In comparison with lifetime abstainers, drinking less than one drink a day is associated with a reduced risk of dying due to any cause. But more than two drinks a day is associated with an increased risk of total, cardiovascular and especially cancer mortality. These are the outcomes of a large multi-country study1 that was recently published. This study confirms previous findings that alcohol has a J-shaped relation with mortality.
What does this study add? Previous studies examining the effect of alcohol consumption on single diseases provide contrasting results, making it difficult to assess the full burden of alcohol consumption. This study gathers data in a harmonized way from 16 cohort studies in 10 European countries with almost 143,000 participants in total.
Results show that drinking less than one drink a day is associated with an 11% lower risk of mortality compared to never drinking. The lowest risk is found among people who consumed approximately 5 grams alcohol a day, which is about three drinks a week.
Drinking one to two drinks a day does not influence the risk of mortality compared to never drinking, but drinking more than two drinks a day is associated with a 13% higher risk.
Cardiovascular and cancer mortality
The lower mortality risk with moderate alcohol consumption is amongst others due to a decrease in cardiovascular mortality. The higher risk of mortality that is found with more than two drinks a day is especially due to cancer mortality.
The ‘sick quitter’ hypothesis suggests that the inclusion of individuals who quit drinking alcohol because of health problems leads to an exaggeration of the poor health profiles of non-drinkers. Therefore, the researchers based their conclusions on the comparison with lifetime abstainers.
Beer, wine and spirits
The authors also looked at the different types of alcohol. The decreased risk of mortality was more apparent in people preferring wine, which is why the authors think the benefits may not be due to the ethanol but to other ingredients. Nevertheless, it is important to note that wine drinkers often have a healthier lifestyle: they smoke less, have a healthier diet and have a higher socio-economic status.3
- 16 cohort studies of which 15 from Europe
- Ex-drinkers are excluded from the reference group
- Measurements among cohorts have been harmonized
- Assessment of alcohol drinking was based both on volume, frequency and pattern of consumption
- Also analyses for type of alcoholic beverage
- Observational research – cannot prove causality
- Di Castelnuovo, A., Costanzo, S., Bonaccio, M., McElduff, P., Linneberg, A., Salomaa, V., et al. (2021). Alcohol Intake and Total Mortality in 142,960 Individuals from the MORGAM Project: a population‐based study. Addiction.
- Di Castelnuovo A., Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de GG. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med 2006; 166(22): 2437-2445.
- Sluik, D., Bezemer, R., Sierksma, A., & Feskens, E. (2016). Alcoholic beverage preference and dietary habits: a systematic literature review. Critical reviews in food science and nutrition, 56(14), 2370-238