Beer, wine or spirits: A large study finds different mortality patterns for each

by · News-Medical

From beverage choice to drinking with meals, researchers followed more than 340,000 adults to investigate how different alcohol consumption patterns relate to long-term mortality.

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In a recent study published in the Nutrition Journal, researchers assessed associations between alcohol consumption and mortality.

Heavy alcohol intake is among the leading causes of mortality. Yet, evidence on the impact of low or moderate intake remains inconsistent. While guidelines in several countries have outlined lower-risk alcohol consumption limits, the World Health Organization (WHO) has more recently specified that no amount of alcohol intake is safe. These different recommendations may contribute to public confusion.

About the study

The researchers used data from the United Kingdom Biobank (UKB) cohort to examine links between total and beverage-specific alcohol intake and all-cause and cause-specific mortality. Exclusions included former drinkers, participants with baseline cardiovascular disease or cancer, and those with incomplete alcohol data. Questionnaires were administered at baseline to assess alcohol intake and collect data on sociodemographic and lifestyle factors. Participants reported intake frequency and average amounts of alcohol consumed by beverage type.

The researchers grouped participants according to their consumption of pure alcohol, using never or occasional intake (no more than 20 g per week) as the reference group. For context, 20 g of pure alcohol is roughly equivalent to a 500 mL beer containing 5% alcohol. Low intake was defined as more than 20 g per week but no more than 20 g per day for men or 10 g per day for women. Moderate intake ranged from above 20 to 40 g per day for men and above 10 to 20 g per day for women, while high intake exceeded 40 g and 20 g per day, respectively. Deaths were identified from death certificates, and the underlying cause was determined using the International Classification of Diseases, 10th revision (ICD-10).

The team used Cox proportional hazards models to examine mortality from all causes, cardiovascular disease (CVD), cancer, and other causes in relation to alcohol intake. The models were adjusted for age, race, sex, education, socioeconomic deprivation, smoking, physical activity, body mass index (BMI), diet quality, clinical characteristics, family medical history, and drinking patterns. For each beverage, mortality was compared with that among people consuming little or none of that beverage, with adjustment for consumption of other alcoholic drinks.

Dose-response relationships and associations between drinking with or outside meals and mortality were also assessed. Subgroup analyses were performed by sex, age, race, physical activity, smoking, BMI, and diet quality. Sensitivity analyses excluded non-drinkers and subjects who died within two years of follow-up.

Findings

The study included 340,924 UKB participants, with a mean age of approximately 56 years. Women accounted for just over half the cohort, and 96.3% of participants were White. Greater physical activity was noted among participants with high total alcohol intake compared to those with never or occasional consumption. Individuals with high alcohol consumption from beer/cider were more likely to be male, reported greater physical activity, and had lower educational attainment and diet quality than those with never or occasional intake.

During a mean 13.4-year follow-up, 22,381 deaths occurred. High total alcohol intake was linked to higher mortality from all causes, cancer, CVD, and other causes compared to never or occasional intake. Moderate total alcohol consumption was associated with elevated cancer mortality only. Low total alcohol intake was associated with lower other-cause mortality. High intake from beer/cider was linked to increased all-cause and cause-specific mortality.

Even low beer/cider consumption was associated with elevated cancer mortality. Alcohol intake from spirits at low or combined moderate-to-high levels was linked to greater all-cause and cause-specific mortality. Lower all-cause and cause-specific mortality were noted with low wine intake; meanwhile, high wine intake was associated with increased cancer mortality.

Moderate or low red wine intake was associated with lower all-cause, CVD, and other-cause mortality, but high red wine intake was linked to higher all-cause and cancer mortality. High white wine consumption was linked to higher all-cause, cancer, and other-cause mortality, while high fortified wine consumption was associated with higher all-cause and other-cause mortality. Across 20 site-specific cancer mortality outcomes, total or beverage-specific alcohol intake was associated with higher mortality in 15 after correction for multiple comparisons, including head and neck, respiratory, gastrointestinal, liver/gallbladder, hematological, breast, and genital cancers. There was a linear relationship between total alcohol intake and mortality from all causes, CVD, and cancer, primarily driven by intake from spirits and beer/cider.

A J-shaped relationship was noted between wine intake and cause-specific and all-cause mortality. Drinking sometimes or usually with meals was associated with lower mortality, while drinking outside meals was linked to stronger adverse associations at higher intake levels. Subgroup analyses revealed stronger associations between total alcohol intake and all-cause mortality in men, younger participants, non-White participants, current smokers, and participants without obesity. Sensitivity analyses yielded comparable results.

Conclusions

Taken together, mortality from all causes, CVD, cancer, and other causes was significantly higher with high total alcohol consumption. Even moderate intake was associated with higher cancer mortality. Low or moderate alcohol intake from wine was associated with lower mortality for some outcomes. These findings suggest that low-to-moderate spirits and beer/cider intake may be associated with adverse mortality outcomes, particularly cancer mortality, but the observational design cannot establish causation. The lower mortality among wine drinkers does not establish a protective effect of wine. Alcohol intake was self-reported and primarily assessed at baseline, and residual confounding and limited generalizability remain possible.

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