While high alcohol intake has been associated with worse health outcomes regardless of the type of alcohol consumed, the potential impacts of low to moderate alcohol intake appear to vary by beverage type, according to a study being presented at the American College of Cardiology's Annual Scientific Session (ACC.26).
The study of more than 340,000 British adults adds to previous research showing less alcohol consumption is better for health and provides new insights into the impacts of drinking at low and moderate levels.
These results come from the general population, and in certain high-risk groups, such as people with chronic diseases or cardiovascular conditions, the risks could be even higher."
Zhangling Chen, MD, PhD, professor at the Second Xiangya Hospital, Central South University in China and study's senior author
Researchers analyzed alcohol consumption habits and mortality outcomes among 340,924 adults who participated in the UK Biobank study between 2006-2022. Each participant completed a dietary questionnaire when they enrolled in the study and were grouped into four categories based on their alcohol intake, measured in terms of grams of pure alcohol per day and week. For reference, a 12-ounce can of beer, a 5-ounce glass of wine and a 1.5-ounce shot of spirits each contain about 14 grams of pure alcohol. People consuming less than 20 g (about 1.5 standard drinks) per week were classified as never or occasional drinkers. Men consuming between 20 g per week and 20 g per day and women consuming between 20 g per week and 10 g per day were considered to have low alcohol consumption. Daily consumption of 20 g to 40 g (about 1.5 to three standard drinks) for men and 10 g to 20 g for women was considered moderate. Daily consumption of more than 40 g (about three drinks) for men and 20 g (about 1.5 drinks) for women was considered high. Health outcomes were tracked for over 13 years on average.
Compared with never or occasional drinkers, those with high alcohol consumption were 24% more likely to die from any cause, 36% more likely to die from cancer and 14% more likely to die from heart disease. Differences in risk by alcohol type emerged at low and moderate levels of consumption, where drinking spirits, beer or cider was associated with a significantly higher risk of death while the same level of wine consumption was associated with a significantly lower risk of death.
Looking at deaths from cardiovascular disease in particular, researchers found that moderate wine drinkers had a 21% lower risk of dying from cardiovascular disease compared with never or occasional drinkers. By contrast, even low intake of spirits, beer or cider was associated with a 9% higher risk of dying from cardiovascular disease compared with drinking never or occasionally.
"Our findings help clarify previously mixed evidence on low to moderate alcohol consumption," Chen said. "These findings can help refine guidance, emphasizing that the health risks of alcohol depend not only on the amount of alcohol consumed, but also on the type of beverage. Even low to moderate intake of spirits, beer or cider is linked to higher mortality, while low to moderate intake of wine may carry lower risk."
Researchers said that several factors may account for the differences by alcohol type. Certain compounds present in red wine, such as polyphenols and antioxidants, may have benefits for cardiovascular health. Wine is also more likely to be consumed with meals and by people who have higher-quality diets and healthier behaviors in general, while spirits, beer and cider are more likely to be consumed outside of meals and were associated with lower overall diet quality and other lifestyle risk factors.
"Taken together, these factors suggest that the type of alcohol, how it is consumed and the associated lifestyle behaviors all contribute to the observed differences in mortality risk," Chen said.
In their analyses, researchers adjusted the data to account for demographic factors, socioeconomic status, lifestyle factors, cardiometabolic factors and family history of diabetes, cardiovascular disease and cancer. However, they said that the research has inherent limitations as an observational study and suggested that high-quality randomized trials could help to better understand the impacts of alcohol consumption. Alcohol consumption was assessed based on self-reporting at baseline and did not capture changes in drinking patterns over time. In addition, UK Biobank participants are generally healthier than the overall population, which may limit the study's generalizability.
Despite these limitations, the study's large sample size and length of follow-up strengthen its statistical power. Researchers said the study provides a more comprehensive and nuanced picture of the health impacts of alcohol consumption than many prior studies, offering a high degree of granularity in terms of the amount and type of alcohol consumed as well as a variety of mortality outcomes.
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