Latest research on moderate drinking

Alcohol is a substance that has been present in our civilization for thousands of years and will probably continue for many more. However, an extensive body of evidence and studies has shown that there is no safe limit for alcohol consumption that is free from health risks (2–5). Much of this evidence comes from the Global Burden of Disease and Risk Factors (GBD) study (1), involving dozens of researchers around the world. Consequently, several countries began to reduce their moderate drinking recommendations, such as Australia and Canada.

In addition to the semantics of the term “moderate drinking”, it is understood that low-risk consumption is a type of alcohol use pattern that follows epidemiological parameters and is socially acceptable, such as, for example, speed limits for vehicles motor vehicles on roads (6). As rightly stated in the scientific article by Holmes et al. (2019) (7), public policy makers must balance epidemiological evidence, expert opinion and pragmatic considerations.

Due to the complexity of the topic, there are important counter-arguments against the interpretation that the only possible recommendation in this scenario would be abstinence. After all, a consumption recommendation that is not feasible would not be truly effective. For example, in an article published in the journal The Lancet Rheumatology (8), the editorial board raises some important points for the debate. In summary, the authors state that:

“The WHO [World Health Organization] warns that there should be greater education about the cancer risks associated with alcohol consumption – possibly including health warnings on alcoholic drink labels – and few would argue against better informing the public regarding the health. But the absolute risks of light to moderate drinking are small, and although there is no known safe level of consumption, it seems reasonable that the quality of life gained from an occasional drink could be considered greater than the potential harm.”

These final remarks are relevant as they recognize the risks associated with low levels of alcohol consumption, as is the case for some types of cancer, and point out that measures that inform consumers of such risks are welcome. The counterpoint made comes from the notion that the absolute risk of health problems in people who drink light to moderately is low. Furthermore, the authors point out that, potentially, the quality of life resulting from the occasional consumption of an alcoholic drink may be greater than the potential harm.

In a study from 2022 (9), the GBD group points out that, after analyzing data from 1990 to 2020, there is strong evidence that alcohol consumption recommendations should be differentiated by age group and local disease rates. For individuals aged 15 to 39 years, the proposed recommendation is 0 to 0.698 drinks per day; for individuals over 40 years of age, the recommendation is 0.114 to 1.87 daily drinks, taking into account a minimum risk of exposure. Although the authors assume that any level of alcohol consumption implies some risk of injury, based on evidence that small amounts of alcohol reduce the risk of some conditions prevalent in older ages, such as ischemic heart disease and diabetes, they conclude that small amounts of alcohol would be safe for people over 40.

There is yet another body of evidence that is emerging regarding the influence of lifestyle on the development of chronic diseases. In 2014, the World Health Organization attributed more than two-thirds of deaths worldwide (38 million) to chronic diseases. Well-established evidence shows that the incidence of cancer, cardiovascular diseases, chronic respiratory diseases and diabetes share modifiable risk factors such as alcohol consumption, body mass index (BMI), smoking, unhealthy diet and physical inactivity. A study examining the incidence of a person's first diagnosis of a chronic disease and the relationships between modifiable lifestyle risk factors (10) showed that for both sexes, not consuming alcohol was associated with a higher risk of diabetes and myocardial infarction in both sexes. Unhealthy BMI has been linked to increased risks of diabetes in both sexes and chronic obstructive pulmonary disease (COPD), lung cancer and myocardial infarction in men. Decreased daily fruit and vegetable consumption was associated with an increased risk of diabetes in both sexes, lung cancer and COPD. As chronic diseases become more prevalent with advancing age, the idea that moderate alcohol consumption is safer for people over 40 years of age, the age group in which coronary heart disease and diabetes are more common, gains reinforcement.

Therefore, it is reasonable to think that the new guidelines, based on the premise that there is no safe level of alcohol consumption, should not be interpreted as a recommendation of abstinence for all people, or that it would no longer be possible to talk about moderation. For some populations, the recommendation remains zero alcohol, as in the case of pregnant women, drivers, and people who, due to some health condition, cannot ingest the substance. However, for people who do not have these limitations, new research, in addition to pointing to the fact that there are risks involved in all consumption patterns (which are exponential in high levels), also indicates that the risk of consumption should be considered based on other variables, such as age and factors associated with lifestyle. In any case, there is still a need for more studies that can support public policies to guide the population that wants to drink and stay healthy.

References:

1. Gratacós-Ginès, J., Bruguera, P., Pérez-Guasch, M., López-Lazcano, A., Borràs, R., Hernández-Évole, H., Pons-Cabrera, M. T., Lligoña, A., Bataller, R., Ginès, P., López-Pelayo, H., & Pose, E. (2024). Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: Results from a systematic review and meta-analysis. Hepatology (Baltimore, Md.), 79(2), 368–379. https://doi.org/10.1097/HEP.0000000000000570
2. Addolorato G., Mirijello A., Barrio P., Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J. Hepatol. 2016;65:618–630. doi: 10.1016/j.jhep.2016.04.029.
3. O'Shea, R. S., Dasarathy, S., McCullough, A. J., Practice Guideline Committee of the American Association for the Study of Liver Diseases, & Practice Parameters Committee of the American College of Gastroenterology (2010). Alcoholic liver disease. Hepatology (Baltimore, Md.), 51(1), 307–328. https://doi.org/10.1002/hep.23258
4. Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., Kim, M. M., Shanahan, E., Gass, C. E., Rowe, C. J., & Garbutt, J. C. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA, 311(18), 1889–1900. https://doi.org/10.1001/jama.2014.3628
5. Addolorato, G., Leggio, L., Ferrulli, A., Cardone, S., Vonghia, L., Mirijello, A., Abenavoli, L., D'Angelo, C., Caputo, F., Zambon, A., Haber, P. S., & Gasbarrini, G. (2007). Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet (London, England), 370(9603), 1915–1922. https://doi.org/10.1016/S0140-6736(07)61814-5