Vitamin D status and associated factors of deficiency among Jordanian children of preschool age.

BACKGROUND/OBJECTIVES: Vitamin D deficiency in children remains a global concern. Although literature exists on the vitamin D status and its risk factors among children in the Middle East, findings have yielded mixed results, and large, representative community studies are lacking. SUBJECTS/METHODS: In a nationally representative survey of 1077 Jordanian children of preschool age (12-59 months) in Spring 2010, we measured 25(OH)D3 concentrations by liquid chromatography-tandem mass spectrometry and calculated prevalence ratios for deficiency associated with various factors. RESULTS: RESULTS showed 19.8% (95% confidence interval (CI): 16.4-23.3%) deficiency (<12 ng/ml) and 56.5% (95% CI: 52.0-61.0%) insufficiency (<20 ng/ml). In adjusted models, prevalence of deficiency was higher for females compared with males (prevalence ratio (PR)=1.74, 95% CI: 1.22-2.47, P=0.002) and lower for children 24-35 months of age (PR=0.64, 95% CI: 0.44-0.92, P=0.018) compared with children 12-23 months of age. In rural areas, there was no difference in prevalence of vitamin D deficiency between those whose mothers had/did not have vitamin D deficiency (P=0.312); however, in urban areas, prevalence of vitamin D deficiency was 3.18 times greater among those whose mothers were vitamin D deficient compared with those whose mothers were not deficient (P=0.000). CONCLUSIONS: Vitamin D deficiency and insufficiency pose significant public health problems in Jordanian children with female children disproportionately affected. Strong associations between vitamin D status in children and urban residency and maternal vitamin D status suggest that the behaviors related to sun exposure in urban mothers likely also affect the sun exposure and thus vitamin D status of their children.

Micronutrient status in Jordan: 2002 and 2010.

BACKGROUND/OBJECTIVES: Two national surveys were conducted in Jordan in 2002 and 2010 to investigate the micronutrient status in women and children. To determine the prevalence of anemia, iron and folate deficiency among women and children in 2010 and compare with the prevalence of anemia and iron deficiency in 2002. SUBJECTS/METHODS: A nationally representative survey was conducted in 2002 (1023 women, 15-49 years of age; 1059 children, 12-59 months of age) and a second survey in 2010 (2035 women; 940 children). Venous blood samples were used to measure hemoglobin, ferritin and red blood cell folate (the latter on a subsample of 393 women). RESULTS: Among women in 2010, the prevalence of folate deficiency and insufficiency was 13.6% and 82.9%, respectively. Geometric mean serum ferritin was higher in 2010 compared with 2002 (21.3 ng/ml vs 18.3, P=0.01); there was no significant change in the prevalence of iron deficiency (35.1% vs 38.7%, P=0.17), iron deficiency anemia (19.1% vs 20.0%, P=0.61) or anemia (29.2% vs 29.3%, P=0.96). Among children, a significantly lower prevalence was observed in 2010 compared with 2002 for iron deficiency (13.7% vs 26.2% P<0.001) and iron deficiency anemia (4.8% vs 10.1%, P<0.001); a nonsignificant lower prevalence was observed for anemia (16.6% vs 20.2%, P=0.09). CONCLUSIONS: In 2010, approximately one of seven women was folate deficient and six out of seven were folate insufficient for the prevention of neural tube defects. Between 2002 and 2010, significant improvement was observed in the prevalence of iron deficiency in children, but not in women.

Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6-24 months of age in the Kyrgyz Republic.

