Think Responsibly: The Risks and Benefits of Alcohol & You

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Sat Feb 17, 2018 8:17 am

The Myth of Moderation Pt 4: Is that a glass of wine (5 oz) you are having, or 1/2 a bottle?
Wine glass capacity in has increased from a mean of 66 mL (~2.25 oz) in 1700 to 449 mL (14 oz) in 2017

Wine glass size in England from 1700 to 2017: a measure of our time
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5623
Published 13 December 2017

Figure 1 shows the capacity of wine glasses from the five sources over time, along with the non-parametric regression fit for the mean (solid line) and the corresponding pointwise 95% confidence intervals (shaded area). Wine glass capacity increased from 66 mL (standard deviation 21.69) (2.25 oz) in the 1700s to 417 mL (SD 170) (14 oz) in the 2000s, and the mean wine glass size in 2016-17 was 449 mL (SD 161) (15.18 oz). This increase was gradual until the 1990s, when it became more marked.

NOTE - The upper end of the chart shows glass size over 27 oz.

Image

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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Wed Apr 04, 2018 6:42 am

No Benefit of Light to Moderate Drinking for Mortality From Coronary Heart Disease When Better Comparison Groups and Controls Included: A Commentary on Zhao et al. (2017)
Journal of Studies on Alcohol and Drugs, 78(3), 387–388 (2017).

https://doi.org/10.15288/jsad.2017.78.387


Significant proportions of the population can be classified as light to moderate drinkers, and many drinkers worldwide believe that alcohol confers valued social benefits. These facts, combined with extensive promotion by the alcohol industry of positive alcohol-related lifestyles and happiness as well as concerted efforts to influence public perceptions of alcohol research (Babor & Robaina, 2013; Institute of Alcohol Studies, 2017), make it relatively unsurprising that scientific research extolling health “benefits” of light to moderate alcohol use receives extensive coverage in the media. Such news reports are read, remembered, and referred to frequently by drinkers who wish to continue enjoying alcohol while maintaining or even enhancing good health.

At the same time, evidence grows for a positive dose- response link between alcohol consumption and numerous cancers (Connor, 2017), and apparent risks of abstaining for all-cause mortality are increasingly questioned (Stockwell et al., 2016). However, many members of the public, the media, and some government health officials continue to hope that at least some aspects of cardiovascular health are benefited by light to moderate drinking.

In this context, Zhao et al.’s (2017—this issue) excellent series of meta-analyses examining links between alcohol use and mortality from coronary heart disease (CHD) is very timely and of great public health importance. Using controls with increased rigor, this research updates and complements their 2016 systematic review and meta-analysis in this journal examining whether light to moderate drinkers have a reduced all-cause mortality risk compared with abstainers (Stockwell et al., 2016).

Zhao and colleagues (Stockwell et al., 2016; Zhao et al., 2017) hypothesize that light to moderate drinkers have a lower risk of mortality (from CHD and other causes) compared with abstainers because some abstainers are former dependent or heavy drinkers, former drinkers who quit because of poor health, or individuals with long-term chronic illness. These selection factors bias abstainers toward poor health. Zhao and colleagues also hypothesize that health differences between alcohol abstainers and light to moderate drinkers may also result from misclassifying infrequent drinkers as abstainers, from failing to control for powerful risk factors of poor health (e.g., low education and smoking), or from a healthy-survivor bias that does not consider other causes of alcohol-related poor health and death over the life course.

In pooled meta-regression analyses in studies of high quality, with controls for heart health, or focusing on subjects under age 55 at baseline, Zhao et al. (2017) observed no benefit of light to moderate drinking for CHD mortality. This is a major finding that further strengthens the growing evidence base that alcohol is not health enhancing, even for specific and selected bodily systems or causes of death.

Estimating long-term effects of alcohol on health is complicated by nonrandom assignment to various levels of adult alcohol use, leading to the use of observational studies. Zhao and colleagues (2017) draw needed attention to key challenges in such designs, including frequent misclassification of former and occasional drinkers as abstainers, the absence of high-quality measures of alcohol use in many large-scale epidemiological studies, the healthy-survivor bias that worsens with cohort age, and residual confounding.

We agree that future epidemiological research needs to consider seriously the methodological challenges raised by Zhao and colleagues (Stockwell et al., 2016; Zhao et al., 2017). Indeed, the limitations of previous studies highlighted in Stockwell et al.’s review directed our own research on this topic (Evans-Polce et al., 2016; Staff & Maggs, 2017). In our prospective work across adulthood, we followed recommendations to minimize many forms of abstainer, misclas- sification, and selection bias.

