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Self-reported alcohol intake is a better estimate of 5-year change in blood pressure than biochemical markers in low resource settings: the PURE study

Zatu, Mandlenkosi C.a,d; van Rooyen, Johannes M.a; Loots, Du Toitb; Wentzel-Viljoen, Edelweissb; Greeff, Minriec; Schutte, Aletta E.a

doi: 10.1097/HJH.0000000000000093

Background: Despite criticism of self-reported alcohol intake, it is a valuable tool to screen for alcohol abuse as a risk factor for cardiovascular disease. We aimed to compare various self-reported estimates of alcohol use with γ-glutamyltransferase (GGT) and percentage carbohydrate deficient transferrin (%CDT) considering their relationship with blood pressure changes (%BP) over a 5-year period in black South Africans.

Method: We recruited 1994 participants and collected 5-year followed up data (N = 1246). Participants completed questionnaires on alcohol intake indicating their former and current alcohol use (‘yes’ response and ‘no’ if alcohol was never used). We assessed alcohol intake (in g) using a quantified food frequency questionnaire. We collected blood samples and measured GGT and %CDT. Brachial BP (bBP) was measured at baseline and follow-up and central BP (cBP) at follow-up only.

Results: Self-reported alcohol intake was significantly associated with the 5-year change in bBP before and after adjusting for confounders (%bSBP: R 2 = 0.263, β = 0.06, P = 0.023; %bDBP: R 2 = 0.326, β = 0.08 P = 0.005), as well as cSBP (R 2 = 0.286, β = 0.09, P = 0.010) and central pulse pressure (R 2 = 0.254, β = 0.06, P = 0.020). GGT and %CDT correlated well with self-reported alcohol intake (r = 0.44; P = 0.001; r = 0.34 P = 0.001), but did not associate significantly with %bBP or cBP at follow-up.

Conclusion: Self-reported alcohol use was strongly associated with a 5-year increase in BP in Africans with a low socio-economic status. This was not found for biochemical measures, GGT and %CDT. Self-reported alcohol intake could be an important measure to implement in primary healthcare settings in middle to low income countries, where honest reporting is expected.

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aHypertension in Africa Research Team (HART)

bCentre of Excellence for Nutrition

cAfrica Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom

dDepartment of Physiology, University of Limpopo (Medunsa), Pretoria, South Africa

Correspondence to Aletta E. Schutte, Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom 2520, South Africa. Tel: +27 18 299 2444; fax: +27 18 299 1053; e-mail:

Abbreviations: %CDT, percentage carbohydrate deficient transferrin; %DBP, percentage change in DBP; %SBP, percentage change in SBP; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BP, blood pressure; cPP, central pulse pressure; CRP, C-reactive protein; cSBP, central SBP; CVD, cardiovascular disease; GGT, γ-glutamyltransferase; HbA1C, glycosylated haemoglobin; HDL-C, high-density lipoprotein cholesterol; PURE study, Prospective Urban and Rural Epidemiology study; TC, total cholesterol

Received 21 June, 2013

Accepted 27 November, 2013

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