relationships between physical activity, alcohol, and obesity within Hispanics/Latinos may also vary by their sociodemographic characteristics. In Hispanics/Latinos, greater acculturation has been associated with more physical activity, higher levels of alcohol consumption, and high BMI [33]. Among Hispanic/Latino adults, males drink more than females [34] and they are also more physically active [35] and less obese [36]. It is also possible that the level of acculturation and/or sex may also influence the relationship between these variables. For example, acculturation and/or sex may influence participation in group sports and subsequent social activities that could involve unhealthy eating and/or alcohol consumption. However, we have little research on this. While we know the prevalence of physical activity, alcohol use, and BMI differs by acculturation level and sex, it remains unclear how these sociodemographic characteristics influence the association between these three cancer and chronic disease risk factors.
The first aim of this study was to describe the relationship between alcohol consumption and physical activity in a specific group of Hispanics/Latinos, Mexican-American adults. The second aim was to assess the association of physical activity and alcohol with obesity. The last aim was to identify differences in these relationships by sex and acculturation status.
Methods
Study Population
We used data from adults who were part of the Mano a Mano cohort, a cohort of Mexican-origin individuals living in the Greater Houston area. Details on the composition of the cohort and recruitment of participants have been published elsewhere [37]. Briefly, to be eligible, individuals had to be a self-reported adult of Mexican-origin, residing in the Greater Houston metropolitan area for at least 1 year prior to recruitment into the study, and able to speak and understand Spanish or English. While participants who were recruited before 2014 were eligible to participate as part of the adult cohort as long as they were > 18 years of age, beginning in 2014, eligibility criteria changed to 35−75 years of age [37]. Several methods of recruitment were used over the years, since the initiation of the cohort in 2001. These methods included recruiting from the community locations, such as libraries, community centers, and clinics, among other locations, random digit dialing, block walking in selected neighborhoods, and snowball sampling [38]. If individuals indicated interest, cohort staff took down contact information and potential participants were contacted by staff to schedule their initial assessment, which included a personal interview and biospecimen collection. The overall cohort is predominately female due to an overrepresentation of Hispanic females at community centers and events [37]. Prior to this assessment, written informed consent in the preferred language of the participants (Spanish or English) was obtained, and participants were compensated with a gift card at the conclusion of the assessment. Data for this study come from individuals who were recruited into the study since 2012, when a new version of the physical activity questionnaire (IPAQ; see below) was introduced. The appropriate Institutional Review Board reviewed and approved this study (Protocols 2009–0379 and CPN00–367).
Measures
We used interviewer-administered questionnaires, which collected sociodemographic and health characteristics, including age, sex, country of birth, marital status, education, income, language acculturation, insurance, general health status, and smoking status. Language acculturation was collected with eight items, four for each language, from the bi-dimensional acculturation scale for Hispanics [39].
Physical Activity
The International Physical Activity Questionnaire (IPAQ) short-form was used beginning in 2012 to assess self-reported physical activity [40]. This 7-item questionnaire asks individuals to report how many days over the last week they spent walking, doing moderate activity, and vigorous physical activity, in addition to how much time they spent doing each activity. From this, individuals were categorized as being low, moderate, or high active individuals, per well-established scoring criteria [41]. Briefly, highly active individuals report either vigorous-intensity activity ≥ 3 days, accumulating at least 1500 MET-min/week or 7 days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving a minimum of at least 3000 MET-min/week. Moderately active individuals report either ≥ 3 days of vigorous-intensity activity of at least 20 min/day (but not reaching 1500 MET-min/week), ≥ 5 days of moderate-intensity activity or walking of at least 30 min/day, or ≥ 5 days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving a minimum of at least 600 MET-min/week. Those categorized as low active meet neither criterion. The IPAQ short-form has acceptable reliability [40].
