Dietary intake and nutritional status of US adult marijuana users: results from the Third National Health and Nutrition Examination Survey Ellen Smit* and Carlos J Crespo Department of Social and Preventive Medicine, School of Medicine, University at Buffalo, SUNY, Buffalo, NY 14214, USA Abstract Objectives: This study examined dietary intakes and nutritional status of marijuana users and non-current marijuana users in US adults aged 20 to 59 years. Methods: We used data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988±1994. Information on self-reported drug use, including marijuana, was obtained as part of the NHANES III physical examination component. Nutritional status was assessed using height and weight, and blood biochemistries. Dietary intake was assessed using a 24-hour recall and a food-frequency questionnaire. Results: Among adults 20±59 years of age, 45% reported ever having used marijuana in their lifetime. A total of 8.7% reported using marijuana in the past month. Current marijuana users had higher intakes of energy and nutrients than non-current marijuana users; however, body mass index (BMI) was slightly lower. We found higher cigarette-smoking rates and higher consumption of sodas and alcohol, specifically beer, among marijuana users than among non-current marijuana users. Marijuana users also consumed more sodium, fewer fruits, and more pork, cheese, and salty snacks. Nutritional status, using indicators of serum nutrients, serum albumin, haematocrit and haemoglobin, was similar between marijuana users and non-current marijuana users. Serum carotenoid levels were lower among marijuana users, independent of cigarette smoking. Conclusion: Dietary intake was different among marijuana users than among non- current marijuana users. Although overall nutritional status was similar, serum carotenoid levels were lower in marijuana users. The long-term health effects of these differences in marijuana users deserve careful consideration in future research. Keywords NHANES III Marijuana users Diet Nutritional status Marijuana is the most commonly used illicit drug in the USA. Approximately one-third of the US population aged 12 years or older, or 72 million persons, have reported smoking marijuana at some point in their life 1 . Trends in marijuana use have not changed dramatically since 1991 1 . The National College Health Risk Behavior Survey found that 59.6% of students aged 25 years and older reported ever having used marijuana, with 8.3% reporting being current users of marijuana 2 . In response to public pressure to allow for the medical use of marijuana, the Office of National Drug Control Policy of the United States evaluated the scientific evidence for the benefits and risks of using marijuana as a medicine 3 . We know little about the long-term effects of marijuana use on the human body and other concomitant health behaviours associated with marijuana consumption. The report called for an increase in research to evaluate the health consequences of marijuana use and other behaviours associated with consumption of marijuana. It is important that we learn more about the changes in dietary habits that accompany marijuana use and their beneficial or detrimental effect in the development of chronic diseases later in life. Use of psychoactive drugs, including marijuana, has been reported to affect food and beverage consumption, and body weight 4±8 . Mendelson studied chronic mari- juana users in a laboratory setting and found that the participants increased caloric intake and gained weight during periods of active marijuana use 5 . Similarly, after administering marijuana to 12 healthy volunteers, Hollis- ter found total food intake, and reports of hunger and appetite, to increase 6 . Foltin et al. also showed that DOI: 10.1079/PHN2000114 Public Health Nutrition: 4(3), 781±786 *Corresponding author: Email esmit@buffalo.edu q The Authors 2001