Low-risk alcohol drinking limits based on associated mortality
e202011167
Keywords:
Alcohol, Mortality, Systematic reviewAbstract
Background: Alcohol is associated with all-cause mortality increase. However, when this increase takes place has not been clearly established. The objective of this study was to establish the levels of alcohol consumption that can be considered low risk for overall mortality.
Methods: Systematic review of cohort studies published since 2014 that established a relationship between general mortality and alcohol consumption in the general population. Those studies not conducted in countries with Spain socio-cultural environment and those that present conflicts of interest were excluded.
Results: The median of alcohol consumption (in grams) from which mortality increased was 23-25 g/day. Differentiating by sex, these values were 20 g/day in women and 24 g/day in men. The minimum value of the median from which an increase in mortality was observed was 17-21 g/day of alcohol; 12 g/day in women and 20 g/day in men.
Conclusions: If we take into account caution principle, taking more conservative levels of average alcohol consumption from which an increase in mortality was observed, low-risk consumption should be 20 g/day in men and 10 g/day in women, assuming that there is no safe level of alcohol consumption.
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References
Rehm J, Gmel GR, Gmel G, Hasan OSM, Imtiaz S, Popoca S et al. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction, 2017; 112:968-1001.
Donat M, Sordo L, Belza MJ, Barrio G. Carga de enfermedad atribuible al alcohol en España: elaboración de una metodología y estimación durante 2001-2017 [Internet]. Madrid: Observatorio Español de las Drogas y las Adicciones; 2020 [citado 2020 jun 24]. Available from: https://pnsd.sanidad.gob.es/profesionales/publicaciones/catalogo/catalogoPNSD/publicaciones/pdf/2020_Mortalidad_atribuible_al_alcohol_en_Espana_2001-2017.pdf
Encuesta sobre alcohol y drogas en España (EDADES), 1995-2019 [Internet]. Madrid: Observatorio Español de las Drogas y las Adicciones. Ministerio de Sanidad, Consumo y Bienestar Social; Plan Nacional de Drogas, Ministerio de Sanidad. 2019, Disponible en: http://www.pnsd.mscbs.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2019_Informe_EDADES.pdf
Klein WMP, Jacobsen PB, Helzlsouer KJ. Alcohol and Cancer Risk: Clinical and Research Implications. JAMA. 2019; 19133.
Schütze M, Boeing H, Pischon P, Kehoe T, Gmel G, Olsen A et al. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ 2011;342: d1584.
IARC monographs on the identification of carcinogenic hazards to humans. Agents classified by the IARC monographs, volumes 1–125. 2019. Disponible en: https://monographs.iarc.fr/agents-classified-by-the-iarc/
IARC Monographs 100E.Consumption of alcoholic beverages. Disponible en: https://monographs.iarc.fr/wp-content/uploads/2018/06/mono100E-11.pdf
Ronksley PE, Brien SE, Turner BJ, Mukamal KG, Ghali WA. Association of alcohol consumption with selected cardiovascular outcome: a systematic review and meta-analysis BMJ 2011; 342: 671.
Zhang C et al. Alcohol intake and risk of stroke: A dose–response meta-analysis of prospective studies. al. International Journal of Cardiology 2014; 174; 3: 667-669
Brien SE, Ronksley PE, Turner BJ, Mukamal KG, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies BMJ; 2011; 342-d636.
Smyth A, Teo KK, Rangarajan S, O’Donnell M, Zhang X, Rana P et al. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet. 2015; 386(10007):1945-54.
Leong DP, Smyth A, Teo KK, McKee M, Rangarajan S, Pais P et al. Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study. Circulation 2014;130(5):390-8.
Wood AL et al. Risk Tresholds for alcohol consumption: combined analysis of individual participant data for 599.512 current drinkers in 83 prospective studies. Lancet 2018; 391:1513-23.
Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 2006;166(22):2437-45.
White IR. The level of alcohol consumption at which all-cause mortality is least. J Clin Epidemiol 1999;52(10):967-75.