BACKGROUND/OBJECTIVES: To combat iron and other micronutrient deficiencies, the Ministry of Health of the Kyrgyz Republic launched a regional Infant and Young Child Nutrition (IYCN) program in 2009, which included promotion of home fortification with micronutrient powder (MNP) containing iron (12.5 mg elemental iron), vitamin A (300 µg) and other micronutrients. Every 2 months children aged 6-24 months were provided 30 sachets to be taken on a flexible schedule. The objective was to assess biochemical indicators of iron and vitamin A status among children aged 6-24 months at the baseline and follow-up surveys. SUBJECTS/METHODS: Cross-sectional representative cluster surveys were conducted in 2008 (n=571 children) and 2010 (n=541). Data collected included measurement of hemoglobin, serum ferritin, soluble transferrin receptor (sTfR), retinol-binding protein, C-reactive protein (CRP) and α1-glycoprotein acid (AGP). RESULTS: Among all children, declines were observed in the prevalence of: anemia, 50.6% versus 43.8% (P=0.05); total iron deficiency (either low ferritin or high sTfR), 77.3% versus 63.7% (P<0.01); and iron deficiency anemia, 45.5% versus 33.4% (P<0.01). Among children without inflammation as measured by CRP and AGP, similar declines were observed, but only declines in total iron deficiency and iron deficiency anemia reached statistical significance. Among all children and those without inflammation, the prevalence of vitamin A deficiency remained the same. CONCLUSIONS: One year after the introduction of home fortification with MNP, within a larger IYCN program, the prevalence of anemia, iron deficiency and iron deficiency anemia declined, but vitamin A deficiency remained unchanged.

Vitamin D status and determinants of deficiency among non-pregnant Jordanian women of reproductive age.

BACKGROUND/OBJECTIVES: Vitamin D deficiency, a risk factor for osteomalacia and osteoporosis, is a re-emerging health problem globally. While sunlight is an important vitamin D source, previous investigations among women whose culture encourages skin covering have been small, not nationally representative, or both. We investigated serum 25-hydroxyvitamin D (25(OH)D(3)) status and factors associated with deficiency in a nationally representative survey of 2013 Jordanian women of reproductive age in Spring 2010. SUBJECTS/METHODS: We measured 25(OH)D(3) concentrations by liquid chromatography-tandem mass spectrometry and calculated prevalence ratios for deficiency associated with skin covering and other factors. RESULTS: Results showed 60.3% (95% CI: 57.1-63.4%) deficiency (<12 ng/ml) and 95.7% (95% CI: 94.4-96.8%) insufficiency (<20 ng/ml) among women. Prevalence of deficiency was 1.60 times higher for women who covered with a scarf/hijab (95% CI: 1.06-2.40, P = 0.024) and 1.87 times higher for women who wore full cover, or a niqab (95% CI: 1.20-2.93, P = 0.006), compared with the women who did not wear a scarf/hijab or niqab. Compared with rural women completing at least secondary education, prevalence of deficiency was 1.30 times higher for urban women of the same education level (95% CI: 1.08-1.57, P = 0.006), 1.18 times higher for urban women completing less than secondary education (95% CI: 0.98-1.43, P = 0.09), and 0.66 times lower for rural women completing less than secondary education (95% CI: 0.52-0.84, P = 0.001). CONCLUSION: Vitamin D deficiency and insufficiency pose significant public health problems in Jordanian women. Prevalence of deficiency is significantly higher among urban women and among women who cover with a scarf/hijab or niqab.

Factors associated with errors in self-reported height and weight in older adults.

OBJECTIVES: Describe the distribution and direction of self-reported versus measured height and weight using variables associated with aging such as cognition, health status, age, and bone mineral density (BMD), and examine the effect of these measurement differences on body mass index (BMI) classification. DESIGN: Data was derived from the third National Health and Nutrition Examination Survey (NHANESIII) conducted from 1988-1994, a nationwide probability sample. PARTICIPANTS: 4,590 non-institutionalized older adults aged 60 and older. MEASUREMENTS: Self-reported and measured height and weight, demographic and lifestyle characteristics, BMD, and subscales from the Mini Mental State Exam were used. Values were considered correct if self-reported height was within one inch of measured height, self-reported weight was within 5 lbs of measured weight, and self-reported BMI was within the same classification as measured BMI. RESULTS: Over-reported height increased with age in both men and women, occurring in 70% of those aged 80 and older. Compared to people with normal BMD, a significantly higher proportion of osteoporotic men (76% versus 47%, P<0.001) and women (52% versus 35%, P<0.001) over-reported their height. Additionally, significant misclassifications of self-reported height and weight occurred among people in poor health and those with poor performances on memory and calculation tests. Nevertheless, there was agreement in BMI classification among almost 80% of the population and among 90% of individuals in the healthy BMI category. CONCLUSION: This study suggests that among an older population, self-reported height and weight may be strongly related to age-associated changes in health status, cognition and BMD.

