The objective of this study was to investigate whether alcohol consumption might affect the quality of life (QOL), depressive mood, and metabolic syndrome in patients with obstructive lung disease (OLD).
Data were obtained from the Korean National Health and Nutrition Examination Survey from 2014 and 2016. OLD was defined as spirometry of forced expiratory volume in 1 second/forced vital capacity <0.7 in those aged more than 40 years. QOL was evaluated using the European Quality of Life Questionnaire-5D (EQ-5D) index. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive mood. Alcohol consumption was based on a history of alcohol ingestion during the previous month.
A total of 984 participants with OLD (695 males, 289 females, age 65.8±9.7 years) were enrolled. The EQ-5D index was significantly higher in alcohol drinkers (n=525) than in non-alcohol drinkers (n=459) (0.94±0.11 vs. 0.91±0.13, p=0.002). PHQ-9 scores were considerably lower in alcohol drinkers than in non-alcohol drinkers (2.15±3.57 vs. 2.78±4.13, p=0.013). However, multiple logistic regression analysis showed that alcohol consumption was not associated with EQ-5D index or PHQ-9 score. Body mass index ≥25 kg/m2, triglyceride ≥150 mg/dL, high-density lipoprotein <40 mg/dL in men and <50 mg/dL in women, and blood pressure ≥130/85 mm Hg were significantly more common in alcohol drinkers than in non-alcohol drinkers (all p<0.05).
Alcohol consumption did not change the QOL or depressive mood of OLD patients. However, metabolic syndrome-related factors were more common in alcohol drinkers than in non-alcohol drinkers.
Chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation, parenchymal destruction, and expiratory airflow limitation [
Alcohol consumption may affect QOL and depressive mood in the general population. In a cross-sectional study in Finland, the amount of alcohol drinking and frequency of binge drinking were associated with impaired QOL in persons with depression [
People with COPD usually stop smoking because of respiratory symptoms or a doctor’s advice. However, many continue to drink to reduce psychological stress and halt the declining QOL after quitting smoking. Relationships of alcohol consumption with QOL, depressive mood, and metabolic syndrome-related factors have not been extensively studied in patients with COPD. Therefore, the objective of this study was to investigate whether alcohol consumption might be associated with QOL, depressive mood, and metabolic syndrome in patients with COPD.
This was designed as a cross-sectional observational study. Data were obtained from the Korea National Health and Nutrition Examination Survey from 2014 and 2016 (KNHANES VI). KNHANES is a nationwide, population-based, cross-sectional program that collects detailed information on the health and nutrition status of non-institutionalized Korean population. Data on demographics, smoking status, and physician-diagnosed comorbidities such as hypertension, stroke, ischemic heart disease, diabetes mellitus, activity limitations, lung function, depressive mood, and QOL were obtained using complex, stratified, multistage probability sampling to represent the Korean population.
Of a total of 12,494 participants in 2014 and 2016 of the KNHANES, we included adults aged over 40 years who had received pulmonary function tests. We also included participants who replied to the alcohol ingestion questionnaire (
The presence of obstructive lung disease (OLD) was defined as forced expiratory volume in 1 second (FEV1) divided by forced vital capacity (FVC) ≤0.7 as suggested by the Global Obstructive Lung Disease (GOLD) guidelines. Trained medical technicians conducted pulmonary function tests using the Thoracic Society/European Respiratory Society Task Force with dry rolling seal spirometers (Model 2130, Sensor Medics, Yorba Linda, CA, USA).
Patient Health Questionnaire-9 (PHQ-9) is a screening tool for measuring depressive mood. It comprises nine symptom-related items that measure the frequency of a participant’s experience of depressive symptoms over the previous 2 weeks. Participants responded to each item with “not at all” (scored as 0), “on several days” (scored as 1), “on more than half the days” (scored as 2), or “nearly every day” (scored as 3). Scores for all individual items were summed to obtain a total PHQ-9 score ranging from 0 to 27, with a higher score indicating a higher severity of depressive mood.
