By Ellen Feldman, MD

Altru Health System, Grand Forks, ND

Dr. Feldman reports no financial relationships relevant to this field of study.

SYNOPSIS: A systematic analysis of data from the Global Burden of Disease Study 2016 on alcohol-linked disorders and patterns of alcohol use over 25 years worldwide found there is no safe level of alcohol consumption.

SOURCE: GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018;392:1015-1035.

Do the health benefits of alcohol balance or override the health risks of alcohol consumption? This and related questions spurred an innovative and comprehensive approach to analyzing data obtained from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 1990-2016. Collaborators analyzed findings obtained from 195 countries and territories over this 26-year period and used several newer epidemiological approaches to understand the prevalence of alcohol use, the health risks associated with alcohol use (including disability and development of alcohol-related diseases and death), and any health benefits associated with alcohol use. The findings are sobering. Among the worldwide population ages 15-49 years, alcohol was the No. 1 cause of disability-adjusted life years (DALY) and the leading risk factor for death, accounting for nearly 10% of deaths in this group. Among all age groups in 2016, 2.8 million deaths worldwide were linked to alcohol use. When looking at death and DALY among all age groups globally, alcohol was the seventh-leading risk factor. Although alcohol consumption rates vary with geographical boundaries, in 2016, more than 2 billion people worldwide consumed alcohol; about 63% were male. Kuwait, Iran, and Palestine emerged with the lowest death rates related to alcohol use among persons 18-49 years of age (0.3-0.4 per 100,000 people), while Lesotho, Russia, and the Central African Republic reported the highest death rates attributable to alcohol in this age group (108.8-145.3 per 100,000 people).

Cardiovascular disease, specific cancers, communicable diseases such as tuberculosis, intentional and unintentional injuries, as well as transportation-related injuries were among the 23 disorders and health states associated with alcohol use. The study authors examined health benefits associated with alcohol, including investigating evidence linking alcohol consumption to protection from ischemic heart disease and diabetes in women.1,2 With a newer approach to the available data, the collaborators concluded that even low levels of alcohol consumption increase the risk of specific cancers in women and that potential health benefits likely are offset by this association. According to the data analysis, the level of consumption minimizing health risk is zero. Notably, researchers did not distinguish between types of alcohol consumed or relative content of drinks consumed (percent alcohol was not noted.) Perhaps doing so would have allowed more meaningful results, but at this point there are no data to support or refute this possibility. Arguably, the most meaningful critique of this study is that it was strictly observational; results must be interpreted with due respect to the methodology.

The authors, who were from more than 40 countries, made a case for revising health guidelines. The study collaborators noted that the current recommendation to consume one to two drinks daily for health benefits is no longer valid and should be revised to reflect “the safest level of drinking is none.” They added that policies addressing alcohol consumption at the population level (such as taxation of alcohol products and cultural modifications) will be most effective at combating the associated health risk. In a related development, the National Institutes of Health’s Moderate Alcohol and Cardiovascular Health trial (a study about the health benefits of moderate alcohol consumption) ended in 2018 in part because of methodological concerns that the study design failed to address the potential health risks of moderate alcohol consumption.3

While advocating abstinence from alcohol may seem unrealistic and excessive, it is within our purview and responsibility to stop promoting drinking for health benefits. This does not mean that we should counsel all patients to stop drinking, but we should be clear that health benefits from alcohol consumption may be overstated and outweighed by risks. Everyday lifestyle and behavior is an essential part of a wellness plan. Providing patients with accurate information about the findings of this study allows each individual to develop a nuanced and comprehensive approach to healthy living.

REFERENCES

  1. UCI Mind. The 90+ Study. Available at: https://bit.ly/2sHqq0Z. Accessed Jan. 11, 2019.
  2. Holst C, et al. Alcohol drinking patterns and risk of diabetes: A cohort study of 70,551 men and women from the general Danish population. Diabetologia 2017;60:1941-1950.
  3. National Institutes of Health. NIH to end funding for Moderate Alcohol and Cardiovascular Health trial, June 15, 2018. Available at: https://bit.ly/2lhBo77. Accessed Jan. 11, 2019.