Secular trends in desired weight of adults.

CONTEXT: The prevalence of overweight and obese adults in the United States is at record levels. OBJECTIVE: The primary purpose is to describe secular trends in desired weight among adults from 1994 to 2003, and secondarily, to examine the hypothetical impact of achieving desired weight on obesity prevalence. DESIGN: Data were from the Behavioral Risk Factor Surveillance System (1994, 1996, 1998, 2000, 2003), a random-digit-dialed telephone survey. SETTING: Sample included respondents from 47 states and the District of Columbia. PARTICIPANTS: Non-institutionalized adults aged 18 years or older were included (N=703 286). MAIN OUTCOME MEASURES: Primary outcome measures included reported weight and desired weight. RESULTS: Means for desired weight increased 2.3 kg between 1994 and 2003, and reported weights increased 3.9 kg. The increased trend was observed across several subgroups for age, race/ethnicity and education. Within subgroups of weight status, the trend has remained relatively stable, particularly when examined in relation to the difference between reported and desired weight as a percentage of reported body weight. Generally, overweight men desired weights approximately 4.5% less than their reported weight, and obese men desired weights approximately 15% less than their reported weight for each corresponding year. For women, approximate values of desired weight were 12% less than reported weight for overweight women and 24% less for obese women. The prevalence of obesity would decrease to 4.4% if individuals weighed their desired weight. CONCLUSIONS: Americans are shifting their desired weight upward, concomitantly with an increase in their reported body weight.

The epidemiology of recent involuntary weight loss in the United States population.

BACKGROUND: Although recent involuntary weight loss (RIWL) has been associated with mortality, no national studies described the prevalence among the general population, characteristics and long-term outcomes of people with RIWL. METHODS: The authors analyzed data from the NHANES II Mortality Study of 5838 individuals 50-74.9 years old who between 1976-1980 underwent a physical examination that included height and weight measurements, biochemical tests and responded to questions about involuntary weight loss within the past six months. Vital status was determined through 1992. Logistic regression was used to examine characteristics associated with RIWL and Cox proportional hazard modeling was used to measure associations between RIWL and mortality. RESULTS: 13.3% of the population reported RIWL with 6.9% reporting > or = 5% RIWL. Obese individuals were at significantly higher risk of RIWL of > or = 5% compared to those with BMI 19-24.9 (OR=1.57. 95% CI: 1.13, 2.18). Other significant risk factors for RIWL included; poor self-reported health, cancer, high white blood cell count, low albumin and low hemoglobin levels, age and current smoking status. RIWL of > or = 5% was significantly associated with mortality (RR=1.24, 95% CI: 1.01, 1.53). CONCLUSION: In summary, RIWL is fairly common among community-dwelling older adults, occurs disproportionately among obese individuals, is associated with characteristics of poor health and independently associated with mortality. These results indicate that RIWL needs to be considered an adverse health indicator even among obese individuals and despite the absence of several clinical indicators of disease.

Inter-relationships among childhood BMI, childhood height, and adult obesity: the Bogalusa Heart Study.

OBJECTIVE: Although the body mass index (BMI, mass index, kg/m2) is widely used as a surrogate measure of adiposity, it is moderately associated (r approximately 0.3) with height among children. We examined whether the resulting preferential classification of taller children as overweight is appropriate. DESIGN: Cross-sectional analyses of children (ages, 3-17 y) examined the relation of height to adiposity (as assessed by BMI and skinfold thicknesses) and fasting levels of insulin. Longitudinal analyses examined the relation of childhood height and weight-height indices to adult (mean age, 25 y) levels of adiposity and fasting insulin. SUBJECTS: Children (n=11,406) and adults (n=2911) who had participated in the Bogalusa Heart Study. MEASUREMENTS: We constructed three weight-height indices: BMI, W/H3, and W/Hp. The triceps and subscapular skinfolds, as well as fasting levels of insulin, were also measured. RESULTS: The classification of children as overweight (BMI-for-age > or =95th percentile) varied markedly by height, with a 10-fold difference in the prevalence of overweight across quintiles of height between the ages of 3 and 10 y. Childhood height, however, was also related to skinfold thicknesses and insulin levels, and all associations were modified in a similar manner by age. Furthermore, childhood height was related to adult adiposity, and of the three childhood weight-height indices, BMI showed the strongest associations with adult adiposity. CONCLUSIONS: Because BMI reflects the positive association between height and adiposity among children, it is a better weight-height index than is either W/H3 or W/Hp.

