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Abstract & Commentary
Synopsis: Danish people who drink only wine have higher IQs, socioeconomic status, and educational levels than do those who drink only beer. Further, they score better on tests of personality and are less likely to smoke cigarettes. These differences may explain some of the health benefits of wine.
Source: Mortensen EL, et al. Arch Intern Med. 2001;161:1844-1848.
This paper is the result of an interesting collaboration between the Danish Epidemiology Science Center in Copenhagen and the Kinsey Institute for Research in Sex, Gender, and Reproduction in Bloomington, Ind. The purpose of this study was to determine if personality and behavior factors explain the apparent health benefits enjoyed by wine drinkers. Mortensen and colleagues compared socioeconomic status, education, IQ, personality, psychiatric symptoms, and health-related behaviors between beer and wine drinkers in Denmark. The study population was a subset of a larger sample that was recruited to study the effects of prenatal exposure to prescribed medications.
There were 693 subjects (330 women) aged 29-34 years. Participants were divided into 4 groups based on beverage drinking in the past week: nondrinkers of either beer or wine (n = 169, 116 women), wine only (n = 94, 73 women), beer only (n = 90, 67 men), both beer and wine (n = 340, 222 men). Consumption of liquor in this group was rare; median consumption was 0-1 drinks/week, regardless of beer or wine consumption. Linear regression revealed an interaction between beer and wine only for women’s parental educational level. There were many interactions between alcohol choice and sex, so data were analyzed separately by gender.
For both men and women, wine drinking was associated with higher scores in parental social status, parental educational level, and subject’s educational and social status. For both sexes, beer drinking was associated with lower scores on IQ scales. This was most dramatic for males: "pure" wine drinking men had average IQs of 113.2, compared with 95.2 for "pure" beer-drinking men. Measures of personality also showed significant differences between beer and wine drinkers. Scores on the Million Clinical Multiaxial Inventory were lower (healthier) for pure wine drinkers, with pure beer drinkers having the highest scores. Beer drinking was associated with a higher prevalence of risk drinking, smoking, and illicit drug use, and wine drinking was associated with a lower prevalence of smoking. Total alcohol consumption was larger for beer drinkers. On most measures, abstinence was associated with a less desirable score than was wine consumption, but with a better score than pure beer consumption.
Comment by Barbara A. Phillips, MD, MSPH
A large body of evidence demonstrates that wine drinkers have a lower risk of coronary heart disease, stroke, upper GI cancer, lung cancer, hip fracture, and all-cause mortality compared with those who are abstinent or who drink beer or liquor.1-7 The current study makes a case for attributing the better health of wine drinkers to their underlying personalities, intelligence, and socioeconomic status, not to any particular health benefit of wine. There are a couple of issues to consider in sorting out the significance of this finding. The first is that alcohol in general is associated with reduced cardiovascular mortality, probably because of ethanol-induced elevations in high density lipoproteins (HDLs)8 and lowering of platelet aggregation.9 The second is that, much as wine drinkers appear healthier than beer drinkers, there is some evidence that red wine drinkers may benefit more than white wine drinkers. Red wine contains antioxidants such as resveratrol, which has been shown to inhibit the expression of tissue factor and cytokines, which are associated with thrombogenesis.10 Unable to find any head-to-head trials about the health benefits of red vs. white wines, I consulted an expert: my brother-in-law. Dr. Charles Orr is a cardiologist, oenophile, and scholar, with whom I have shared more than a few glasses of wine. Although there do not appear to be epidemiologic studies directly comparing health benefits of red and white wine, there is substantial in vitro evidence that red wine contains more antioxidant and antiplatelet activity than does white wine.11,12 My consultant also pointed out what should have been obvious to me: although this study indicates that wine drinkers are smarter, better educated, etc, etc than beer drinkers, it does not prove causality.13 It may be that, contrary to Mortensen et al’s assertion that personality characteristics dictate beverage choice, the converse is true. Maybe drinking wine makes us smarter.
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2. Gronbaek M, et al. J Epidemiol Community Health. 1999;53:721-724.
3. Truelsen T, et al. Stroke. 1998;29:2467-2472.
4. Gronbaek M, et al. BMJ. 1998;317:844-847.
5. Prescott E, et al. Am J Epidemiol. 1999;149:463-467.
6. Hoidrup S, et al. Am J Epidemiol. 1999;149:993-1001.
7. Gronbaek M, et al. BMJ. 1995;310:1165-1169.
8. Gaziano JM, et al. N Engl J Med. 1993;329:1829-1834.
9. Elwood PC, et al. Circulation. 1991;83:38-44.
10. Pendurthi U, et al. Arterioscler Thromb Vasc Biol. 1999;19:419-426.
11. Araya J, et al. Br J Nutr. 2001;86:189-195.
12. Ivanov V, et al. J Agric Food Chem. 2001;49:4442-4449.
13. Personal communication. Charles M. Orr, MD, September 21, 2001.
Dr. Phillips, Professor of Medicine, University of Kentucky, and Director, Sleep Disorders Center, Samaritan Hospital, Lexington, Ky., is Associate Editor of Internal Medicine Alert.Readers are Invited
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