Moderate alcohol consumption and lower total mortality risk: justified doubts or established facts?

Giovanni de Gaetano, Marialaura Bonaccio, Augusto Di Castelnuovo, Licia Iacoviello and Simona Costanzo

Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.

A J-shaped curve describing the relationship between alcohol consumption and total mortality, represents the range of optimum exposure to moderate alcohol, while the increased risk in life-long non-drinkers or heavy/irregular drinkers reflects sub-optimal risky exposure. It has been suggested that lower risk of mortality associated with light-to-moderate alcohol intake might be due to a misclassification of drinking patterns (the inclusion in the reference group of high-risk subjects who had become abstainers) or to unmeasured and unknown confounders. As a consequence, some Organizations consider alcohol to be harmful even if consumed in light amounts (“zero tolerance”). At this time, while waiting for a long-term clinical trial to provide solid answers to the controversies surrounding moderate alcohol intake, four key messages can be listed, based on the available solid epidemiological evidence:

  • Moderate alcohol should be consumed in the context of an otherwise healthy lifestyle such as Mediterranean diet.
  • The choice to consume alcohol should be made on an individual basis, taking into account both its influence on wellbeing and individual’s specific health risk profile.
  • Lifelong abstainers or occasional drinkers should not adopt regular moderate drinking solely to improve their health.
  • The hazards of heavy or binge drinking should be highlighted.