Alcohol intake and total mortality in 142 960 individuals from the MORGAM Project: a population-based study

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  • Augusto Di Castelnuovo
  • Simona Costanzo
  • Marialaura Bonaccio
  • Patrick McElduff
  • Veikko Salomaa
  • Satu Männistö
  • Marie Moitry
  • Jean Ferrières
  • Jean Dallongeville
  • Barbara Thorand
  • Hermann Brenner
  • Marco Ferrario
  • Giovanni Veronesi
  • Emanuela Pettenuzzo
  • Abdonas Tamosiunas
  • Inger Njølstad
  • Wojciech Drygas
  • Yuri Nikitin
  • Stefan Söderberg
  • Frank Kee
  • Guido Grassi
  • Dirk Westermann
  • Benedikt Schrage
  • Salim Dabboura
  • Tanja Zeller
  • Kari Kuulasmaa
  • Stefan Blankenberg
  • Maria Benedetta Donati
  • Giovanni de Gaetano
  • Licia Iacoviello

Aim: To test the association of alcohol consumption with total and cause-specific mortality risk. Design: Prospective observational multi-centre population-based study. Setting: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project. Participants: A total of 142 960 individuals (mean age 50 ± 13 years, 53.9% men). Measurements: Average alcohol intake by food frequency questionnaire, total and cause-specific mortality. Findings: In comparison with life-time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI) = 7–14%] reduction in the risk of total mortality, while intake > 20 g/day was associated with a 13% (95% CI = 7–20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake > 20 g/day was associated with a 22% (95% CI = 10–35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high-density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively. Conclusions: In comparison with life-time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality.

OriginalsprogEngelsk
TidsskriftAddiction
Vol/bind117
Udgave nummer2
Sider (fra-til)312-325
ISSN0965-2140
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
S.C. and A.D.C. were the principal investigator and the co‐applicant, respectively, of a study supported by a research grant from ERAB (the European Foundation for Alcohol Research; id. EA1767, completed in January 2020), outside the submitted work. A.D.C. reports personal fees as member of the Organizing Committee for the 7th European Beer and Health Symposium (2014), Beer and Health Initiative (The Dutch Beer Institute foundation—The Brewers of Europe), outside the submitted work. S.C. reports personal fees as member of the Organizing Committee and speaker for the 9th European Beer and Health Symposium (Bruxelles 2019) and for given lecture at the 13th European Nutrition Conference|FENS 2019 (Dublin), sponsored by the Beer and Health Initiative (The Dutch Beer Institute foundation—The Brewers of Europe), outside the submitted work. G.d.G. is a member of the International Scientific Forum on Alcohol Research ( http://alcoholresearchforum.org ), an independent organization of scientists that prepares critiques of emerging research reports on alcohol and health. The members of the Forum donate their time and effort to the review of papers and receive no financial support for their contributions to critiques. The Forum itself receives no support from any organization or company in the alcoholic beverage industry. However, whether the support for individual members is from governmental agencies, universities, private foundations or other groups, none of these organizations has any input into the conclusions presented in the critiques published on the forum web‐site. A detailed disclosure statement signed by each member of the forum is available at: http://alcoholresearchforum.org/disclosure‐statement . G.d.G. was also previously a consultant to the Web Newsletter of Assobirra, the Italian Association of the Beer and Malt Industries (until 2019) and is a corresponding member of the non‐profit Accademia Italiana della Vite e del Vino; G.d.G. reports personal fees for a lecture at the 8th European Beer and Health Symposium (2017), Beer and Health Initiative (The Dutch Beer Institute Foundation—The Brewers of Europe), outside the submitted work. V.S. was supported by the Finnish Foundation for Cardiovascular Research and has received honoraria from Novo Nordisk and Sanofi and travel support from Novo Nordisk. V.S. also has ongoing research collaboration with Bayer Ltd (all unrelated to the present study). S.S. was supported by the Swedish Heart–Lung Foundation, the County Council of Västerbotten (ALF, VLL‐548791) and Umeå University, and reports speakers’ honoraria from Actelion Pharmaceuticals Ltd and from Astra Zeneca Ltd (unrelated to the present study). J.F. reports lectures fees from Amgen, MSD, Sanofi and Servier. B.S. is funded by the German Research Foundation.

Funding Information:
The MORGAM Project received funding from Medical Research Council London grant G0601463 (80983) and European Union FP7 project BiomarCaRE (HEALTH‐F2–2011‐278 913). The activities of the MORGAM Data Centre have also been sustained by recent funding from European Union FP 7 project CHANCES (HEALTH‐F3–2010‐242 244). The present analysis was partially supported by the Ministero della Salute, Italy, Bando Ricerca Finalizzata 2018 RF‐2018‐12 367 074 and by the Associazione Italiana per la Ricerca sul Cancro AIRC “5xMILLE”, Italy, bando n. 12237. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. A.D.C. affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, and no important aspect of the study has been omitted.

Publisher Copyright:
© 2021 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

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