Alcohol Use
Alcohol use was assessed with a single question adapted from the National Health Interview Survey asking participants if they have or ever drank any alcoholic beverages at least once per month for 1 year or more. Response options included yes, currently; yes, but I quit; and no, never.
Body Mass Index
Lastly, height and weight were measured by trained field staff [37]. Body mass index was calculated as body weight in kilograms (kg) divided by height in meters (m) squared (kg/m2).
Statistical Analyses
We used descriptive statistics to characterize the sample. To analyze the relationship between alcohol consumption and physical activity, we used chi-squared tests for categorical data. We produced both unadjusted and adjusted linear regression models to assess the association of physical activity and alcohol consumption with obesity. In adjusted models, we first adjusted for age, gender, country of birth, marital status, income, insurance, health score, language acculturation, and smoking status (model 2). Additionally, we adjusted for either physical activity or alcohol depending on the model (model 3). To assess the interaction of physical activity and alcohol consumption on obesity, we tested a physical activity × alcohol use interaction term. To identify any differences in these relationships by sex or acculturation status (country of birth and language acculturation), we also tested these sociodemographic variables as additional moderators using methods laid out by Hayes and colleagues using the PROCESS v3.5.1 for SAS [42, 43]. For ease of interpretation, we presented stratified models for variables with a significant interaction term. A p-value of < 0.05 was considered statistically significant. All analyses were performed using SAS software (SAS 9.4, SAS Institute Inc., Cary, NC, USA).
Results
Descriptive Statistics
The average age of the sample (n = 3897) was 49 years; most individuals were women, were married or living with a partner, had less than a high school diploma, were never smokers, and had health insurance (Table 1). Mexico was the country of birth for almost 80% of the sample, and 60% reported that they were Spanish dominant. The average BMI of the sample was almost 33 kg/m2, and 59% of the sample met or exceeded the threshold for obesity (BMI ≥ 30 kg/m2). Most individuals in the sample reported never using alcohol (70%) and reported moderate or high levels of physical activity (58%).
Table 1.
Descriptive statistics for sample
| Variable, (n, %) | Total | Men | Women |
|---|---|---|---|
| n = 3897 | n = 944 | n = 2953 | |
| Age, M (SD) | 48.5 (11.3) | 49.4 (12.5) | 48.2 (10.8) |
| Female | 2953 (75.8) | ||
| Marital status | |||
| Not married | 996 (25.6) | 167 (17.69) | 829 (28.08) |
| Married/living with a partner | 2900 (74.4) | 777 (82.31) | 2123 (71.92) |
| Annual household income | |||
| No response | 1435 (36.8) | 308 (32.63) | 1127 (38.16) |
| < $25,000 | 1321 (33.9) | 292 (30.93) | 1029 (34.85) |
| ≥ $25,000 | 1141 (29.3) | 344 (36.44) | 797 (26.99) |
| Educational level | |||
| < High school diploma | 2596 (66.6) | 626 (66.31) | 1970 (66.73) |
| High school graduate/GED | 601 (15.4) | 157 (16.63) | 444 (15.04) |
| Some add. education | 699 (17.9) | 161 (17.06) | 538 (18.22) |
