Abstract
AimsIncreases in glass sizes and wine strength over the last 25 years in the UK are likely to have led to an underestimation of alcohol intake in population studies. We explore whether this probable misclassification affects the association between average alcohol intake and risk of mortality from all causes, cardiovascular disease and cancer.MethodsSelf-reported alcohol consumption in 1997–1999 among 7010 men and women in the Whitehall II cohort of British civil servants was linked to the risk of mortality until mid-2015. A conversion factor of 8 g of alcohol per wine glass (1 unit) was compared with a conversion of 16 g per wine glass (2 units).ResultsWhen applying a higher alcohol content conversion for wine consumption, the proportion of heavy/very heavy drinkers increased from 28% to 41% for men and 15% to 28% for women. There was a significantly increased risk of very heavy drinking compared with moderate drinking for deaths from all causes and cancer before and after change in wine conversion; however, the hazard ratios were reduced when a higher wine conversion was used.ConclusionsIn this population-based study, assuming higher alcohol content in wine glasses changed the estimates of mortality risk. We propose that investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses. Prospectively, researchers need to collect more detailed information on alcohol including serving sizes and strength.Short summaryThe alcohol content in a wine glass is likely to be underestimated in population surveys as wine strength and serving size have increased in recent years. We demonstrate that in a large cohort study, this underestimation affects estimates of mortality risk. Investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses.
Highlights
The chronic harm to health from alcohol consumption in the population is typically determined using findings from longitudinal observational studies with self-reported consumption as the exposure
We propose that investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses
Investigator-led cohorts need to revisit conversion factors based on more accurate estimates of alcohol content in wine glasses
Summary
The chronic harm to health from alcohol consumption in the population is typically determined using findings from longitudinal observational studies with self-reported consumption as the exposure. Misclassification of alcohol intake has implications firstly for calculating the proportion of the population who drink above low-risk drinking guidelines. In the UK over the past 25 years, there has been an increase in glass size serving and the strength of alcoholic beverages, for wine (Stead et al, 2013), which is likely to have resulted in people underestimating the amount of alcohol that they consume. Licensees were encouraged to call 175 ml a ‘standard’ glass and 125 ml ‘small’ (Stead et al, 2014), effectively increasing the typical size offered by 50 ml
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