Summary
Fund
The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol may reduce the risk of some health outcomes, but increase the risk of others, suggesting that the overall risk depends, in part, on the rates of underlying disease, which vary by region, age, sex and year.
Methods
For this analysis, we constructed load-weighted dose-response relative risk curves across 22 health outcomes to estimate the level of theoretical minimum risk exposure (TMREL) and non-drinker equivalence (NDE), the level of consumption at which the risk to health is equivalent to that of a non-drinker, using the disease rates of the Study of the Global Burden of Disease, Injury and Risk Factors (GBD) 2020 for 21 regions , including 204 countries and territories, by age group of 5 years, sex and year for people. from 15 to 95 years and older from 1990 to 2020. From the ECM, we quantified the population that consumed harmful amounts of alcohol.
Discoveries
Load-weighted relative risk curves for alcohol consumption varied by region and age. Among people aged 15 to 39 in 2020, the TMREL ranged from 0 (95% uncertainty range 0-0) to 0.603 (0.400-1.00) standard drinks per day, and the NDE ranged from 0.002 (0–0) and 1 · 75 (0 · 698–4 · 30) standard drinks per day. Among people 40 years of age or older, the load-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL ranging from 0.114 (0-0.403) to 1.87 (0.500-3). ). · 30) standard drinks per day and an ECM ranging from 0 · 193 (0–0 · 900) to 6 · 94 (3 · 40–8 · 30) standard drinks per day. Among people who consumed harmful amounts of alcohol in 2020, 59.1% (54.3–65.4) were between 15 and 39 years old and 76.9% (73.0–81.3) were men.
Interpretation
There is solid evidence supporting alcohol consumption recommendations that vary by age and location. Stronger interventions are needed, especially those tailored to younger people, to reduce the substantial overall health loss attributable to alcohol.
Financing
Bill and Melinda Gates Foundation.
Introduction
Alcohol consumption accounted for 1.78 million (95% uncertainty range. [UI] 1 · 39–2 · 27) deaths in 2020 and was the leading risk factor for mortality among men aged 15–49 years (Bryazka D, unpublished). The relationship between moderate alcohol consumption and health is complex, as demonstrated by multiple previous studies.1
- Griswold MG
- Fullman N
- Hawley C
- et al.
Alcohol consumption and burden for 195 countries and territories, 1990–2016: a systematic analysis for the 2016 study of the global disease burden.2
- Shield K
- Manthey J
- Rylett M
- et al.
National, regional, and global disease burdens from 2000 to 2016 attributable to alcohol consumption: a comparative risk assessment study.3
- Wood AM
- Capt. S
- Butterworth AS
- et al.
Risk thresholds for alcohol consumption: Combined analysis of individual participant data for 599,912 current drinkers in 83 prospective studies.4
- Rehm J
- Gmel Sr, GE
- Gmail G
- et al.
The relationship between the different dimensions of alcohol consumption and the burden of disease: an update.5
- Millwood IY
- Walters RG
- Mei XW
- et al.
Conventional and genetic evidence on the etiology of alcohol and vascular disease: a prospective study of 500,000 men and women in China.6
- of the Luitgaarden IAT
- van Oort S
- Bouman EJ
- et al.
Alcohol consumption in relation to cardiovascular disease and mortality: a systematic review of Mendelian randomization studies. Alcohol consumption at any level is associated with loss of health due to various diseases, such as liver cirrhosis, breast cancer, and tuberculosis, as well as injuries.7
- Liu Y
- Nguyen N
- Colditz GA
Links between alcohol consumption and breast cancer: a look at the evidence.8
- Imtiaz S
- Shield KD
- Roerecke M
- Samokhvalov AV
- Lönnroth K
- Rehm J
Alcohol consumption as a risk factor for tuberculosis: meta-analysis and disease burden.9
- Taylor B
- Irving HM
- Kanteres F
- et al.
The more you drink, the stronger you fall: a systematic review and meta-analysis of how jointly increased acute alcohol consumption and the risk of injury or collision.10
- Roerecke M
- Vafaei A
- Hasan OSM
- et al.
Alcohol consumption and risk of liver cirrhosis: a systematic review and meta-analysis. At the same time, some studies have found that drinking small amounts of alcohol reduces the risk of cardiovascular disease and type 2.11 alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analysis and systematic review and meta-analysis of the impact of intensive consumption opportunities on risk for moderate drinkers.12
- Pietraszek A.