Burger M, Brönstrup A, Pietrzik K. Derivation of tolerable upper alcohol intake levels in Germany: A systematic review of risks and benefits of moderate alcohol consumption. Preventive Medicine 2004;39(1):111-27.
Stockwell T, Zhao J, Panwar S, Roemer A, Naimi T and Chickritzhs T. Do “Moderate” Drinkers Have Reduced Mortality Risk?A Systematic review and meta-analysis of alcohol consumption and all-cause mortality. J. Stud. Alcohol Drugs 2016; 77, 185–198.
Stringhini S, Carmeli C, Jokela M, Avendano M, Muennig P, Guida F et al. Socioeconomic status and the 25 x 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women. Lancet 2017;389(10075):1229-37.
Holman CD, English DR, Milne E, Winter MG. Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations. Med J Aust 1996;164(3):141-5.
Gmel G, Gutjahr E, Rehm J. How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis. Eur J Epidemiol 2003;18(7):631-42.
Jayasekara H, MacInnis RJ, Hodge AM, Hopper JL, Giles GG, Room R et al. Alcohol consumption for different periods in life, intake pattern over time and all-cause mortality. J Public Health (Oxf) 2015;37(4):625-33.
Wang C, Xue H, Wang Q, Hao Y, Li D, Gu D et al. Effect of drinking on all-cause mortality in women compared with men: a meta-analysis. J Womens Health (Larchmt) 2014;23(5):373-81
Goulden R. Moderate Alcohol Consumption Is Not Associated with Reduced All-cause Mortality. The American Journal of Medicine 2016;129, 180-186.
Naimi TS, Brown DW, Brewer RD, Giles WH, Mensah G, Serdula MK et al. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. American Journal of Preventive Medicine. Am J Prev Med 2005;28(4):369-73.
Kalinowski A, Humphreys K. Government standard drink definitions and low-risk consumption alcohol consumption guidelines in 37 countries. Addiction 2016; 111:1293-1298.
Reduced Alcohol Related Harm (RARHA) disponible en: http://www.rarha.eu/Resources/Guidelines/Documents/Overview%20WP5_T1%20LowRiskDrinkingGuidelines_FINAL.pdf
Ferrari P, Licaj I, Muller DC, Kragh Andersen P, Johansson M, Boeing H et al. Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study. BMJ Open 2014;4(7):e005245.
Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015. 10;350:h384.
Perreault K, Bauman A, Johnson N, Britton A, Rangul V, Stamatakis E. Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts. Br J Sports Med 2017;51(8):651-657.
Bobak M, Malyutina S, Horvat P, Pajak A, Tamosiunas A, Kubinova R, Simonova G, Topor-Madry R, Peasey A, Pikhart H, Marmot MG. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe. Eur J Epidemiol 2016;31(1):21-30.
Luksiene D, Tamosiunas A, Virviciute D, Radisauskas R. The Prognostic Value of Combined Smoking and Alcohol Consumption Habits for the Estimation of Cause-Specific Mortality in Middle-Age and Elderly Population: Results from a Long-Term Cohort Study in Lithuania. Biomed Res Int 2017;2017:9654314.
Licaj I, Sandin S, Skeie G, Adami HO, Roswall N, Weiderpass E. Alcohol consumption over time and mortality in the Swedish Women’s Lifestyle and Health cohort. BMJ Open 2016; 2;6(11):e012862.
Midlöv P, Calling S, Memon AA, Sundquist J, Sundquist K, Johansson SE. Women’s health in the Lund area (WHILA)--Alcohol consumption and all-cause mortality among women--a 17 year follow-up study. BMC Public Health 2016; 12;16:22.
GBD 2016 Alcohol and Drug Use Collaborators. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry 2018;5(12):987-1012.
Shield KD, Gmel G, Gmel G, Mäkelä P, Probst C, Room R et al. Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines. Addiction 2017;112(9):1535-44.
Kunzmann AT, Coleman HG, Huang WY, Berndt SI (2018) The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study. PLoS Med 15(6): e1002585.
Ley 33/2011, de 4 de octubre, General de Salud Pública. https://www.boe.es/buscar/act.php?id=BOE-A-2011-15623
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