Drinking and eating patterns may matter when it comes to alcoholic beverages

The current study investigated the relationship between the alcohol drinking patterns, adherence to the Mediterranean diet (Med Diet) and their combined effects on total mortality, cardiovascular, cancer and digestive-system diseases, and other causes of death.

Several epidemiological studies have suggested a beneficial effect of low-to-moderate consumption of alcoholic beverages. At the same time, alcohol has been described as risk factor for the development of several types of cancer, and chronic abuse of alcoholic beverages has been associated with many health problems. The effect of moderate quantities of alcoholic beverages remains controversial.

Drinking pattern and the context in which the alcoholic beverage is consumed may therefore influence the effects of alcohol in the body. The Mediterranean dietary pattern and its effects on longevity have been extensively studied and moderate amounts of alcohol, mainly in the form of wine, are characteristic of such eating pattern. Recent studies have shown that a higher adherence to the Mediterranean alcohol drinking pattern (MADP) can protect against general mortality.

The objective of this study was to examine the joint effects of alcohol drinking patterns and adherence to a Mediterranean diet on total mortality, which includes cardiovascular disease, digestive disorders, cancer, and other diseases.

To investigate this question, the data of 3411 consumers of alcoholic beverages (follow up from 2005-2006 until 2022) from 2 Italian prospective studies were analysed. The adherence to the MADP was assessed by the MADP index (*) and adherence to the Med Diet by the relative Med Diet score (**).

The results showed that the effects of alcohol consumption vary, depending on drinking patterns and the dietary context in which the alcoholic beverage was consumed.

In this study, there was a widespread pattern of moderate wine consumption during meals, typical of Southern Italian populations and the Med Diet. The type of alcoholic beverage could influence the effect of alcohol on health. Previous studies carried out on different types of alcoholic beverages have shown that moderate wine consumption was associated with a lower risk of cardiovascular disease, cancer, and all-cause mortality. The current results also showed a lower mortality among wine drinkers compared to drinkers of other alcoholic beverages. The protective effect of wine may be due in part to the bioactive compounds and polyphenols in wine and partly to the lower total amount of alcohol consumed. Subjects with good eating habits and a high adherence to the Med Diet rarely consumed high quantities of alcoholic beverages.

This study indicates that the harmful effects of alcoholic beverages on mortality vary, depending on the drinking patterns and the dietary context:

• Drinkers with low adherence to MADP and the Med Diet had the highest risk of mortality from all causes and mortality from cancer.
• The researchers concluded that high adherence to the Med Diet could mitigate/modify the harmful effects of moderate amounts of alcohol, particularly for wine drinkers. They highlight the importance of considering drinking patterns, type of alcoholic beverages and diet together when evaluating effects on mortality.

(*) Alcohol consumption pattern was assessed with adherence to the MADP:

1. moderate alcohol intake (g/d)
2. alcohol consumption per week
3. low spirit consumption
4. wine preference
5. wine preferably consumed with meals
6. preference of red wine over other types of wine
7. no excess consumption (maximum drinks on a single occasion)

The first 2 item scored 0 to 2 while the remaining 5 scored 0 to 1. Higher scores indicate high adherence to the MADP.

(**) the Mediterranean relative scoring system assigns scores (rMED) without alcohol intake (rMEDNA) based on tertiles of reported intake of nine food clusters: fruit (excluding fruit juices), vegetables (excluding potatoes), fresh fish, cereals, legumes, olive oil, meat and dairy products. A score of 0, 1 or 2 was assigned for increasing tertiles of each food cluster, except meat and dairy products (with 2, 1 or 0 as maximum score). The scores were added yielding rMEDNA scores from 0-18 (low = 0-6, medium = 7-10, High = 11-18).

Information about alcohol consumption was collected via a questionnaire.