July 21, 2022 -- Adults older than 40 who have one or two alcoholic drinks a day may reduce their risk of heart disease, stroke, and diabetes, according to a global study.

For those under 40, though, the same benefits do not apply, in large part because of injuries sustained when under the influence of alcohol.

The health risks and benefits of moderate alcohol consumption are complex and remain a hot topic of debate. The data suggest that small amounts of alcohol may reduce the risk of certain health outcomes over time but increase the risk of others, wrote Dana Bryazka, a researcher at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, and colleagues, in a paper published this month in The Lancet.

“We estimate that 1.78 million people worldwide died due to alcohol use in 2020,” Bryazka says. “It is important that alcohol consumption guidelines and policies are updated to minimize this harm, particularly in the populations at greatest risk.”

“Existing alcohol consumption guidelines frequently vary by sex, with higher consumption thresholds set for males compared to females. Interestingly, with the currently available data we do not see evidence that risk of alcohol use varies by sex,” she noted. But this latest research shows the risks may vary by age.

In the study, the researchers analyzed disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for the years 1990 to 2020 for 21 regions, including 204 countries and territories.

The data were analyzed by 5-year age group, sex, and year for people aged 15 to 95 and older. The researchers used clinical standards known as the theoretical minimum risk exposure level, or TMREL, and non-drinker equivalent (NDE), both of which helped define the safe minimum or maximum daily intake of alcohol for a certain population.

When the TMREL is reached or exceeded, it may have negative consequences for one’s health.

One standard drink was defined as 10 grams of pure alcohol, equivalent to a small glass of red wine (100 milliliters or 3.4 fluid ounces) at 13% alcohol by volume, a can or bottle of beer (375 milliliters or 12 fluid ounces) at 3.5% alcohol by volume, or a shot of whiskey or other spirits (30 milliliters or 1 fluid ounce) at 40% alcohol by volume.

Overall, the TMREL was low regardless of age, sex, time, or geography, and varied from no drinks to just under two. But it was lowest for males aged 15 to 39 (0.136 drinks per day) and only slightly higher for females aged 15 to 39 (0.273), representing 1 to 2 tenths of a standard drink.

For adults aged 40 and older without any underlying health conditions, drinking a small amount of alcohol may provide some benefits, such as reducing the risk of heart disease, stroke, and diabetes, the researchers noted. In general, for people aged 40 to 64, TMRELs ranged from about half a standard drink per day to almost two standard drinks, with only slight variations between men and women.

For those older than 65, the TMRELs represented just over three standard drinks per day.

The researchers also found that people who drank harmful amounts of alcohol were most likely to be aged 15 to 39 (59.1%) and male (76.9%).

But health and alcohol interaction is complicated, the researchers noted.

“These findings seemingly contradict a previous [Global Burden of Diseases, Injuries, and Risk Factors Study] estimate published in The Lancet, which emphasized that any alcohol use, regardless of amount, leads to health loss across populations,” wrote Robyn Burton, PhD, and Nick Sheron, MD, both of King’s College, London, in an accompanying comment.

“Across most geographical regions in this latest analysis, injuries accounted for most alcohol-related harm in younger age groups. This led to a minimum risk level of zero, or very close to zero, among individuals aged 15 [to] 39 years across all geographical regions,” which is lower than the level for older adults because of the shift in alcohol-related disease burden towards cardiovascular disease and cancers, they said.

“This highlights the need to consider existing rates of disease in a population when trying to determine the total harm posed by alcohol,” they wrote.

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The Lancet: "Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020," "Complex relationship between health and moderate alcohol use."

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