The European Quality of Life Questionnaire-5D (EQ-5D) was used to evaluate five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) to assess QOL. Participants responded to each dimension with three functional levels: no problems, some problems, or extreme problems. These responses were converted into EQ-5D summary index scores using a specific Korean valuation set developed by the time trade-off protocol at the Korean Centers for Disease Control and Prevention. EQ-5D index ranged from 0 to 1 [
Metabolic syndrome was defined according to the new International Diabetes Federation criteria except that waist circumference cutoff was modified to be specific to the Korean population [
The definition of a drinker was based on self-report. A person was classified as a drinker if he or she had consumed at least one glass of alcohol per month over the past year without distinguishing between beers, soju, and foreign liquors. Otherwise the person was classified as a non-drinker. Alcohol drinkers were additionally asked to complete a questionnaire regarding the amount and frequency of alcohol consumption in the past 30 days. Daily alcohol consumption was calculated based on the average consumption frequency and amount per occasion. Participants were categorized into three groups according to their baseline alcohol consumption: low-risk (<5 g/day), moderate-risk (≥5 but <30 g/day for men, ≥5 but <15 g/day for women), and high-risk (≥30 g/day for men, ≥15 g/day for women) alcohol drinkers [
The nutrition survey was divided into a 24-hour dietary recall, a dietary behavior survey, and a food security survey. For the 24-hour dietary recall, a team of dieticians visited each participant’s household and conducted individual interviews with all household members over the age of 1 year to collect data about names of dishes or food, amounts consumed, and the location and type of meals eaten a day prior in chronological order. To determine the exact amount of the intake, we investigated each individual’s intake using various measuring aids. For nutrients, we examined total energy and proportions of energy from carbohydrates, proteins, fats, and other components [
All continuous values are described as mean±standard deviation and categorical values are reported as absolute numbers and percentages. Student’s t-test or Mann-Whitney U test was used to analyze continuous values according to data distribution. Categorical values were analyzed using the chi-square test or Fisher’s exact test. Multiple logistic regression analysis was performed to evaluate factors associated with depressive mood and QOL. In all comparisons, a p-value of <0.05 was considered statistically significant. All statistical analyses were performed using SPSS version 25.0 (IBM Corporation, Armonk, NY, USA) for Windows (Microsoft Corporation, Redmond, WA, USA).
A total of 984 participants with OLD (695 males, 289 females, age 65.8±9.7 years) were enrolled in the study. A total of 525 alcohol drinkers and 459 non-alcohol drinkers were identified (
The EQ-5D index was significantly higher in alcohol drinkers than in non-alcohol drinkers (0.94±0.11 vs. 0.91±0.13, p=0.002). PHQ-9 scores were considerably lower in alcohol drinkers than in non-alcohol drinkers (2.15±3.57 vs. 2.78±4.13, p=0.014) (
Multiple logistic regression analysis evaluated factors associated with QOL (EQ-5D index) and depressive mood (PHQ-9 score) in OLD. Results showed that QOL, age, male sex, current smoking, activity limitation, sputum production for 3 months, and calorie intake per day were significantly associated with the EQ-5D index. Male sex, BMI, activity limitation, and sputum production were considerably associated with the PHQ-9 score. However, alcohol consumption was not associated with the EQ-5D index or PHQ-9 score (
Results of assessing metabolic syndrome-related factors with alcohol consumption showed that BMI ≥25 kg/m2, TG ≥150 mg/dL, HDL-C <40 mg/dL in men and <50 mg/dL in women, and BP ≥130/85 mm Hg were significantly more common in alcohol drinkers than in non-alcohol drinkers (p=0.035, p=0.001, p=0.001, and p=0.002, respectively) (
This study evaluated associations of alcohol consumption with QOL and depressive mood in Korean adults with OLD. Results showed that alcohol consumption did not change the QOL or depressive mood in individuals with OLD. However, it might increase the risk of metabolic syndrome. In addition, high-risk alcohol drinkers showed more depressive moods than low to moderate alcohol drinkers.
Associations of alcohol consumption with QOL and depressive mood in the general population have been reported yet. One study from Korea showed that moderate drinkers (alcohol >28 g/week) exhibited lower depressive mood and higher QOL than non-drinkers and lower drinkers [
In patients with mild to moderate COPD, psychiatric problems and alcohol abuse were more common than in age-matched controls, which might impair QOL [
Metabolic syndrome is also commonly considered one of the systemic manifestations of COPD [
A cohort study in the general Korean population, including a national nutritional survey, showed that heavy alcohol consumption was associated with a significantly higher ratio of high BP, higher TG and fasting blood glucose lvels, and lower HDL levels [
Total calorie intake was associated with a higher QOL in the COPD population in this study. Malnutrition is a common problem in COPD patients. It can lower QOL in COPD patients [
In this study, sputum production, not cough, was associated with depressive mood and QOL in the COPD population. Several studies have shown that cough and sputum production are essential determinants of QOL in stable COPD patients [
This study has some limitations. First, our data did not include any post-bronchodilator spirometer measurement. In addition, the diagnosis of COPD was assessed only based on pre-bronchodilator spirometer measurement. Second, men had a higher proportion than women among alcohol drinkers and
Conceptualization: Heo IR, Kim HC. Methodology: Heo IR, Kim HC. Formal analysis: Heo IR, Kim HC. Data curation: Kim HC. Software: Heo IR, Kim HC. Validation: Kim HC. Writing - original draft preparation: Heo IR, Kim HC. Writing - review and editing: Kim TH, Ju SM, Yoo JW, Lee SJ, Cho YJ, Jeong YY, Lee JD. Approval of final manuscript: all authors.