Additional ongoing challenges in research seeking to understand apparent costs of alcohol abstention will be to better account for early-life selection factors (e.g., child/ado- lescent health), adult lifestyle factors (e.g., quality measures of physical activity, diet, and access to and use of medical screening and treatment), drinking patterns within time (e.g., total volume, binge drinking frequency, special occasion drinking), drinking trajectories across time (i.e., using data collected at multiple intervals), and reasons for cutting down or quitting. Given the intriguing findings in Zhao et al. (2017) of differences of association by sample ethnicity and age, future research should consider in greater depth how harm may vary by population subgroups or change more dynamically across decades from adolescence through midlife through old age (Evans-Polce et al., 2016). Such analyses would benefit from large epidemiological studies following individuals from childhood or adolescence across significant periods of the adult life course.

Together, these meta-analyses are pushing researchers to take seriously the notion that selection and lifestyle factors are driving observed health benefits of low-dose alcohol consumption. If health benefits of light to moderate alcohol use are indeed spurious, as these thorough meta-analyses suggest, recommendations for the majority nonabstaining adult population may require revision, in light of consequential negative health effects of alcohol for injuries, cancer, and all-cause mortality, and, at best, no benefit for death due to CHD. Although these results are not what the majority of drinking adults may desire to believe, the public deserves to hear and to read in more complete and balanced detail the ever-growing evidence that drinking alcohol is very unlikely to improve their health and more likely may have the opposite effect.
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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Thu Aug 23, 2018 6:30 pm

There is strong support here for the guideline published by the Chief Medical Officer of the UK who found that there is “no safe level of alcohol consumption”.13


Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Alcohol use is a leading risk factor for global disease burden and causes substantial health loss.
GBD 2016 Alcohol Collaborators† Show footnotes
Open Access
Published: August 23, 2018
DOI:https://doi.org/10.1016/S0140-6736(18)31310-2
https://www.thelancet.com/journals/lanc ... 40-6736(18)31310-2/fulltext

Summary

Background

Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.
Methods

Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.
Findings

Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.
Interpretation

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.




No level of alcohol consumption improves health
Open Access
Published:August 23, 2018
https://www.thelancet.com/journals/lanc ... 40-6736(18)31571-X/fulltext

The conclusions of the study are clear and unambiguous: alcohol is a colossal global health issue and small reductions in health-related harms at low levels of alcohol intake are outweighed by the increased risk of other health-related harms, including cancer. There is strong support here for the guideline published by the Chief Medical Officer of the UK who found that there is “no safe level of alcohol consumption”.13 The findings have further ramifications for public health policy, and suggest that policies that operate by decreasing population-level consumption should be prioritised.
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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Fri Apr 05, 2019 4:02 am

Interesting analysis


A comparison of gender-linked population cancer risks between alcohol and tobacco: how many cigarettes are there in a bottle of wine?
Hydes et al. BMC Public Health (2019) 19:316 https://doi.org/10.1186/s12889-019-6576-9

Abstract

Background: In contrast to our knowledge about the number of cancers attributed to smoking, the number of cancers attributed to alcohol is poorly understood by the public. We estimate the increase in absolute risk of cancer (number of cases per 1000) attributed to moderate levels of alcohol, and compare these to the absolute risk of cancer attributed to low levels of smoking, creating a ‘cigarette-equivalent of population cancer harm’.

Methods: Alcohol and tobacco attributable fractions were subtracted from lifetime general population risks of developing alcohol- and smoking-related cancers, to estimate the lifetime cancer risk in alcohol-abstaining non- smokers. This was multiplied by the relative risk of drinking ten units of alcohol or smoking ten cigarettes per week, and increasing levels of consumption.

Results: One bottle of wine per week is associated with an increased absolute lifetime cancer risk for non-smokers of 1.0% (men) and 1.4% (women). The overall absolute increase in cancer risk for one bottle of wine per week equals that of five (men) or ten cigarettes per week (women). Gender differences result from levels of moderate drinking leading to a 0.8% absolute risk of breast cancer in female non-smokers.

Conclusions: One bottle of wine per week is associated with an increased absolute lifetime risk of alcohol-related cancers in women, driven by breast cancer, equivalent to the increased absolute cancer risk associated with ten cigarettes per week. These findings can help communicate that moderate levels of drinking are an important public health risk for women. The risks for men, equivalent to five cigarettes per week, are also of note.
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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Sat Apr 06, 2019 5:52 am

Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China

PublishedOnline
The Lancet
April 4, 2019 http://dx.doi.org/10.1016/ S0140-6736(18)31772-0

Summary
Background
Moderate alcohol intake has been associated with reduced cardiovascular risk in many studies, in comparison with abstinence or with heavier drinking. Studies in east Asia can help determine whether these associations are causal, since two common genetic variants greatly affect alcohol drinking patterns. We used these two variants to assess the relationships between cardiovascular risk and genotype-predicted mean alcohol intake in men, contrasting the findings in men with those in women (few of whom drink).

