EXPERT REACTION: Cut the booze to fewer than 10 drinks a week to avoid an early death

Embargoed until: Publicly released:

An analysis of over half a million drinkers worldwide suggests alcohol consumption should be limited to below 100g per week - that's less than 10 standard Aussie drinks - to lower the risk of death from any cause. The ten standard drinks per week limit suggested by the research is significantly lower than the 'no more than two-a-day' that can be consumed within the Australian Guidelines. The research, which included Australian authors and data, found that drinking more than this amount weekly lowered people's life expectancy at age 40 by between six months and five years. The more people drank, the higher the risk of a range of life threatening illnesses, including stroke and heart failure.

Journal/conference: The Lancet

Organisation/s: The Australian National University, George Institute for Global Health, The University of Sydney, The University of Western Australia, The University of New South Wales

Funder: EB reports grants from the National Health and Medical Research Council of Australia, during the conduct of the study. See paper for full list of funders

Media Release

From: The Lancet

Alcohol limits in many countries should be lowered, evidence suggests

  • Drinking more than about 100g/week (5-6 glasses of wine) estimated to be linked to a shorter life expectancy
  • 100 g/week is lower than the recommended limit in the USA, Italy, Portugal, and Spain
  • Study included data from 600,000 drinkers – half of whom drank more than 100 g/week 

Recommended alcohol limits in many countries should be lowered to around 100g/week for men and women, according to an analysis of data from nearly 600,000 current drinkers in 19 countries, published today in The Lancet.

100 g/week is equivalent to 5-6 standard UK glasses of wine or pints of beer per week or 12.5 units. Recommended limits in Italy, Portugal, and Spain are almost 50% higher than this, and in the USA, the upper limit for men is nearly double this (196 g/week or 11 glasses; 98 g/week for women). The findings from the study are in line with UK guidance which was recently lowered to 6 glasses a week for men and women.

The international team of researchers analysed individual participant data taken from 83 studies in 19 high income countries. The researchers also had access to data on participants’ age, sex, history of diabetes, smoking status and several other factors known to be related to cardiovascular disease. None of the participants had a known history of cardiovascular disease.

The study included data from 599,912 current drinkers. About 50% reported drinking more than 100 g/week, and 8.4% drank more than 350 g/week.

The study found an increase in all causes of death above 100 g/week alcohol consumed, supporting reductions of alcohol consumption limits in most existing guidelines across the globe.

In comparison to those who reported drinking less than 100 g/week, those who reported drinking 100-200 g/week, 200-350 g/week, or more than 350 g/week had an estimated lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.

Dr Angela Wood, lead author, University of Cambridge, UK, says: “The key message of this research for public health is that, if you already drink alcohol, drinking less may help you live longer and lower your risk of several cardiovascular conditions.” [1]

The researchers also looked at the association between alcohol consumption and different types of cardiovascular disease. Higher alcohol consumption was associated with a higher risk of stroke, heart failure, fatal hypertensive disease, and fatal aortic aneurysm. For these conditions, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. By contrast, increased alcohol consumption was associated with a somewhat lower risk of non-fatal heart attacks (“myocardial infarction”).

“Alcohol consumption is associated with a slightly lower risk of non-fatal heart attacks but this must be balanced against the higher risk associated with other serious – and potentially fatal – cardiovascular diseases,” explains Dr Wood. [1]

The authors note that the different relationships between alcohol intake and various types of cardiovascular disease could be explained, at least in part, by the effect of alcohol consumption on elevated blood pressure and on factors related to elevated high-density lipoprotein cholesterol (HDL-C).

“Doctors and other healthcare professionals must heed this message and transmit it to their patients. This study has shown that drinking alcohol at levels which were believed to be safe is actually linked with lower life expectancy and several adverse health outcomes,” Dr Dan G Blazer, co-author, Duke University, USA [1]

The study focused on current drinkers to reduce the risk of bias caused by those who abstain from alcohol due to poor health. However, the authors note some limitations. Participants were recruited between 1964 and 2010 and each participant had a minimum of 12 months follow up. The study did not look at the effect of alcohol consumption over the life-course or account for people who may have reduced their consumption due to health complications. Finally, the study used self-reported alcohol consumption.

