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Late-Life Alcohol Consumption and 20-Year Mortality
By Ilene
A very interesting study showed that moderate drinking has a positive effect on mortality compared to abstinence and heavy drinking. Moderate drinking initially showed a stronger beneficial effect than light drinking, however, after numerous confounding factors were controlled for, the increased benefit was not significant.
Here’s how abstinence, light drinking, moderate drinking and heavy drinking were defined in the methods section of the study, Late-Life Alcohol Consumption and 20-Year Mortality (published in Alcoholism: Clinical and Experimental Research, Wiley):
Based on the approximation that in the United States 5 oz of wine, 12 oz of beer, and 1 shot (1.5 oz) of hard liquor contain an average of 0.6 oz (approximately 14 g) of pure, 100% alcohol (NIAAA, 2007), we defined 4 categories of average daily alcohol consumption at baseline: (1) abstainer (0 g); (2) light, defined as consuming up to less than 1 drink ⁄ d (consuming more than 0 g but less than 14 g ⁄ d); (3) mod- erate, defined as consuming between 1 to less than 3 drinks per day (14 g to <42 g ⁄ d); and (4) heavy, defined as drinking 3 or more drinks per day (42 g ⁄ d or more).
The Abstract summarizes what the researches did and what they found:
Background: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention.
Methods: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate.
Results: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers.
Conclusions: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk. Late-Life Alcohol Consumption and 20-Year Mortality
Light drinkers contemplating increasing your alcohol consumption in order to experience the health benefits note that "after adjusting for the effects of age and gender, all eleven additional covariates, …abstainers and heavy drinkers continued to show increased mortality risks of 49 and 42%, respectively, compared to moderate drinkers. However, after adjusting for all covariates, the slightly higher relative risk for light drinkers (12%) compared to moderate drinkers was no longer significant."
The study also found that moderate drinkers consuming up to two drinks per day were nearly identical in 20-year mortality risk with moderate drinkers consuming two to three drinks per day.
Prior to reading this study, I believed the health benefits of drinking alcohol (on heart disease) were more substantially offset by the adverse effects (increased cancer risks, liver disease). This study shows that the statistics significantly favor light-to-moderate drinking over abstinence. Health benefits are thought to be related to a protective effect on heart disease. Mechanisms might include increasing high-density lipoprotein cholesterol, fibrinolysis, endothelial function, and antioxidant effects. Alcohol also reduces plasma viscosity, fibrinogen concentration, platelet aggregation, and inflammation. Adverse effects of heavy drinking are primarily due to noncardiovascular illnesses–e.g. alcohol is associated with increased risk for certain cancers, liver disease, pancreatitis, and hypertension.
Conclusion: For many individuals, two or three alcoholic beverages a day seem to provide a favorable risk/reward ratio.
I think I’ll open up that bottle of red wine that’s been sitting on top of the fridge for year and a half.
For another perspective and more information, here’s a report on the study by John Cloud writing in TIME.
Even More Evidence for the Health Benefits of Drinking
By JOHN CLOUD, courtesy of TIME
After TIME.com ran my story about how moderate and even heavy drinking are both associated with living longer than average, lots of readers e-mailed me their skepticism. One limitation of the study I was writing about (here’s a pdf from the journal Alcoholism: Clinical and Experimental Research) is that the authors — who followed a group of drinkers for 20 years — could only speculate about the biological mechanism allowing those drinkers to live longer than the nondrinkers in the study. One possibility, for instance, is that alcohol use seems to be associated with heart health, particularly for those who consume red wine, which contains resveratrol.
Then I got an e-mail from David Foster of the Department of Biological Sciences at Hunter College in New York City. He referred me to a paper he got published earlier this year in the journal Cell Cycle. The paper offers another reason drinking is associated with longevity: it seems to shorten the lifespan of cancer cells. The presence of alcohol can inhibit a protein called mTOR (an abbreviation for a protein with a regal full name, “the mammalian target of rapamycin”; doesn’t that sound like the title of a great sci-fi novel?), which is a critical regulator of signals that keep cancer cells alive.
Scientists have known for some time that suppressing mTOR can extend longevity; Foster says resveratrol and calorie restriction both seem to extend life because they suppress mTOR. Foster notes that alcohol can reduce stress, something the authors of the other paper also mention.
But there is of course a caveat, one you may have seen last night on Mad Men: too much alcohol can harm your quality of life even as it extends it. As Foster told me, “In principle, higher levels of alcohol would work better, but of course there is a point where there is a tradeoff with liver and behavioral problems.”
In other words, if Don Draper can barely get through a meeting without a drink, who cares how long he lives?