| Country of birth | |||
| Mexico | 3112 (79.9) | 743 (78.71) | 2369 (80.22) |
| USA | 785 (20.1) | 201 (21.29) | 584 (19.78) |
| Language acculturation | |||
| Spanish dominant | 2309 (60.29) | 484 (52.10) | 1825 (62.91) |
| English dominant | 1192 (31.12) | 338 (36.38) | 854 (29.44) |
| Bilingual | 329 (8.59) | 107 (11.52) | 222 (7.65) |
| General health status | |||
| Poor/fair | 1795 (46.1) | 384 (40.76) | 1411 (47.80) |
| Good | 1534 (39.4) | 383 (40.66) | 1151 (38.99) |
| Very good/excellent | 565 (14.5) | 175 (18.58) | 390 (13.21) |
| Has health insurance | 2537 (65.1) | 635 (67.27) | 1902 (64.41) |
| Smoking status | |||
| Never smoker | 2832 (72.7) | 429 (45.49) | 2403 (81.40) |
| Former smoker | 657 (16.9) | 311 (32.98) | 346 (11.72) |
| Current smoker | 406 (10.4) | 203 (21.53) | 203 (6.88) |
| Total sitting time, h/day, M (SD) | 4.1 (3.0) | 4.4 (3.0) | 3.9 (2.9) |
| Physical activity | |||
| Low activity | 1628 (41.8) | 391 (41.42) | 1237 (41.89) |
| Moderate activity | 1236 (31.7) | 261 (27.65) | 975 (33.02) |
| High activity | 1033 (26.5) | 292 (30.93) | 741 (25.09) |
| Alcohol use | |||
| Never | 2733 (70.1) | 293 (31.04) | 2440 (82.63) |
| Former | 440 (11.3) | 262 (27.75) | 178 (6.03) |
| Current | 724 (18.6) | 389 (41.21) | 335 (11.34) |
| BMI (kg/m2), M (SD) | 32.5 (6.8) | 31.0 (5.9) | 32.9 (7.1) |
Missing data n = 1 for marital status, n = 1 for educational level, n = 67 for language acculturation, n = 3 for general health status, n = 2 for smoking status
Relationship Between Alcohol Consumption and Physical Activity
When examining the relationship between physical activity and alcohol use in this Mexican-American cohort, those who reported current alcohol consumption had a greater proportion of individuals who had high levels of physical activity than either of the groups who reported never or former alcohol use (Table 2) and never or former alcohol use had a greater proportion of individuals who engaged in low levels of physical activity.
Table 2.
Association between physical activity and alcohol use
| Variable, (n, %) | Alcohol use | ||
|---|---|---|---|
| Never | Former | Current | |
| n = 2733 | n = 440 | n = 724 | |
| Physical activity | |||
| Low activity (n = 1628) | 1157 (42.33) | 199 (45.23) | 272 (37.57) |
| Moderate activity (n = 1236) | 878 (32.13) | 137 (31.14) | 221 (30.52) |
| High activity (n = 1033) | 698 (25.54) | 104 (23.64) | 231 (31.91) |
Chi-square test: p = 0.0041
Association of Physical Activity and Alcohol Consumption with BMI
Table 3 provides the results for the associations of physical activity and alcohol use with BMI. Results from adjusted linear regression analysis, controlling for covariates (model 2), and additionally alcohol use (model 3) indicate that compared to those with low activity levels, those with higher activity had lower BMI. There was also a significant inverse relationship between current alcohol use and BMI such that those reporting current alcohol use, compared to never using alcohol, had lower BMI. This relationship was consistent across unadjusted and adjusted models. We tested an interaction term between physical activity and alcohol consumption in the full sample and found no significant interaction.
Table 3.