- Gregersen S
- Hermansen K
Alcohol and type 2 diabetes. A review.13
- Ding C
- O’Neill D
- Bell S
- Stamatakis E
- Britton A
Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women. As a corollary, it is likely that the amount of alcohol that minimizes health loss will depend on the distribution of the underlying causes of the disease burden in a given population. Because this distribution varies greatly by geography, age, sex, and time, the level of alcohol consumption associated with the lowest health risk would depend on the age structure and composition of the disease. of this population.14
- Sherk A
- Gilmore W
- Churchill S
- Lensvelt E
- Stockwell T
- Chikritzhs T
Implications of cardioprotective assumptions for national alcohol consumption guidelines and alcohol harm control systems.15
- Sherk A
- Thomas G
- Churchill S
- Stockwell T
Does drinking within the low-risk guidelines prevent harm? Implications for high-income countries using the international model of alcohol harm and policies.16OMS Global Alcohol and Health Status Report 2018.Two amounts are fundamentally relevant in formulating effective, evidence-based guidelines and alcohol control policies: the theoretical minimum exposure level (TMREL), which represents the level of consumption that minimizes alcohol consumption. loss of health by alcohol for a population, and the non-drinker. level of equivalence (NDE), which measures the level of alcohol consumption at which a drinker’s risk of losing health is equivalent to that of a non-drinker. Most studies to date consider one or a small subset of health outcomes associated with alcohol consumption at the same time, although several broader systematic meta-analyzes have been performed.1
- Griswold MG
- Fullman N
- Hawley C
- et al.
Alcohol consumption and burden for 195 countries and territories, 1990–2016: a systematic analysis for the 2016 study of the global disease burden.4
- Rehm J
- Gmel Sr, GE
- Gmail G
- et al.
The relationship between the different dimensions of alcohol consumption and the burden of disease: an update.17
- Corrao G
- Bagnardi V
- Zambon A
- The Old C
A meta-analysis of alcohol consumption and the risk of 15 diseases.18
- Xi B
- Veeranki SP
- Zhao M
- My C
- Yan I
- Mi J
Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in US adults.19Alcohol consumption levels compared to drinking habits to predict all-cause mortality and specific-cause mortality of current drinkers. The results of these studies vary in their TMREL estimates. Several studies have found evidence of a J-shaped relationship between alcohol consumption and all-cause mortality.3
- Wood AM
- Capt. S
- Butterworth AS
- et al.
Risk thresholds for alcohol consumption: Combined analysis of individual participant data for 599,912 current drinkers in 83 prospective studies.18
- Xi B
- Veeranki SP
- Zhao M
- My C
- Yan I
- Mi J
Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in US adults.20
- Father J
- Buckley C
- WC Kerr
- Brennan A
- Purshouse RC
- Rehm J
Impact of body mass and alcohol consumption on liver and all-cause mortality in 240,000 adults in the United States. However, others have reported that the alcohol-weighted TMREL for all causes or attributable cause is zero standard beverages per day.1
- Griswold MG
- Fullman N
- Hawley C
- et al.
Alcohol consumption and burden for 195 countries and territories, 1990–2016: a systematic analysis for the 2016 study of the global disease burden.21
- Habtemichael LH
- Djekic D
- Rosengren AR
- et al.
Alcohol consumption in young men and risk of heart failure and all-cause mortality: a cohort study. Uncertainty about the effect of alcohol on health loss for all causes results from differences in the relative composition of the disease between studies, contradictory studies on individual health outcomes, differences in covariates, and methods of treatment. ‘study, estimation of consumption patterns, as well as issues related to selection bias. .22
- Fillmore KM
- Stockwell T
- Chikritzhs T
- Bostrom A
- Kerr W
Moderate alcohol consumption and reduced mortality risk: systematic error in prospective studies and new hypotheses.23
- Wallach JD
- Sergui S
- Chu
- et al.
Assessment of confusion in epidemiological studies evaluating alcohol consumption on the risk of ischemic heart disease.Context research
Evidence before this study
The risks of moderate alcohol consumption on health outcomes have been widely studied and debated for many years. Studies have considered the health impacts associated with alcohol consumption through a variety of approaches, ranging from exploring the effects on a single disease, to considering multiple health outcomes, to use of mortality for all causes as a result. Several systematic reviews on this topic have also been published, and in recent years several publications have used Mendelian randomization to explore the association between alcohol consumption and health outcomes. In general, the conclusions have varied, which contributes in part to this issue being controversial and the subject of debate. Several studies have found evidence of a J-shaped relationship between alcohol consumption and all-cause mortality or burden; that is, at low levels of consumption, alcohol reduces the risk of mortality from all causes, while above some threshold it increases the risk. However, other studies, including a GBD 2016 Alcohol Collaborators publication in The Lancet in …