Medical/Scientific Council Comments
Several articles dealt with all-cause mortality rather than disease specific-mortality. The data from the Normative Aging Study continue to confirm that the improved outcome of moderate drinkers is not due to the inclusion of people who have stopped drinking due to ill health in the abstainer group. Several articles indicate to us that the improved mortality related to moderate alcohol consumption is most apparent in middle-aged and older people, where the prevalence of CAD is the highest. Even here, however, we are reminded that the relationship between alcohol consumption and mortality will vary widely from population to population, depending on the average level of drinking and the prevalence of those diseases that can be affected by alcohol consumption. Two articles tell us that an Italian male population is quite different from a group of Iowans. From the point of view of health and disease prevalence, older people living in New Haven and East Boston more closely resemble.
Summaries.
To investigate the criticism that sick former drinkers are included in the non-drinker category of previous studies that showed moderate consumers of alcohol have a lower risk of death from CAD than non-drinkers and heavy drinkers, deLabry, et al. followed 1823 male subjects participating in a longitudinal study who were prescreened for absence of serious chronic disease. After 12 years of follow-up, the authors found that overall mortality rates were lowest for moderate drinkers (nondrinker = 0-29 drinks per year, moderate = 30-1,094 d/y, heavier + 1,094 or more d/y). The authors concluded, "Copious evidence shows that heavy drinking is harmful to health. On the other hand, a growing body of evidence indicates that moderate drinking may have long-term beneficial health effects."
De Labry LO, et al. Alcohol consumption arid mortality in an American male population: recovering the U-shaped curve findings form the Normative Aging Study., Journal of Studies on Alcohol 1992; 53:25-32.
Farchi, et al. examined the relation of alcohol consumption to mortality using the data of the Italian part of a larger study of seven countries by analyzing the dietary habits of 1,536 men aged 45-64. The authors noted that this cohort drank much higher quantities of alcohol than those reported in other studies. They found a J-shaped relationship between consumption and overall mortality as well as for cancer and CAD deaths. The authors concluded that "heavy alcohol consumption is a high-risk factor for all causes of death", and that "moderate consumption has not been proven to be beneficial to health, neither is it a risk. It remains to be ascertained whether there is a threshold value above which alcohol is a risk factor. In this study, a relatively wide range of daily alcohol consumption has no measurable effect on mortality."
Farchi G, et al. Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study., International Journal of Epidemiology 1992; 1(1):74-81.
Klatsky, et al. conducted a prospective cohort study of 128,934 adults between 1978-1985 to study the relation between alcohol consumption and cause of death. Overall mortality was lowest in those who drank less than 1 drink a day(d/d) and highest in those who drank more than 6 d/d. They found that heavier drinkers (>6 d/d) were at greater risk for death from noncardiovascular diseases, especially cirrhosis, unnatural death and tobacco-related cancers. This risk appeared to be higher in women and younger persons (<40 years). Lighter drinkers (1-2 d/d)-were at lower risk for death from cardiovascular disease, 30% lower risk than nondrinkers, especially CAD. The authors concluded that "women and younger persons appear more susceptible to the increased mortality risk of heavy drinking. The reduced cardiovascular risk of lighter drinkers is more pronounced in older persons."
Klatsky AL, Alcohol and mortality., Annals of Internal Medicine 1992; 117:646-54.
Scherr, et al. studied the association between alcohol consumption and mortality among three elderly population$ (>65 years) living in East Boston, Iowa, and New Haven. The distribution of alcohol consumption differed between East Boston, Iowa end' New Haven. After adjusting for sex, age, smoking, and mental status, the investigators found that people drinking less than an ounce of a day had the lowest overall mortality in East Boston and New Haven. In Iowa, their mortality rate was the same as for non-drinkers. For just cardiovascular mortality, the differences were not as striking. The authors concluded that moderate alcohol consumption is associated with lower mortality in the elderly, as it is in middle-aged populations and speculate that the differences in Iowa may be attributed to both the lower rates of heart disease in the mid-west as well as to the lower levels of alcohol consumption.
Scherr PA, et al. Light to moderate alcohol consumption and mortality in the elderly., Journal of the American Geriatric Society 1992; 40(i):651-7.
<RETURN TO RESEARCH ISSUES LISTING> <RETURN TO INDEX PAGE>