No potential conflict of interest relevant to this article was reported.
No funding to declare.
Flow diagram of the study population. FEV1/FVC: forced expiratory volume per 1 second/forced vital capacity; COPD: chronic obstructive pulmonary disease.
Comparison of (A) quality of life (EuroQol Five-Dimension Questionnaire [EQ-5D] index) and (B) depressive mood (Patient Health Questionnaire [PHQ-9] score) between alcohol drinkers and non-alcohol drinkers in chronic obstructive pulmonary disease.
Comparison of clinical characteristics between alcohol drinkers and non-alcohol drinkers in enrolled obstructive lung disease patients
Characteristic | Alcohol drinkers (n=525) | Non-alcohol drinkers (n=459) | p-value | |
---|---|---|---|---|
Age, yr | 63.7±10.0 | 68.2±8.78 | 0.000 | |
Male sex | 447 (85.1) | 78 (14.9) | 0.000 | |
BMI, kg/m2 | 24.1±2.87 | 23.7±3.14 | 0.034 | |
Smoking status | ||||
Current smoker | 167 (31.8) | 95 (20.7) | 0.000 | |
Never smoked | 108 (20.6) | 232 (50.5) | 0.000 | |
Ex-smoker | 250 (47.6) | 132 (28.8) | 0.000 | |
Alcohol consumption | ||||
Light to moderate-risk | 318 (60.6) | |||
High-risk | 207 (39.4) | |||
PFT | ||||
FEV1, L | 2.49±0.6 | 2.03±0.61 | 0.005 | |
FEV1, % predicted | 80.5±14.6 | 78.4±17.1 | 0.036 | |
FVC, L | 3.87±0.83 | 3.19±0.88 | 0.000 | |
FVC, % predicted | 91.3±13.3 | 88.5±15.8 | 0.000 | |
FEV1/FVC, L | 0.64±0.06 | 0.63±0.07 | 0.116 | |
Underlying disease | ||||
Hypertension | 218 (41.5) | 184 (40.1) | 0.083 | |
Ischemic heart disease | 26 (5.1) | 24 (5.4) | 0.961 | |
Stroke | 6 (1.1) | 14 (3.1) | 0.055 | |
Diabetes | 71 (13.5) | 80 (17.4) | 0.220 | |
Arthritis | 57 (11.2) | 100 (22.5) | 0.000 | |
CRF | 3 (0.6) | 1 (0.2) | 0.590 | |
LC | 1 (0.2) | 3 (0.7) | 0.427 | |
Lung cancer history | 5 (1) | 0 | 0.926 | |
Pulmonary TB history | 37 (7.0) | 45 (9.8) | 0.241 | |
Depression history | 13 (2.5) | 17 (3.7) | 0.445 | |
Laboratory finding (n=939) | ||||
Glucose, mg/dL | 107.7±25.3 | 103.8±23.9 | 0.016 | |
AST, IU/L | 24.9±7.17 | 22.6±7.16 | 0.001 | |
ALT, IU/L | 22.9±13.8 | 20.5±11.5 | 0.004 | |
Hemoglobin, g/dL | 14.8±1.31 | 13.8±1.45 | 0.000 | |
Hematocrit, % | 44.4±3.68 | 42.1±4.08 | 0.000 | |
BUN, mg/dL | 15.9±4.47 | 16.49±4.81 | 0.049 | |
Creatinine, mg/dL | 0.82±0.20 | 0.89±0.22 | 0.027 | |
Nutritional intake (n=845) | ||||
Food, g | 1,616.5±809.4 | 1,381±719.8 | 0.000 | |
Water, g | 1,146.7±711.7 | 958.1±608.0 | 0.000 | |
Calories, kcal | 2,081.0±767.1 | 1,787.7±716.5 | 0.000 | |
Protein, g | 70.9±35.1 | 58.9±29.6 | 0.000 | |
Lipid, g | 38.28±28.6 | 30.67±25.2 | 0.000 | |
Carbohydrate, g | 320.3±120.1 | 315.1±125.9 | 0.535 | |
Physical activity | ||||
Activity limitation | 43 (8.2) | 58 (12.6) | 0.064 | |
Vigorous activity in the workplace | 11 (2.1) | 9 (2.0) | 0.971 | |
Vigorous activity for leisure | 54 (10.3) | 26 (5.7) | 0.030 | |
Cough over 3 months |
32 (6.1) | 29 (6.3) | 0.885 | |
Sputum over 3 months |
75 (14.3) | 60 (13.1) | 0.581 | |
Weight loss for a year | 59 (11.2) | 69 (15.0) | 0.151 |
Values are presented as mean±standard deviation or number (%).