Use of nonprescription weight loss products: results from a multistate survey.

CONTEXT: Lifestyle changes to lose weight can be difficult; hence, both prescription and nonprescription diet products are appealing. Usage patterns of the nonprescription products phenylpropanolamine (PPA) and ephedra are of particular interest because of recent safety concerns. OBJECTIVE: To estimate the prevalence of overall and specific nonprescription weight loss product use by demographic characteristics, prescription diet pill use, diabetic status, and lifestyle choices. DESIGN AND SETTING: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1998 in 5 states: Florida, Iowa, Michigan, West Virginia, and Wisconsin. PARTICIPANTS: Population-based sample of 14 679 noninstitutionalized adults 18 years or older. MAIN OUTCOME MEASURES: Prevalence of nonprescription weight loss product use in 1996-1998. RESULTS: Seven percent reported overall nonprescription weight loss product use, 2% reported PPA use, and 1% reported ephedra product use. Overall use was especially common among young obese women (28.4%). Moreover, 7.9% of normal-weight women reported use. There was no difference in nonprescription weight loss product use by daily consumption of fruits and vegetables; however, more users than nonusers reported being physically active (for those who exercised >/=30 minutes 5 times per week, odds ratio, 1.5; 95% confidence interval, 1.2-2.0). Among prescription weight loss product users, 33.8% also took nonprescription product. CONCLUSIONS: With increasing rates of obesity, nonprescription product use is likely to increase. Clinicians should know about their patients' use of both prescription and nonprescription weight loss products.

What are preschool children eating? A review of dietary assessment.

Accurate assessment of dietary intake among preschool-aged children is important for clinical care and research, for nutrition monitoring and evaluating nutrition interventions, and for epidemiologic research. We identified 25 studies published between January 1976 and August 2000 that evaluated the validity of food recalls (n = 12), food frequency questionnaires (n = 9), food records (n = 2), or other methods (n = 2). We identified four studies that evaluated the reproducibility of food frequency questionnaires. Validity studies varied in validation standard and study design, making comparisons between studies difficult. In general, food frequency questionnaires overestimated total energy intake and were better at ranking, than quantifying, nutrient intake. Compared with the validation standard, food recalls both overestimated and underestimated energy intake. When choosing a method to estimate diet, both purpose of the assessment and practicality of the method must be considered, in addition to the validity and reproducibility reported in the scientific literature.

BMI rebound, childhood height and obesity among adults: the Bogalusa Heart Study.

OBJECTIVE: The beginning of the post-infancy rise in the body mass index (BMI, kg/m2) has been termed the adiposity rebound, and several studies have found that an early rebound increases the risk for overweight in adulthood. We examined whether this relation is independent of childhood BMI levels. DESIGN: A longitudinal study of 105 subjects who examined at ages 5, 6, 7, 8 and 19-23 y. RESULTS: Subjects with an age at the BMI rebound (age(min)) of < or =5 y were, on average, 4-5 kg/m2 heavier in early adulthood than were subjects whose age(min) was > or =7 y. Age(min), however, was also correlated with childhood BMI levels (r approximately -0.5), and we found that age(min) provided no additional information on adult overweight if the BMI level at age 7 y (or 8 y) was known. In contrast, childhood height, which was also correlated with age(min) (r=-0.47), was independently related to adult BMI. Among relatively heavy (BMI=16.0 kg/m2) 5-y-olds, a child with a height of 120 cm was estimated to be 1.2 kg/m2 heavier in adulthood than would a 104 cm tall child. CONCLUSIONS: Although an early BMI rebound was related to higher levels of relative weight in adulthood, this association was not independent of childhood BMI levels. The relation of childhood height to adult BMI needs to confirmed in other cohorts, but it is possible that childhood height may help identify children who are likely to become overweight adults.

