From choice of drinks to consumption during meals, researchers followed more than 340,000 adults to study the link between different patterns of alcohol consumption and long-term mortality.
Total and beverage-specific alcohol consumption at midlife and all-cause mortality: a prospective cohort study. Image credit: Tero Vesalainen /Shutterstock
In a recent study published in the Nutritional journalresearchers assessed associations between alcohol consumption and mortality.
Excessive alcohol consumption is one of the leading causes of death. Yet evidence on the impact of low or moderate intake remains inconsistent. While guidelines in several countries have set limits for safer alcohol consumption, the World Health Organization (WHO) has more recently clarified that no amount of alcohol consumed is safe. These different recommendations can contribute to public confusion.
About the study
The researchers used data from the UK Biobank (UKB) cohort to examine associations between total and beverage-specific alcohol consumption and all-cause and cause-specific mortality. Exclusions included former drinkers, participants with baseline cardiovascular disease or cancer, and those with incomplete alcohol data. Questionnaires were administered at baseline to assess alcohol consumption and collect data on sociodemographic and lifestyle factors. Participants reported drinking frequency and average quantities of alcohol consumed by beverage type.
The researchers grouped participants based on their pure alcohol consumption, using never or occasional drinking (no more than 20 g per week) as the reference group. As a reminder, 20 g of pure alcohol is approximately equivalent to 500 ml of beer containing 5% alcohol. Low intake was defined as greater than 20 g per week but not more than 20 g per day for men or 10 g per day for women. Moderate intake ranged between 20 and 40 g per day for men and between 10 and 20 g per day for women, while high intake exceeded 40 and 20 g per day, respectively. Deaths were identified from death certificates and the underlying cause was determined using the International Classification of Diseases, 10th revision (ICD-10).
The team used Cox proportional hazards models to examine all-cause mortality, cardiovascular disease (MCV), cancer and other causes linked to alcohol consumption. Models were adjusted for age, race, sex, education, socioeconomic deprivation, smoking, physical activity, and body mass index (BMI), diet quality, clinical characteristics, family medical history, and alcohol consumption habits. For each drink, mortality was compared to that of people consuming little or no of this drink, with adjustment for the consumption of other alcoholic drinks.
Dose-response relationships and associations between mealtime or non-meal alcohol consumption and mortality were also assessed. Subgroup analyzes were performed according to gender, age, race, physical activity, smoking, BMI, and diet quality. Sensitivity analyzes excluded non-drinkers and subjects who died within two years of follow-up.
Results
The study included 340,924 UKB participants, with an average age of approximately 56 years. Women made up just over half of the cohort and 96.3% of participants were white. Greater physical activity was observed in participants with high total alcohol consumption compared to those who never or occasionally drank. People with high alcohol consumption from beer or cider were more likely to be men, reported greater physical activity, and had lower education levels and diet quality than those who never or occasionally drank.
During a mean follow-up of 13.4 years, 22,381 deaths occurred. High total alcohol consumption was linked to higher mortality from all causes, cancer, cardiovascular disease and other causes, compared with never or occasional consumption. Moderate total alcohol consumption was only associated with high cancer mortality. Low total alcohol consumption was associated with lower mortality from other causes. High beer/cider consumption was linked to increased all-cause and cause-specific mortality.
Even low beer/cider consumption was associated with high cancer mortality. Consumption of alcohol from spirits at low or combined moderate to high levels was linked to higher all-cause and cause-specific mortality. Lower all-cause and cause-specific mortality was observed with low wine consumption; Meanwhile, high wine consumption was associated with increased cancer mortality.
Moderate or low red wine consumption was associated with lower all-cause mortality from cardiovascular disease and other causes, but high red wine consumption was linked to higher all-cause and cancer mortality. High consumption of white wine was associated with higher all-cause mortality from cancer and other causes, while high consumption of fortified wine was associated with higher mortality from all causes and other causes. Of 20 site-specific cancer mortality outcomes, total or beverage-specific alcohol consumption was associated with higher mortality in 15 cases after correction for multiple comparisons, including head and neck, respiratory, gastrointestinal, liver/gallbladder, hematologic, breast, and genital cancers. There was a linear relationship between total alcohol consumption and all-cause mortality, cardiovascular disease and cancer, mainly due to the consumption of spirits and beer/cider.
A J-shaped relationship was observed between wine consumption and cause-specific and all-cause mortality. Drinking sometimes or usually with meals was associated with lower mortality, while drinking outside of meals was linked to stronger adverse associations at higher levels of consumption. Subgroup analyzes revealed stronger associations between total alcohol consumption and all-cause mortality among men, younger participants, non-White participants, current smokers, and non-obese participants. Sensitivity analyzes gave comparable results.
Conclusions
Overall, mortality from all causes, cardiovascular disease, cancer, and other causes, was significantly higher with higher total alcohol consumption. Even moderate consumption was associated with higher cancer mortality. Low or moderate alcohol consumption from wine was associated with lower mortality for some outcomes. These findings suggest that low to moderate consumption of spirits and beer/cider may be associated with adverse mortality outcomes, particularly cancer mortality, but the observational design cannot establish causality. The lower mortality among wine drinkers does not establish a protective effect of wine. Alcohol consumption was self-reported and primarily assessed at baseline, and residual confounding and limited generalizability remain possible.
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Journal reference:
Gn Health
