Daily Alcohol Intake and Risk of All-Cause Mortality
- No amount of alcohol consumption led to a longer life.
- Increased risk is associated with approximately >3 beverages daily in men and >2 beverages daily in women.
- Prior studies that suggested improved outcomes with moderate alcohol intake often mischaracterized former heavy drinkers as “nondrinkers” and inconsistently used occasional drinkers or lifetime nondrinkers as the reference groups.
Does daily alcohol intake increase all-cause mortality? Might it be beneficial?
This systemic review and meta-analysis of 107 cohort studies involving over 4.8 million participants evaluates the risk relationship between level of alcohol consumption and all-cause mortality.
There was no significant reduced risk of all-cause mortality in occasional drinkers. Additionally, there was no reduced risk in low volume drinkers (about one beverage daily) compared to lifetime nondrinkers. Increased risk of mortality is noted in people who drank 25-44 g of alcohol per day (average beverage contains 12-13 g) and significantly increased risk of those who drank 45-64 g/day and >65 g/day. Women had higher risks compared to men.
Low daily alcohol intake gives neither harm nor benefit. However, there is increased risk of all-cause mortality at relatively low levels of daily alcohol intake in women (>2 beverages/day) and in men (>3 beverages/day). Prior studies suggesting a possible benefit of low-level alcohol intake may have reached that conclusion by mischaracterizing former heavy drinkers and using inconsistent reference groups as the comparators.
Alcohol consumption is a widespread activity in many societies and is sometimes thought to have benefit in cardiovascular and all-cause risk reduction when done in moderation. Previous studies have led many health care providers to suggest that 1-2 alcoholic beverages have no harm and may have health benefits. This extensive meta-analysis of 107 studies done between 1980 and 2021 identified biases in prior studies that blurred the differences between abstainers and drinkers. When these biases are addressed, the conclusion is that no amount of daily alcohol is beneficial, and risk of all-cause mortality goes up at a relatively low level of daily alcohol intake—at a lower level for women than for men—but still at a low level.
Based on this new analysis, clinicians should no longer suggest that a little alcohol intake may be a beneficial thing for their patients and instead indicate that, at certain levels, it may be detrimental. Accordingly, drinking alcohol should be viewed as an activity that is best done with appropriate moderation (or abstention). We must acknowledge that things such as alcohol intake, “party” foods, sodium, and fat intake are things that many people find as enjoyable and indispensable parts of life—but that these activities probably should be done at least with moderation, and certainly with no expectation of a specific health benefit.
Keywords: Alcoholic Beverages, Alcoholic Intoxication, Alcoholism, Ethanol, Alcohol Abstinence, Metabolic Syndrome, Patient Outcome Assessment, Primary Prevention, Risk Assessment
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