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Consumption of different types of alcohol and mortality

 

We know that a moderate amount of alcohol consumption is beneficial for health. What we don't know for certain is whether the type of alcohol makes a difference. This paper examines the effect of wine, beer and spirits on death from all causes, coronary heart disease and cancer.

Message

Wine drinkers are at lower risk for all-cause mortality than non-wine drinkers. Light drinkers who avoid wine have a 10% reduced risk of all-cause mortality; those who include wine have a 34% reduced risk. Light to moderate wine consumption (1-21 glasses a week) reduces mortality from all causes, coronary heart disease and cancer. Consuming more than 22 alcoholic drinks a week (excluding wine) is associated with a 63% increased risk of cancer; if consumption includes wine the risk drops to 24%. Consuming more than 21 beer or spirit drinks a week is associated with an increased risk of mortality.

Reference

M Gronbaek et al. Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Annals of Internal Medicine 2000 133: 411-419.

Study

Participants were 13,064 men and 11,459 women, aged between 20 to 98 years, from three Copenhagen studies. Information was obtained on alcohol intake and lifestyle. Participants were followed from study entry (1964, 1971 and 1976) until death or the end of the follow-up period (number of years not given). A total of 4,833 participants died. Of these, 1,075 died of coronary heart disease and 1,552 died of cancer.

In these studies, beer contains 11.6g of alcohol and an average serving of wine or spirits contains 12g.

Results

The results were adjusted for age, gender, education, body mass index, physical activity and smoking status. All the results use non-drinkers as a comparison.

Total alcohol intake and mortality (Figure 1)

All-cause mortality - compared with no alcohol, up to 21 drinks a week reduced all-cause mortality by 18%.

Coronary heart disease mortality - drinking reduced the risk of death from coronary heart disease by between 32% and 49%.

Cancer mortality - alcohol consumption above 22 drinks a week was associated with a 35% increased risk of death from cancer.

Intake of beer, wine and spirits and mortality (Figures 2, 3 & 4)

All-cause mortality

Light to moderate beer or spirit drinking (1-21 drinks a week) had little or no effect on the risk of all-cause mortality (1-7 drinks of beer a week reduced the risk of all-cause mortality by 10%).

More than 21 drinks of beer or spirits a week increased the risk by 31% and 42% respectively.

In contrast, light to moderate wine consumption reduced risk of all-cause mortality by 20% (1-7 drinks a week) and 24% (8-21 drinks a week).

Coronary heart disease mortality

Spirit drinking had no effect on the risk of death from coronary heart disease.

Consumption of beer and wine reduced the risk by similar margins: 1-7 drinks a week of beer and wine reduced the risk by 22% and 26% respectively; 8-21 drinks a week by 37% and 36%.

Cancer mortality

Beer and spirit drinking were associated with an increased risk of death from cancer: more than 21 spirit drinks a week increased the risk by 81%; consuming beer increased the risk by 32% (8-21 drinks a week) and 46% (more than 21 drinks a week).

In contrast, light to moderate wine consumption reduced risk of cancer mortality by 14% (1-7 drinks a week) and 22% (8-21 drinks a week).

Wine Intake (from total alcohol intake) and Mortality

All-cause mortality

At all levels of alcohol intake, wine drinkers were at lower risk for all-cause mortality than non-wine drinkers.

Compared with non-drinkers, light drinkers (1-7 drinks a week) who avoided wine had a 10% reduced risk of all-cause mortality (relative risk 0.90, 95% confidence interval 0.82 to 0.99); light drinkers who drank wine had a 34% reduced risk (relative risk 0.66, 95% confidence interval 0.55 to 0.77).

Coronary heart disease mortality

At all levels of alcohol intake, wine drinkers were at lower risk for death from coronary heart disease than non-wine drinkers.

Compared with non-drinkers, light drinkers who avoided wine had a reduced risk of death from coronary heart disease of 24% (relative risk 0.76, 95% confidence interval 0.63 to 0.92); light drinkers who drank wine had a 42% reduced risk (relative risk 0.58, 95% confidence interval 0.47 to 0.72).

Cancer mortality

At all levels of alcohol intake, wine drinkers had a lower risk of death from cancer than non-wine drinkers. However, as total alcohol intake increased, risk of death from cancer increased.

Compared with non-drinkers, drinkers (whatever the amount) who avoided wine increased their risk of death from cancer.

Compared with non-drinkers, light to moderate drinkers (1-21 a week) who drank wine had a reduced risk of death from cancer.

At 22-35 drinks a week, excluding wine carried a risk of 63%, including wine carried a risk of 24% (relative risks 1.63 and 1.24, 95% confidence interval 1.23 to 2.16 and 0.97 to 1.57 respectively).

Comment

This paper has a wealth of information. As well as providing an overall picture of the effects of different types of alcohol on mortality, the results are useful for more specific events. Of course, other factors will play a part on an individual level, for example, genetic and lifestyle factors, such as diet.