ReviewModerate alcohol use and health: A consensus document
Section snippets
Methodology
The Nutrition Foundation of Italy coordinated a team of Italian experts, as follows: selected Italian scientific societies were contacted and required to provide topic-specific reviews of the alcohol–health relation. Twenty societies out of 23 agreed (see Appendix 1), although one finally chose not to contribute to this document. All contributions were merged, discussed and agreed upon by the entire Panel, which approved the final paper in September 2012.
Methodological limitations in the assessment of alcohol–health associations
All studies on the associations between alcohol and health are methodologically complex. This is due to the methods used to assess alcohol consumption, to the choice of control groups and to the correct definition of confounding factors. Assessment of alcohol consumption is usually done by specific questionnaires, where frequency and amount of consumption are collected. This procedure often underestimates the true rate of consumption, especially in heavy drinkers, who tend to report
Coronary heart disease and fatal arrhythmia
Data derived from epidemiological studies and obtained in primary care individuals consistently show the existence of a significant inverse association between moderate alcohol use and cardiovascular risk (mainly, myocardial infarction and stroke). Conversely, excessive intake does increase cardiovascular risk. Several meta-analyses reported a ‘J’-shaped curve that describes the association between alcohol consumption and cardiovascular risk, namely a higher risk associated to both abstention
Lipid profile
An early review, published in 1999 [44], suggested that moderate alcohol use is associated with increased plasma concentrations of high-density lipoprotein (HDL) cholesterol (HDL-c), with a clear dose–response relationship, namely, an increase of 0.133 mg/dl for every gram of alcohol ingested daily. Likewise, every gram of alcohol was associated with a 0.294 mg/dl increase in plasma apolipoprotein A-I levels (Apo-AI; the foremost component of HDL) and of 0.190 mg/dl in triacylglycerol (TG)
Metabolic syndrome
The metabolic syndrome (MS) is a multifactorial disorder that, according to the recent International Diabetes Federation definition, requires the presence of central obesity and at least two of the four following abnormalities: high TGs, low HDL-c, high blood pressure or raised fasting plasma glucose level. According to the Adult Treatment Panel-III (ATP-III) definition (with which the general practitioner is more familiar), the presence of any three of the five risk factors mentioned above
Moderate alcohol use and liver disease
Alcoholic liver disease (ALD) is the most prevalent cause of advanced liver disease in the Western world. It comprises a large spectrum of liver injuries, ranging from fatty liver or simple steatosis (alcoholic fatty liver disease, AFLD) to acute alcoholic hepatitis, alcoholic steatohepatitis (ASH), chronic hepatitis with hepatic fibrosis and cirrhosis [100], [101]. Non-alcoholic fatty liver disease (NAFLD), on the other hand, is the most common liver disorder in Western countries and affects
Alcohol, cognitive impairment and dementia
Five epidemiological studies have been published on the association between alcohol use and incidence of dementia and Alzheimer's disease [111], [112], [113], [114], [115]. In addition, two meta-analyses examined 26 and 15 studies, respectively [116], [117].
The available evidence comes mostly from longitudinal cohort studies, in which non-dement or mild cognitive impairment (MCI) elderly have been followed to monitor their cognitive performance. The results are summarised in Table 3.
All studies
Alcohol, skeletal frailty and osteoporosis
Several observational studies indicate that alcohol consumption might influence bone density, depending on intake levels. In general, moderate alcohol use has no significant influence on bone density (or it has even positive effects), whereas data on heavy intake are conflicting, mainly pointing to negative effects on bone structure.
The effects of two or three drinks/d depend on age, sex and hormonal profile; for example positive effects are described for menopausal, but not for fertile women.
Alcohol and cancer
Most cancers are reportedly not associated with moderate alcohol intake. Only the association between light alcohol consumption and cancer risk for sites for which sufficient or limited evidence for carcinogenicity of alcohol is available [128], [129], that is, cancers of the upper digestive and respiratory tract (oral and pharyngeal cancer, oesophageal squamous cell carcinoma and laryngeal cancer), colorectum, pancreas and breast will be examined in this paper. Adenocarcinoma of the oesophagus
Alcohol and all-cause mortality
The most objective way to evaluate the role of alcohol in health is to assess total mortality (i.e., for all causes) associated with its use. Infarction, risks and benefits are, in this manner, compared with the same epidemiological hard ‘end’ point.
The association between total mortality and alcohol consumption not only depends on quantities and drinking behaviour, but also on the distribution of causes of death in the population at study. Further to the first study that showed a ‘J’-shaped
Differential health effects of the various alcoholic beverages
Alcoholic beverages contain both ethanol and other components. The quality and quantity of the latter differs greatly between wine, beer and spirits, as well as within these categories (red vs. white wine, different beers, etc.). While the role of ethanol in human health has been elucidated to a great extent, that of the non-alcoholic components is less clear. Several experimental studies (in vitro and in animals) suggest that these components (in particular, polyphenols) might play important
Conclusions
Dozens of epidemiological studies and the meta-analyses that analysed their results clearly show a statistically significant association between moderate alcohol consumption, that is two or three drinks/d or 24–36 g of ethanol/d for men and one to two drinks/d or 12–24 g of ethanol/d for women and risk reduction of specific clinical events, namely those involving the cardio-circulatory system such as atherosclerosis, myocardial infarction or ischaemic (though not haemorrhagic) stroke. This
References (160)
- et al.
Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders
Lancet
(2009) - et al.
Alcohol consumption, atherosclerotic progression, and prognosis among patients with coronary artery bypass grafts
Am Heart J
(2006) - et al.
Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis
J Am Coll Cardiol
(2010) - et al.
Alcohol consumption and risk of atrial fibrillation: a meta-analysis
J Am Coll Cardiol
(2011) - et al.
Light-to-moderate alcohol consumption and risk of sudden cardiac death in women
Heart Rhythm
(2010) - et al.
A high-score Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes
J Thromb Haemost
(2003) - et al.
Effects of alcohol on lipoprotein lipase, hepatic lipase, cholesteryl ester transfer protein, and lecithin:cholesterol acyltransferase in high-density lipoprotein cholesterol elevation
Atherosclerosis
(1994) The French paradox: possible involvement of ethanol in the protective effect against cardiovascular diseases
Nutrition
(2002)- et al.
Effect of alcohol consumption on endothelial function in men with coronary artery disease
Atherosclerosis
(2002) - et al.
Effects of red wine on endothelial function: postprandial studies vs clinical trials
Nutr Metab Cardiovasc Dis
(2009)