Good practice principles low rik drinking EU RARHA

Annex 3
Positive health effects of alcohol
Deire Mongan a
It is well established that people consuming alcohol at low-risk levels have better health than those who
do not use alcohol at all. However, there is still controversy of the causality of this association. Even if
there was a causal component, it has been argued in recent years that the benefits accruing from lowrisk
alcohol consumption may have been overstated.
Fillmore et al. classified longitudinal studies on alcohol and health according to how “an abstainer”
was defined, as this is the key reference group to which all drinkers are typically compared. They found
that when studies explicitly excluded former and occasional drinkers from the abstainer reference
group, there was limited evidence of protection from moderate alcohol consumption.[ 1 ]
A 2016 systematic review and meta-regression analysis of studies which included 3 998 626
individuals, investigated alcohol use and mortality risk after controlling for quality-related study
characteristics. The authors reported that estimates of mortality risk from alcohol were significantly
altered by study design and characteristics. When meta-analyses were adjusted for these factors, lowvolume
alcohol consumption had no net mortality benefit compared with lifetime abstention or
occasional drinking.[ 2 ]
Fekjaer (2013) reported evidence of health benefits from alcohol use for implausible types of
health conditions including deafness, hip fractures, the common cold, cancers, birth complications,
dementia, and liver cirrhosis in observational longitudinal studies. In these studies the J-shape curve
was observed, with lower risk for low-volume drinkers compared with abstainers even though a causal
basis for such associations is highly unlikely.[ 3 ]
A 2014 genetic study reported that a genetic variant associated with reduced drinking lowered
rather than increased cardiovascular risk among low-volume drinkers, which challenges the concept of
a cardioprotective effect associated with low-risk alcohol consumption.[ 4 ] There is also evidence of
lifestyle confounding factors influencing results. Research has shown that nondrinkers are more likely
than low-risk drinkers to have characteristics associated with increased CVD mortality in terms of
demographic factors, social factors, behavioural factors, access to health care, and health-related
conditions.[ 5 ]
1
Fillmore K et al. (2006) Moderate alcohol use and reduced mortality risk: systematic error in prospective studies.
Addiction Research and Theory, 14: p.101-32.
2
Stockwell T et al. (2016) Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-
Analysis of Alcohol Consumption and All-Cause Mortality. J Stud Alcohol Drugs, 77(2): p.185-98.
3
Fekjaer H (2013) Alcohol-a universal preventive agent? A critical analysis. Addiction, 108(12): p.2051-7.
4
Holmes M et al. (2014) Association between alcohol and cardiovascular disease: Mendelian randomisation
analysis based on individual participant data. Bmj, 349: p.g4164.
5
Naimi T et al. (2005) Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S.
adults. Am J Prev Med, 28(4): p.369-73.
a
Health Research Board, Ireland
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Good practice principles for low risk drinking guidelines