Unadjusted and adjusted linear regressions for the association of physical activity, alcohol use, and body mass index
| Adjusted estimate, 95% | Full sample | Male | Female | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | |
| Physical activity (ref: low) | |||||||||
| Moderate activity | −0.03 (−0.07, 0) | −0.02 (−0.05, 0.02) | −0.02 (−0.05, 0.02) | 0.01 (−0.06, 0.08) | 0.03 (−0.04, 0.10) | 0.03 (−0.04, 0.10) | −0.05* (−0.09, −0.01) | −0.03 (−0.07, 0.01) | −0.03 (−0.07, 0.01) |
| High activity | −0.07*** (−0.11, −0.04) | −0.04* (−0.07, −0.01) | −0.03* (−0.07, −0.01) | 0.02 (−0.05, 0.09) | 0.04 (−0.03, 0.11) | 0.04 (−0.03, 0.11) | −0.09*** (−0.13, −0.05) | −0.06** (−0.09, −0.02) | −0.05** (−0.09, −0.02) |
| Alcohol use (ref: never) | |||||||||
| Former alcohol use | −0.02 (−0.05, 0.01) | −0.01 (−0.05, 0.02) | −0.01 (−0.05, 0.02) | −0.04 (−0.11, 0.04) | −0.05 (−0.12, 0.03) | −0.05 (−0.13, 0.03) | 0.05** (0.01, 0.08) | 0.01 (−0.03, 0.05) | 0.01 (−0.03, 0.05) |
| Current alcohol use | −0.07*** (−0.10, −0.04) | −0.05** (−0.09, −0.02) | −0.05** (−0.09, −0.01) | −0.08* (−0.16, −0.01) | −0.10* (−0.18, −0.02) | −0.10** (−0.18, −0.03) | −0.02 (−0.05, 0.02) | −0.04* (−0.08, −0.01) | −0.04* (−0.08, −0.01) |
p < 0.05,
p < 0.01,
p < 0.001;
model 1, univariate; model 2, adjusted for age, sex (not in stratified models), country of birth, marital status, education, income, insurance, health score, language acculturation, smoking status; model 3, all model 2 covariates and either alcohol use (in physical activity models) or physical activity (in alcohol use models)
Differences by Sex and Acculturation Status
We also tested sex and acculturation as significant effect modifiers, though only sex significantly modified the relationship between physical activity and BMI (p = 0.01 for interaction term). The same significant association between high activity and lower BMI from the full sample was observed in women (see Table 3). However, the interaction between sex and physical activity was such that in men, there was no significant association between physical activity and BMI. The interaction terms for country of birth or language acculturation were not significant, that is, these variables did not meaningfully impact the relationship between alcohol use and physical activity with BMI.
Discussion
The first aim of this study was to characterize the relationship between alcohol consumption and physical activity in Mexican-American adults. We found that current alcohol users had a higher proportion of individuals who had high activity than either the never or former alcohol use categories. These findings align with other studies in the literature showing a positive relation between alcohol intake and physical activity in the general population [20–22] and among Hispanics/Latinos [23, 24].
The second aim of this study was to assess the association of physical activity and alcohol consumption with obesity in Mexican-American adults. Consistent with the literature, we found that high levels of physical activity were significantly protective of BMI in the full sample of Mexican-origin adults [26, 44]. We found a significant inverse relationship between current alcohol use and BMI in the full sample such that current alcohol use was associated with less obesity. This contributes new evidence to the currently mixed literature on the association between alcohol use and BMI [27–29, 45, 46]. In general, light-to-moderate alcohol use has been shown to be potentially protective against obesity while heavy alcohol use is associated with greater BMI [27–29, 45, 46], though this has not been universally reported [32]. Physical activity has been previously noted as a potential confounder in this relationship between alcohol use and BMI [32], but in our study, the relationship remained statistically significant after controlling for physical activity. Mixed findings in this area are likely attributable to a variety of factors, but in particular, the lack of specificity in type of alcoholic beverage consumed [28, 47]. Unfortunately, in this study, we were not able to assess the type of alcoholic beverage nor the amount per week of drinks consumed. Further research is needed on alcohol use and BMI in Mexican-American adults to inform health promotion messaging.