Professor Edoardo Casiglia, co-author, University of Padua, Italy, adds: “This study provides clear evidence to support lowering the recommended limits of alcohol consumption in many countries around the world.” [1]

Writing in a linked Comment, Professors Jason Connor and Wayne Hall, University of Queensland Centre for Youth Substance Abuse Research, Australia, say: “The drinking levels recommended in this study will no doubt be described as implausible and impracticable by the alcohol industry and other opponents of public health warnings on alcohol. Nonetheless, the findings ought to be widely disseminated and they should provoke informed public and professional debate.”

NOTES TO EDITORS
The study was funded by the UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council. 
[1] Quotes from authors and cannot be found in the text of the article.

Attachments:

  • The Lancet
    Web page
    Please link to the article in online versions of your report (the URL will go live when the embargo lifts).

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Bu Yeap is from the School of Medicine at the University of Western Australia and is an author on the paper

The study is important as it analyses data from nearly 600,000 people from all over the world. What it shows is that the amount of alcohol consumed affects the risk of dying: this risk is lowest when alcohol intake is less than 100g per week. It is increased with consumption of 100 - 200g per week (~5 per cent higher), and much more so at 300 g per week (~20 per cent higher) and 500g per week (~50 per cent higher). Higher alcohol consumption is associated with lower risk of heart attack, but higher risk of stroke, heart failure and other heart events. Overall, for a 40-year-old man, the estimated reduction in life expectancy is nearly five years for alcohol consumption of more than 350g per week, for a 40-year-old woman it is around four years, compared to consumption of less than 100g per week.
 
Several Australian studies (AUSDIAB, Busselton Health Study, Health In Men Study, Dubbo Study) were part of this collaboration, contributing to the research and making the findings relevant to Australians.
 
An important message from this study is that optimal life expectancy is associated with a relatively low level of alcohol consumption (less than 100g per week), and that higher levels of consumption increase mortality risk.
 
This would be a suitable time for current Australian guidelines on alcohol consumption to be reviewed so that this new information can be considered.

Last updated: 12 Apr 2018 3:49pm
Associate Professor David Sullivan is from the NHMRC Clinical Trials Centre at the Sydney Medical School in the University of Sydney

This is a large-scale analysis that benefits from its use of patient-specific data.

It concentrates on dissecting the various effects of alcohol consumption on cardiovascular disease, and in doing so demonstrates a pattern of increasing harm from alcohol associated with all aspects of cardiovascular disease except myocardial infarction, which declines. When the two trends are considered together, any benefit from alcohol is eliminated for intakes of more than 100 grams-per-week.  

The study recognises its limitations, the most important of which is the need to rely on self-reported alcohol consumption.

Given the huge health burden imposed by alcohol, a reliable biological marker of the level of alcohol consumption is sorely needed.

Another shortcoming is the absence of information concerning other adverse health outcomes such as cancer and liver disease. Although these were insufficient to alter the findings concerning total mortality, they may be sufficient to alert patients to the need to reduce alcohol use for other reasons.

Last updated: 12 Apr 2018 3:48pm
Dr Gillinder Bedi is Head, Substance Use Research at Orygen, the National Centre of Excellence in Youth Mental Health

This is a large study of relationships between alcohol use and subsequent death and heart disease. In current drinkers, weekly alcohol consumption predicted overall risk of death.

Increased mortality risk started at around 100 grams of alcohol weekly (10 Australian standard drinks) in men and women. This is lower than the upper limit of low-risk drinking in current Australian guidelines (up to 2 standard drinks daily, or a maximum of 140 grams of alcohol per week). According to these analyses, a 40 year old who drank at the upper limit of Australian low-risk guidelines would have a 6-month reduction in life expectancy.

The main strength of this study is its size, including almost 600,000 drinkers across 19 developed countries. It also attempted to control for factors likely to skew the results, such as pre-existing heart disease, diabetes, and cigarette smoking.

The study remains observational, however, and did not account for factors like psychiatric illness, which is linked both to early mortality and alcohol consumption. Thus, while this study does potentially support lowering the low-risk drinking guidelines in Australia, these guidelines should reflect the overall state of knowledge, rather than a single study, no matter how large and well controlled.

