Alcohol intake, morbidity, and mortality.

Abstract

Byline: T. Sathyanarayana Rao, Chittaranjan. Andrade This is an era in which we are increasingly concerned about the quality of the air that we breathe and the food that we eat. Alcohol, a beverage that has pleased our species for millennia, is one of the foods the consumption of which, in the words of the immortal bard, should give us pause. In this editorial, we express our concerns on the subject through a presentation and discussion of the results of two large epidemiological studies [sup][1],[2] published nearly two decades apart. A voluminous body of literature shows that men and women who consume alcohol regularly have higher death rates from accidental injury, violence, suicide, poisoning, cirrhosis of the liver, cancer, and, possibly, hemorrhagic stroke. Much literature also supports the view that men and women who regularly drink have lower death rates from coronary heart disease and thrombotic stroke. What is the net impact of these favorable and unfavorable alcohol-mediated effects on persons with regular alcohol intake? Because the incidence of different alcohol-related events varies between men and women, across age groups, and across other sociodemographic and clinical categories, it is evident that any study of the balance of risk will need to take subpopulations into account. The subject was addressed in a large epidemiological study, described by Thun et al . [sup][1] in 1997. The sample in this study [sup][1] comprised nearly half a million Americans, aged 30 years or more, who provided complete information about smoking and drinking habits. There were totally 238,206 men and 251,420 women aged 30-104 years (mean, 56 years). About 98% of these men and women could be followed for up to 9 years, during which period 12% died. Death certificates were obtained for all but 2% of those who died. In this study, alcohol consumption was assessed at baseline and at endpoint using questionnaires, and was categorized as none, less than daily but at least thrice a week, 1 drink per day, 2-3 drinks per day, and 4 or more drinks per day. For operational purposes, one drink was considered as 12 g of absolute alcohol; in common parlance, this amounts to about one small peg (30 ml) of 75[degrees] proof liquor. On the surface, it appears that this classification is somewhat unsatisfactory on several counts; more useful quantitative indices, for example, might have been average daily consumption of absolute alcohol, lifetime consumption of absolute alcohol, and quantity of absolute alcohol consumed per drinking occasion. However, such indices can be reliably calculated only from data obtained through direct interview; furthermore, such quantitative indices may not be helpful when the relationship between alcohol consumption and mortality variables is nonlinear (as actually transpired for several variables in the study). Therefore, considering the epidemiologic nature of the investigation, the investigators [sup][1] did the best that was possible under the circumstances. After excluding from analysis former drinkers and those with baseline cancer or cirrhosis, it was discovered that the results, in general, supported existing literature: *In men, consumption of alcohol was associated with significantly increased risk of mortality due to the following: Cirrhosis, alcoholism, or both; injuries and external causes; alcohol-related cancers (mouth, esophagus, pharynx, larynx, liver); colorectal cancer; all other cancers *In women, consumption of alcohol was associated with significantly increased risk of mortality due to the following: Cirrhosis, alcoholism, or both; alcohol-related cancers; breast cancer. Risks of death due to colorectal cancer, all other cancers, injuries, and external causes were not significantly elevated *In both sexes, consumption of alcohol was found to significantly decrease the risk of mortality due to the following: Coronary heart disease when there was no disease preexisting; coronary heart disease when such disease did preexist; stroke; other circulatory disease; all cardiovascular disease; all other causes. …