The last aim of this study was to identify differences in the relationships between physical activity, alcohol consumption, and obesity by sex and acculturation status. While high levels of physical activity were significantly protective of BMI in women, the association in men was not significant. Previous research indicates that compared to men, women have greater mean BMI change from exercise interventions [48]. However, the biological mechanism for these findings is not yet understood, though it could be due to sex differences in fat deposition patterns and fat oxidation during exercise hormones [49, 50]. It is surprising, however, that we found no protective effect of physical activity on higher BMI in Mexican-origin men. There are a few potential reasons for these findings. First, in Mexican-origin males, the majority of physical activity tends to be in the occupational domain [51], which typically does not confer the same health benefits as purposeful, leisure-time physical activity [52]. In fact, in some European studies, occupational physical activity has been associated with negative health outcomes, such as high blood pressure [53] and cardiovascular mortality [54]. Though this relationship may be confounded by high levels of job stress in occupations that require physical activity as part of normal job functions, others have found the relationship persists even after controlling for job stress and other important factors [55]. Furthermore, it is important to note that BMI is not a perfect metric of body fat, with BMI overestimating adiposity in men [56]. Therefore, it is possible that men categorized as obese using BMI were actually more muscular. Lastly, results could be due to uncontrolled confounding. For example, our analyses did not control for diet, which is an important predictor of obesity. Therefore, it is possible that more active men consume calories in excess of their energy expenditure from physical activity, which may have contributed to the observed effect. Regardless, men and women both should be encouraged to be physically active for the many widely recognized benefits to health. However, further research is needed to understand the relationship between diet, alcohol, physical activity, and weight in Mexican-origin men.
Although we found gender differences in the relationships between physical activity, alcohol, and obesity, we found no significant differences by country of birth or language acculturation. Although higher US acculturation has been associated with more physical activity, higher levels of alcohol consumption, and higher BMI [33], acculturation may not have a strong impact on the relationship between these variables.
This study did have some limitations. First, we used a self-reported measure of physical activity, which has known measurement issues [57]. In the self-report physical activity measure (IPAQ-short form), participants are asked to report physical activity from all domains together, so we are unable to tease apart the effects of each domain. Thus, except for level of physical activity, the effect of each domain of physical activity with respect to BMI in Mexican-origin adults remains unresolved. Although current alcohol use was inversely associated with BMI, it is unknown how much or what types of alcohol were consumed in this population. Given this limitation, we therefore cannot categorize into light, moderate, or heavy alcohol use or indicate the dominant types of alcoholic beverage consumed. We can infer from existing literature across racial/ethnic groups that compared to those who never use alcohol, light-to-moderate alcohol use may potentially provide protection against obesity [27, 58], while heavy alcohol use may be at higher risk for obesity [28, 46]. Furthermore, the type of alcoholic beverage may influence this relationship given the wide range in calories across types [47]. While diet is known to be associated with BMI [59], dietary data was not collected for this cohort study. Lastly, we used BMI as a measure of body fat, which is an imperfect measure; and thus, some people may actually be muscular and categorized as obese, especially men. Future studies with Mexican-Americans or Hispanic/Latino adults more generally should measure and control for diet, as well as assess the number of drinks and types of alcoholic beverages to further define the relationships between alcohol, physical activity, and obesity. Despite these limitations, our study assessed a large sample of Mexican-Americans, who are studied less frequently than needed, on the relationships between important cancer and chronic disease prevention behaviors.
Conclusions
In this study of Mexican-origin adults, we determined that adults with high levels of physical activity and those who currently used alcohol had lower BMIs. These results can be used to inform multiple behavior change interventions in Mexican-origin adults.
Acknowledgements
We thank Gary Deyter for the editorial assistance, and Kplola Y Elhor Gbito for assistance with revisions.
Funding
This research was supported, in part, by the Cancer Prevention and Research Institute of Texas (RP170259), by MD Anderson’s Cancer Center Support Grant (CA016672), and by the Prevent Cancer Foundation. The cohort receives funds collected pursuant to the Comprehensive Tobacco Settlement of 1998 and appropriated by the 76th legislature to The University of Texas MD Anderson Cancer Center from the Caroline W. Law Fund for Cancer Prevention, and the Dan Duncan Family Institute for Risk Assessment and Cancer Prevention.
Abbreviations
- PA
Physical activity
- BMI
Body mass index
- IPAQ
International Physical Activity Questionnaire
Footnotes
Ethics Approval and Consent to Participate The Institutional Review Board of The University of Texas MD Anderson Cancer Center approved this study (Protocols 2009–0379 and CPN00–367). Participants provided written consent.
Conflict of Interest The authors declare no competing interests.
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