Use of prescription weight loss pills among U.S. adults in 1996-1998.

BACKGROUND: Pharmacotherapy is recommended for the treatment of obese persons with a body mass index of 30 kg/m(2) or higher or a body mass index of at least 27 kg/m(2) plus an obesity-related comorbid condition. OBJECTIVE: To estimate the prevalence of use of prescription weight loss pills in the United States in 1996-1998. DESIGN: 1998 Behavioral Risk Factor Surveillance System, a nationally representative telephone survey. SETTING: United States. PARTICIPANTS: 139 779 adults 18 years of age and older. MEASUREMENTS: Self-reported pill use for 1996-1998, body mass index (current and before pill use), age, sex, and race or ethnicity. RESULTS: The 2-year prevalence of pill use was 2.5% (95% CI, 2.1% to 2.9%), or 4.6 million U.S. adults. Use was higher in women than in men (4.0% vs. 0.9%, respectively) and highest among Hispanic respondents (3.2%). Of pill users, 25% were not overweight (body mass index < 27 kg/m(2) before using pills. CONCLUSIONS: Nearly 5 million U.S. adults used prescription weight loss pills in 1996-1998. However, one quarter of users were not overweight, suggesting that weight loss pills may be inappropriately used, especially among women, white persons, and Hispanic persons.

Secular trends in height among children during 2 decades: The Bogalusa Heart Study.

OBJECTIVE: To examine trends in height among 5- to 17-year-old children between 1973 and 1992. DESIGN: A panel design consisting of 7 cross-sectional surveys. PARTICIPANTS: All schoolchildren residing in Bogalusa, La, were eligible. A total of 24 070 examinations were performed. RESULTS: During the study period, the mean height of schoolchildren increased by 0.70 cm per decade independently of race, sex, and age. Trends were most pronounced among preadolescents, blacks, and boys, with 9- to 12-year-old black boys showing a height increase of 1.8 cm per decade. We observed a decrease in the number of relatively short children (<10th percentile of height) and an increase in the number of tall children (>90th percentile of height). Because a secular trend was not seen among the 15- to 17-year-old children, our findings likely reflect an acceleration of maturation. CONCLUSIONS: It has generally been assumed that secular increases in height among schoolchildren in the United States ceased by the mid-1900s. Our findings, which may be due to various environmental factors, demonstrate that care must be taken when using nonconcurrent reference data to assess the growth of children. Additional study is needed to determine if these secular trends are continuing and to examine possible explanations and consequences of these trends.

The spread of the obesity epidemic in the United States, 1991-1998.

CONTEXT: The increasing prevalence of obesity is a major public health concern, since obesity is associated with several chronic diseases. OBJECTIVE: To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults. DESIGN: Cross-sectional random-digit telephone survey (Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998. SETTING: States that participated in the Behavioral Risk Factor Surveillance System. MAIN OUTCOME MEASURES: Body mass index calculated from self-reported weight and height. RESULTS: The prevalence of obesity (defined as a body mass index > or =30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases). CONCLUSIONS: Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.

Are health care professionals advising obese patients to lose weight?

CONTEXT: Implementation of the National Institutes of Health's 1998 guidelines, which recommended that health care professionals advise obese patients to lose weight, required baseline data for evaluation. OBJECTIVES: To describe the proportion and characteristics of obese persons advised to lose weight by their health care professional during the previous 12 months and to determine whether the advice was associated with reported attempts to lose weight. DESIGN: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. SETTING: Population-based sample from 50 states and the District of Columbia. PARTICIPANTS: A total of 12835 adults, 18 years and older, classified as obese (body mass index > or =30 kg/m2), who had visited their physician for a routine checkup during the previous 12 months. MAIN OUTCOME MEASURES: Reported advice from a health care professional to lose weight, and reported attempts to lose weight. RESULTS: Forty-two percent of participants reported that their health care professional advised them to lose weight. Using multivariate logistic regression analysis, we found that the persons who were more likely to receive advice were female, middle aged, had higher levels of education, lived in the northeast, reported poorer perceived health, were more obese, and had diabetes mellitus. Persons who reported receiving advice to lose weight were significantly more likely to report trying to lose weight than those who did not (OR, 2.79; 95% CI, 2.53-3.08). CONCLUSIONS: Less than half of obese adults report being advised to lose weight by health care professionals. Barriers to counseling need to be identified and addressed.

