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Critique 180: The association of alcohol intake with total mortality risk among women — 9 February 2016

The follow up of more than 6,000 women in a population-based cohort in an area of southern Sweden was used to estimate how baseline levels of alcohol consumption, at age 50-59 years, related to total mortality risk over the subsequent 17 years. At baseline, 26% of women reported no alcohol consumption while 13% reported an average of 12 or more grams of alcohol per day. Thus, the large majority (61%) were light drinkers, reporting the equivalent of no more than one drink per day. The authors report that, even when adjusting for education, marital status, smoking, BMI, physical fitness, diabetes and ischemic heart disease before screening, mortality risk during follow up was significantly higher among non-drinkers and heavier drinkers than among women reporting the equivalent no more than one typical drink per day. They state that their analyses thus support a “J-shaped” association between alcohol and total mortality risk, and that “The observed protective effect of light drinking (1–12 grams/day) could thus not be attributed to any of these known confounders.”

Forum members agreed this was a well-done study, but noted that the authors were unable to adjust for the pattern of drinking (regular versus binge), previous drinking among abstainers, or potential changes in drinking during follow up. Also, beverage-specific results are not presented. Further, the data presented in this study are not adequate to judge the specific level of alcohol consumption at which total mortality risk for drinkers reaches or exceeds the risk for non-drinkers; in other words, the “threshold” for adverse effects of alcohol on mortality cannot be determined very well. Nevertheless, the results of these analyses are very consistent with most long-term follow-up studies and support a “J-shaped” association between alcohol and the risk of total mortality.

Reference: Midlöv P, Calling S, Memon AA, Sundquist J, Sundquist K, Johansson S-E. Women’s health in the Lund area (WHILA) – Alcohol consumption and all-cause mortality among women – a 17 year follow-up study. Pre-publication: BMC Public Health 2016;16:22. DOI 10.1186/s12889-016-2700-2.

For the full critique of this paper by members of the International Scientific Forum on Alcohol Research, please click here.
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