Life is a risky affair wine/alcoholic beverages and disease: is a risk-free consumption possible?

A large study in the renowned journal The Lancet last week caused uncertainty among all wine drinkers.

According to the publication, even very moderate drinking is worse than not drinking at all. This conclusion seems to contradict a large body of other studies which have found that moderate drinking is associated with a healthier and longer life expectancy and lower cardiovascular events.

Commentary by the Wine Information Council:

• The GDB-study is not a new, independent study but a statistical model which is based on collected data from previous studies.
• Consequently, the GBD-study does not show any new scientific evidence, but confirms the results of previous studies: with increasing consumption, certain health risks increase (particularly the risk of certain cancers), on the other hand, however, with light to moderate consumption, health benefits (especially in cardiovascular disease and diabetes) have been observed.
• The GDB-study claims to present a global estimate of the alcohol effects and presumes in its model that the same amounts of alcohol in all countries worldwide have the same effects, despite different environmental and living conditions as well as nutritional factors. The problem is that data from many divergent cultures were combined to determine a single association between the consumption of alcoholic beverages and health.
• Contrary to the previous long-term studies and meta-analyses*, which show a decreased risk of the most common cause of death (heart attack) and total mortality, the GBD-study pools ALL more or less alcohol-related health risks. This is done with the same risk measure (relative risk) for rare diseases and health risks (such as tuberculosis) in industrialised countries as well as for the most common causes of death (such as coronary heart diseases, diabetes and certain cancers) – but total mortality has not been presented.
• The results of the previous meta-analyses in industrialised countries investigating the health benefits of moderate wine/alcohol consumption are still valid for the residents of these countries and present a higher evidence level than the current model, the results of which are based on estimates of global data – including those of developing countries.
• The policy makers should not use global average data for the risk assessment but data that are relevant for the respective population.
• Considering all the evidence, this GBD-study gives no reason to question the established drinking guidelines. Light to moderate consumption of up to 20 g of alcohol per day for women and up to 30 g per day for men (considering the individual circumstances and contraindications) within the international average and does not need to be adjusted. Consequently, the drinking guidelines used in Wine in Moderation are compatible with the current scientific evidence and in line with the international average of drinking guidelines.**

*Meta-analysisA meta-analysis is a method of summarizing the results of the same research purpose and comprehensiv...: Summary and quantitative and qualitative analysis of several primary studies

** These are generic guidelines; individuals should always consult their physician or family doctor if they have any doubts related to their drinking patterns and their health.

Appendix with detailed information:

What was examined?

The Institute for Health Metrics and Evaluation (IHME, Seattle, funded by the Bill & Melinda Gates Foundation) built a large and complex statistical model from a vast range of data sources (using estimates of drinking prevalence, average consumption and the burden of disease attributable to alcohol use) and analysed the data.

The researchers examined:

• 694 previous studies to estimate the global prevalence of alcohol consumption
• 592 studies to study the health risks associated with alcohol (in 195 countries between 1990 and 2016).

Results:

• The report states that 2.8 million deaths (4.85% of all deaths) worldwide in 2016 were alcohol-related.
• The study examined the effects of alcohol consumption on a list of only 23 alcohol-related health outcomes, as opposed to most previous research examining the impact of alcohol consumption on overall health and all-cause mortality. Despite the limitation to certain diseases, only a small increase in relative risk was observed at low levels of drinking.
• Researchers found that pooling the 23 outcomes indicates a 0.5% increase in relative risk for moderate drinkers (defined as people consuming up to one standard drink that is, 10g of alcohol every day), when compared to abstainers. This risk increased to 7% for people who consumed two drinks per day, and to 37% for consumption of five drinks per day.
  In absolute numbers, this means that:
  • For each set of 100,000 people who have one drink a day per year, 918 can expect to experience one of the 23 alcohol-related problems in any year.
  • Of those who drink nothing, 914 will have an issue whether they drink an alcoholic beverage or not.
  • This means that 99,082 individuals are not affected.
  • Only 4 in 100,000 individuals who consume a drink a day may have a problem caused by the drinking, according to this study.
  • At two drinks per day, the number of individuals experiencing a problem increased to 977.

• These findings do not invalidate previous epidemiological studies that have found health benefits at low levels of consumption but confirm these results (J-shaped curve) as the example of diabetes and coronary heart disease in Figure 1 (from the appendix of the GBD-study) shows. Even at five drinks per day, which is an excessive amount, the vast majority of people are unaffected.

Figure 1 Relative risk of diabetes and coronary heart disease and alcohol consumption (red square: moderate consumption of alcoholic beverages) (¹)