Last updated: 12 Apr 2018 1:34pm
Professor Michael Farrell is Director of the National Drug and Alcohol Research Centre at the University of New South Wales

This is an interesting paper which confirms previous studies, but with large scale international data. It indicates that risk increases above 100 grams per week and notes that 50 per cent of the study population consumed that or above that. There is a dose harm effect with increased consumption associated with increased cardiovascular harms apart from Myocardial Infarction.

On balance, the more complex issue is how we calculate the benefit risk ratio across the lifetime and how we figure the overall benefit of two added years in a total life.

While this study will contribute to the debate that our colleague Jurgen Rehm (director of the CAMH Institute for Mental Health Policy Research) University of Toronto sums up as “less is better”, it probably does not add too much to what we already know about this. But it is unquestionably a landmark study.

Last updated: 11 Apr 2018 12:22pm
Emeritus Professor Jake Najman is from the Queensland Alcohol and Drug Research and Education Centre (QADREC) at The University of Queensland

Firstly, the all-cause mortality findings are more  important that the cardiovascular mortality data, suggesting that even modest quantities of alcohol  increase the risk of earlier death. The data make it even clearer that the alcohol industry is promoting a misleading view that alcohol use is benign. 

Secondly, there has been a fiction, used by the alcohol industry to maintain almost unrestrained advertising for its products, that small quantities of alcohol are beneficial, even healthy (reducing the risk of cardiovascular disease). This study makes it clear that alcohol leads to many other diseases which, in total, increase the risk of death. 

Health Minister Hunt is currently considering legislation to regulate the alcohol industry. His understanding of the findings of this study may be important in the decisions he makes.

Last updated: 11 Apr 2018 12:20pm
Emeritus Professor Mark Wahlqvist is former Professor and Head of Medicine at Prince Henry’s Hospital and Monash Medical Centre, Associate Dean (International Health and Development) and Director of the Asia Pacific Health and Nutrition Centre

The Lancet paper on risk thresholds for alcohol consumption is a landmark publication. Its great strength is that it dissects out the conflicting risk alcohol presents for cardiovascular disease, particularly ischaemic heart disease on the one hand favourable, and hypertension with stroke, cardiac failure and arrhythmias on the other hand unfavourable. The net, best expressed as all-cause mortality is that above 100g per week, alcohol intake is unfavourable.

The effective sample size is large, almost 600,000, but no locality or regional data are provided. This is particularly important for non-European regions and populations and in socio-economic development where hypertension with stroke and chronic renal disease is such a preventable risk factor for premature mortality, along with dietary pattern problems and infectious disease. The risk threshold is likely to be lower in these settings.

The findings presented are remarkably similar for men and women, but this begs the question about pregnancy and fetal alcohol syndrome, and the clear association between alcohol consumption and breast cancer. More cautionary advice for  women, and especially when pregnancy is possible, is required than the proposed threshold would suggest. The same might be said for men with associated cancer risk factors such as smoking, physical inactivity and obesity.

This paper appears at a time when sugary drink consumption is a growing health concern. The beverage industry has identified an opportunity to exploit alcoholic beverage consumption as an alternative, notably for young women.

A message which would reassure women during the reproductive years that two standard drinks a day is safe, when it may well not be, plays to this commercial sector. Nothing is said in the Lancet report about the modulating effect of consuming alcohol with food or other approaches to safer alcohol consumption.

A report like this should be accompanied by a policy approach to reduce the risk of its unintended consequences.

Last updated: 11 Apr 2018 12:19pm
Statement from the National Health and Medical Research Council (NHMRC)

The National Health and Medical Research Council (NHMRC) is reviewing the Australian Guidelines to Reduce Health Risks from Drinking Alcohol 2009 (the 2009 Alcohol Guidelines).

Evidence reviews on the health effects of alcohol consumption are currently underway, which will help inform the recommendations in the revised guidelines. Until then, the 2009 Alcohol Guidelines remain NHMRC’s current advice.

Last updated: 11 Apr 2018 12:18pm

News for:

Australia
New Zealand
NSW
WA
ACT

Media contact details for this story are only visible to registered journalists.