Participants had to respond to the following question: “Have you had a cough on most days for 3 months or more during the past year?”.
Participants had a response to the following question: “Have you had sputum almost every day for at least 3 consecutive months 1 year?”
BMI: body mass index; PFT: pulmonary function test; FEV1: forced expiratory volume per 1 second; FVC: forced vital capacity; FEV1/FVC: forced expiratory volume per 1 second/forced vital capacity; CRF: chronic renal failure; LC: liver cirrhosis; TB: tuberculosis; AST: aspartate transaminase; ALT: alanine transferase; BUN: blood urea nitrogen.
Comparison of quality of life (EQ-5D index) and depressive mood (PHQ-9 score) between alcohol drinkers and non-alcohol drinkers in obstructive lung disease patients
Alcohol drinkers (n=525) |
Non-alcohol drinkers (n=459) | p-value | ||
---|---|---|---|---|
Light to moderate-risk (n=318) | High-risk (n=207) | |||
EQ-5D index (n=954) | 0.94±0.11 | 0.91±0.13 |
0.002 | |
0.94±0.1 | 0.93±0.12 |
0.342 | ||
PHQ-9 score (n=940) | 2.15±3.57 | 2.78±4.14 |
0.014 | |
1.83±3.08 |
2.64±4.19 |
0.01 |
Values are presented as mean±standard deviation.
p=0.012.
p=0.002.
p=0.785.
EQ-5D: EuroQol Five-Dimension Questionnaire; PHQ: Patient Health Questionnaire.
Multiple logistic regression analysis for factors associated with quality of life (EQ-5D index) and depressive mood (PHQ-9 score)
Variable | Quality of life (EQ-5D index) |
Depressive mood (PHQ-9 score) |
||
---|---|---|---|---|
β±SE | p-value | β±SE | p-value | |
Age, yr | –0.003±0.001 | 0.000 | 0.025±0.026 | 0.342 |
Male sex | –0.057±0.018 | 0.001 | 1.356±0.605 | 0.026 |
BMI, kg/m2 | 0.000±0.002 | 0.886 | –0.197±0.078 | 0.012 |
FEV1, % predicted | 0.000±0.001 | 0.693 | 0.018±0.031 | 0.573 |
Current smoking | –0.041±0.016 | 0.012 | 0.878±0.561 | 0.119 |
Alcohol drinking | 0.016±0.014 | 0.282 | 0.351±0.497 | 0.480 |
Level of education, >12 years |
0.000±0.001 | 0.693 | –0.012±0.040 | 0.775 |
Activity limitation by any cause | 0.148±0.019 | 0.000 | –3.979±0.656 | 0.000 |
Metabolic syndrome | –0.022±0.018 | 0.206 | 0.228±0.604 | 0.706 |
Weight change for a year |
–0.005±0.010 | 0.602 | 0.301±0.343 | 0.381 |
Cough over 3 months | –0.07±0.03 | 0.852 | 0.009±1.043 | 0.993 |
Sputum for 3 months | –0.004±0.023 | 0.021 | 1.821±0.788 | 0.022 |
Calories intake per day | –0.0002±0.000 | 0.036 | 0.000±0.000 | 0.124 |
Weight change was defined by the following question: “Have there been any changes in your weight during the last year? If so, how much weight did you lose or gain?” Answers were categorized as “No change,” weight loss of 3–6 or ≥6 kg, or weight gain of 3–6 or ≥6 kg.
Level of education >12 years was defined as an education period over 12 years, including elementary, middle, and high schools.
EQ-5D: EuroQol Five-Dimension Questionnaire; PHQ: Patient Health Questionnaire; SE: standard error; BMI: body mass index; FEV1: forced expiratory volume per 1 second.
Comparison of metabolic syndrome-related factors between alcohol drinkers and non-alcohol drinkers in obstructive lung disease patients
Variable | Alcohol drinkers (n=525) | Non-alcohol drinkers (n=459) | p-value |
---|---|---|---|
BMI, kg/m2 (>25%) | 235 (44.8) | 175 (38.1) | 0.035 |
Waist circumference, cm (>90 in men, >80 in women) | 206 (39.2) | 202 (44) | 0.130 |
TG, mg/dL (>150) | 205 (40.7) | 132 (30.3) | 0.001 |
HDL, mg/dL (<40 in men, <50 in women) | 131 (26.1) | 196 (46.1) | 0.000 |
BP, mm Hg (>130 in systolic and 85 in diastolic) | 74 (14.1) | 35 (7.6) | 0.001 |
FBG, mg/dL (>110) | 151 (30) | 110 (25.3) | 0.111 |
Values are presented as number (%).
BMI: body mass index; TG: triglyceride; HDL: high-density lipoprotein; BP: blood pressure; FBG: fasting blood glucose.