The health effects of alcoholic beverages cannot be assessed only by the amount consumed. This is the conclusion of a new study from the UK where the researchers – for the first time – examined how the mortality risk is affected when considering the drinking pattern.
Just to be clear: we are not talking about excessive drinking amounts which – without any doubts – reduce the life expectancy. It is about moderate consumption, which has been associated with a reduced mortality risk in some studies that, unlike other ones, were taking into account the type of alcoholic beverage, the frequency and drinking pattern, and not only assessing the amount of alcohol consumed.
In the UK Biobank study, the type of alcoholic beverage was not considered but for the first time, it was analysed how the drinking pattern affected/influenced the relationship of the drinking amount and mortality risk of more than 300,000 participants of the study.
From the nearly half a million participants (between37 and 73 years) of this observational study, the researchers only selected those who indicated that they consume alcoholic beverages and that did not have coronary heart diseases and cancer. Participants were asked about their drinking habits from where the researchers calculated their weekly consumption, that resulted between 6.4 g and 518.4 g of alcohol per week.
In addition to the amount, the participants indicated whether they consumed the alcoholic beverages regularly and if they were consumed with the meals or not. To better capture their overall drinking habits, the scientists developed a score (Drinking Habits Score) that combined the frequency of alcohol intake and whether it was consumed with the meals. Points were given for each favorable drinking habit: one point for regular consumption (at least 3 times per week) and one for consumption with a meal.
During the 9 year follow-up period, 8600 individuals died and based on their data, the researchers could not only asses the association between mortality and the amount of alcoholic beverages that was consumed weekly but also if and how healthy drinking patterns can affect the mortality risks.
From linear associations to J-shaped curves
The influence of favourable drinking patterns was considerable:
- When the alcoholic beverages were consumed with a meal, not only the mortality from cardiovascular diseases, cancer and other causes decreased significantly, but also the total mortality (risk of dying from any cause).
- The relation between the amount of alcohol consumed and the risk of all-cause mortality was different, on the basis of the drinking habits:
When only the drinking amounts were considered, the total mortality risk started to increase significantly above 300 g of alcohol weekly. With healthy drinking patterns – regular drinking and drinking with the meal – a U-shaped association was found, with a consistent and significantly lower risk in participants consuming between 50 g and 300 g per week and no increased risk up to 400 g per week than those who had the lowest amount of alcohol and unfavourable drinking habits.
- Similar effects were observed for the different specific mortality rates such as for cardiovascular diseases, cancer and from other causes.
- Also, the cancer mortality was affected by favourable drinking patterns: for the cancer mortality risk, a positive and linear association was observed in participants with unfavourable drinking habits. In contrast, a U-shaped association was seen in individuals with favourable drinking habits, where a moderate intake of alcoholic beverages (50-200g of alcohol/week) was not related to any increased cancer mortality risk.
For the first time, the researchers reported that drinking habits significantly modified the relationship between the actual amount of alcohol intake and the risk of mortality from all causes.
Since it is an observational study, no cause-and-effect relationship can be derived. However, the results are important for the communication of responsible drinking patterns: not only the amount but also the drinking pattern (and the type of alcoholic beverage) are critical for the health effects.
Source: Ma H, Li X, Zhou T, Sun D, Shai I, Heianza Y, Rimm EB, Manson JE, Qi L. Alcohol Consumption Levels as Compared With Drinking Habits in Predicting All-Cause Mortality and Cause-Specific Mortality in Current Drinkers. Mayo Clin Proc. 2021 Jul;96(7):1758-1769. doi: 10.1016/j.mayocp.2021.02.011. PMID: 34218856; PMCID: PMC8262073.
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