Prevalence of attempting weight loss and strategies for controlling weight.

CONTEXT: Overweight and obesity are increasing in the United States. Changes in diet and physical activity are important for weight control. OBJECTIVES: To examine the prevalence of attempting to lose or to maintain weight and to describe weight control strategies among US adults. DESIGN: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. Setting The 49 states (and the District of Columbia) that participated in the survey. PARTICIPANTS: Adults aged 18 years and older (N = 107 804). MAIN OUTCOME MEASURES: Reported current weights and goal weights, prevalence of weight loss or maintenance attempts, and strategies used to control weight (eating fewer calories, eating less fat, or using physical activity) by population subgroup. RESULTS: The prevalence of attempting to lose and maintain weight was 28.8% and 35.1 % among men and 43.6% and 34.4% among women, respectively. Among those attempting to lose weight, a common strategy was to consume less fat but not fewer calories (34.9% of men and 40.0% of women); only 21.5% of men and 19.4% of women reported using the recommended combination of eating fewer calories and engaging in at least 150 minutes of leisure-time physical activity per week. Among men trying to lose weight, the median weight was 90.4 kg with a goal weight of 81.4 kg. Among women, the median weight was 70.3 kg with a goal weight of 59.0 kg. CONCLUSIONS: Weight loss and weight maintenance are common concerns for US men and women. Most persons trying to lose weight are not using the recommended combination of reducing calorie intake and engaging in leisure-time physical activity 150 minutes or more per week.

Dose-effect of fenfluramine use on the severity of valvular heart disease among fen-phen patients with valvulopathy.

OBJECTIVE: To determine whether the severity of valvulopathy was associated with the dosage of fenfluramine taken by fenfluramine-phentermine users with valvulopathy. DESIGN: Out of 105 suspected valvulopathy case reports received by the US Food and Drug Administration (FDA) among fenfluramine-phentermine users, 74 patients meeting FDA case definition for valvulopathy were included in this study. Patients with severe valvulopathy were classified as those either undergoing valve replacement surgery or having severe aortic or mitral regurgitation; all other patients were considered to have less severe valvulopathy. RESULTS: The proportion with severe valvulopathy increased from 20-66% with increasing fenfluramine dosage from /=60 mg/d. Compared with patients taking<40 mg/d fenfluramine, patients taking >/=60 mg/d had an adjusted odds ratio of 9.2 (95% confidence interval=2.1-40.8) for severe valvulopathy. CONCLUSION: Compared to patients with less severe valvulopathy, those with severe valvulopathy were substantially more likely to have taken >/=60 mg/d fenfluramine.

Assessing alcohol consumption: beverage-specific versus grouped-beverage questions.

OBJECTIVE: The quantity-frequency method is commonly used to measure alcohol intake in large surveys. Because of time and space constraints, questionnaires are often shortened by combining questions on all types of alcohol into a single question. We investigated the effect of this practice using data from the Behavioral Risk Factor Surveillance System. METHOD: We examined data collected from 213,842 respondents to surveys conducted by 32 states and the District of Columbia participating in the years 1987, 1988, 1989 and 1990. The 1987 and 1988 surveys asked questions about respondents' frequency and level of intake of specific alcohol-containing beverages. The 1989 and 1990 surveys asked about the frequency and quantity of intake of alcohol-containing beverages by combining all beverages into a single group. RESULTS: Among drinkers, the mean number of drinks per month was higher for those who were asked beverage-specific questions than for those who were asked grouped-beverage questions (men: 37.0 vs 29.6; women: 17.0 vs 13.9). CONCLUSION: Caution must be used in comparing level of alcohol intake from surveys in which beverages are not grouped identically.