Methods
The prospective China Kadoorie Biobank enrolled 512 715 adults between June 25, 2004, and July 15, 2008, from ten areas of China, recording alcohol use and other characteristics. It followed them for about 10 years (until Jan 1, 2017), monitoring cardiovascular disease (including ischaemic stroke, intracerebral haemorrhage, and myocardial infarction) by linkage with morbidity and mortality registries and electronic hospital records. 161498 participants were genotyped for two variants that alter alcohol metabolism, ALDH2-rs671 and ADH1B- rs1229984. Adjusted Cox regression was used to obtain the relative risks associating disease incidence with self- reported drinking patterns (conventional epidemiology) or with genotype-predicted mean male alcohol intake (genetic epidemiology—ie, Mendelian randomisation), with stratification by study area to control for variation between areas in disease rates and in genotype-predicted intake.

Findings
33% (69 897/210 205) of men reported drinking alcohol in most weeks, mainly as spirits, compared with only 2% (6245/302 510) of women. Among men, conventional epidemiology showed that self-reported alcohol intake had U-shaped associations with the incidence of ischaemic stroke (n=14930), intracerebral haemorrhage (n=3496), and acute myocardial infarction (n=2958); men who reported drinking about 100 g of alcohol per week (one to two drinks per day) had lower risks of all three diseases than non-drinkers or heavier drinkers. In contrast, although genotype- predicted mean male alcohol intake varied widely (from 4 to 256 g per week—ie, near zero to about four drinks per day), it did not have any U-shaped associations with risk. For stroke, genotype-predicted mean alcohol intake had a continuously positive log-linear association with risk, which was stronger for intracerebral haemorrhage (relative risk [RR] per 280 g per week 1·58, 95% CI 1·36–1·84, p<0·0001) than for ischaemic stroke (1·27, 1·13–1·43, p=0·0001). For myocardial infarction, however, genotype-predicted mean alcohol intake was not significantly associated with risk (RR per 280 g per week 0·96, 95% CI 0·78–1·18, p=0·69). Usual alcohol intake in current drinkers and genotype- predicted alcohol intake in all men had similarly strong positive associations with systolic blood pressure (each p<0·0001). Among women, few drank and the studied genotypes did not predict high mean alcohol intake and were not positively associated with blood pressure, stroke, or myocardial infarction.

Interpretation
Genetic epidemiology shows that the apparently protective effects of moderate alcohol intake against stroke are largely non-causal. Alcohol consumption uniformly increases blood pressure and stroke risk, and appears in this one study to have little net effect on the risk of myocardial infarction.
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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Thu Jul 11, 2019 6:49 am

CMAJ - Change in moderate alcohol consumption and quality of life

“We found that lifetime alcohol abstainers reported the highest level of mental well-being. Women who quit drinking were found to have a greater improvement in mental well-being than lifetime abstainers.”

“In contrast, initiation and persistent moderate drinking for 4 years were not associated with better mental or physical well-being”

http://www.cmaj.ca/content/191/27/E753
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Re: Think Responsibly: The Risks and Benefits of Alcohol & Y

Postby JeffN » Thu Aug 12, 2021 3:44 pm

Alcohol use and cardiometabolic risk in the UK Biobank: A Mendelian randomization study.
PLoS One. 2021 Aug 11;16(8):e0255801. doi: 10.1371/journal.pone.0255801. eCollection 2021.
PMID: 34379647

Abstract

Observational studies suggest alcohol use promotes the development of some adverse cardiometabolic traits but protects against others including outcomes related to coronary artery disease. We used Mendelian randomization (MR) to explore causal relationships between the degree of alcohol consumption and several cardiometabolic traits in the UK Biobank. Using the well-established ADH1B Arg47His variant (rs1229984) and up to 24 additional SNPs recently found to be associated with alcohol consumption in an independent dataset as instruments, we conducted two-stage least squares and inverse weighted variance MR analyses, both as one-sample analyses in the UK Biobank and as two-sample analyses in external consortia. In the UK Biobank inverse variance weighted analyses, we found that one additional drink of alcohol per day was positively associated with systolic blood pressure (beta = 2.65 mmHg [1.40, 3.89]), hemorrhagic stroke (OR = 2.25 [1.41, 3.60]), and atrial fibrillation (OR = 1.26 [1.07, 1.48]), which were replicated in multivariable analyses. Alcohol was also associated with all cardiovascular disease and all-cause death. A positive association with myocardial infarction did not replicate in multivariable analysis, with suggestive mediation through blood pressure; similarly, a positive association between alcohol use with type 2 diabetes was mitigated by BMI in multivariable analysis. Findings were generally null in replication with two-sample analyses. Alcohol was not protective for any disease outcome with any analysis method, dataset, or strata. Stratifications by sex and smoking in the UK Biobank revealed higher point estimates of risk for several outcomes for men and mixed results for smoking strata, but no statistically significant heterogeneity. Our results are consistent with an overall harmful and/or null effect of alcohol on cardiometabolic health at all levels of use and suggest that even moderate alcohol use should not be promoted as a part of a healthy diet and lifestyle.
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