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Critique 245:  Effects of different patterns of alcohol consumption on risk of mortality, major cardiovascular events, cirrhosis, and cancer —  25 January 2021

This study was designed to determine factors that affect the pattern of alcohol consumption (including the frequency of consumption, type of beverage, with or without food, etc.), rather than just the reported average amount of alcohol, related to all-cause mortality, major cardiovascular events-MACE (MI/stroke/cardiovascular death), accidents/injuries, liver cirrhosis, all-cause and alcohol-related cancer incidence.  It was based on a large prospective cohort study of UK Biobank (UKB) participants and included more than 300,000 subjects; outcomes were ascertained over a 9-year median follow-up period.  Non-drinkers and only occasional drinkers were excluded from the analyses, so this paper does not judge the effects of light or moderate drinking versus not drinking, but only the effects of the pattern of reported alcohol consumption among regular drinkers.

The study showed that in comparison with subjects who consumed red wine more than 50% of the time (the reference group) there were lower risks of many adverse outcomes than among consumers of more than 50% of the time of spirits; the latter had 25% greater risk of all-cause mortality, 31% greater risk of MACE, and 48% higher risk of liver cirrhosis after controlling for total weekly alcohol consumption and relevant confounders.  In comparison with red-wine drinkers, consumers of beer/cider showed an 18% higher risk for all-cause mortality, 16% higher risk of MACE, and 36% higher risk of liver cirrhosis.   There were no statistically significant differences in outcomes between white wine drinkers and red wine drinkers.

Consumption of alcohol with food, versus not with food, showed a 10% (CI 2%-17%) lower risk of all-cause mortality.  While consumers reporting alcohol consumption 3-4 days/week had lower risk of some adverse outcomes than subjects reporting intake on only 1-2 days/week, for some reasons subjects reporting daily or near-daily intake had an increased risk of liver cirrhosis, probably related to under-reporting by some heavy drinkers.

Forum members agree with the conclusions of this study as reported in the Authors’ Abstract: “Red wine drinking, consumption with food and spreading alcohol intake over 3–4 days were associated with lower risk of mortality and vascular events among regular alcohol drinkers, after adjusting for the effects of average amount consumed.”  The results of this well-done study emphasize how inappropriate it is to use just the total average alcohol intake when relating the consumption of alcoholic beverages to the risk of adverse health outcomes.

Reference:  Jani BD, McQueenie R, Nicholl BI, Field R, Hanlon P, Gallacher KI, Mair FS, Lewsey J.  Association between patterns of alcohol consumption (beverage type, frequency and consumption with food) and risk of adverse health outcomes: a prospective cohort study.  BMC Medicine 2021;19:8.  https://doi.org/10.1186/s12916-020-01878-2.

For the full critique of this paper by the International Scientific Forum on Alcohol Research, please click here.

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