Alcohol consumption and risk of cardiovascular disease, cancer and mortality: a prospective cohort study

Authors: ZHANG, XINYAN - Pennsylvania State University; LIU, YAN - Kailuan Hospital; LI, SHANSHAN - Boston University; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; CHEN, SHUOHUA - Kailuan Hospital; NA, MUZI - Pennsylvania State University; VELDHEER, SUSAN - Pennsylvania State College Of Medicine; XING, AIJUN - Kailuan Hospital; WANG, YANXIU - Kailuan Hospital; WU, SHOULING - Kailuan Hospital; GAO, XIANG - Pennsylvania State University

Submitted to: Nutrition Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/27/2021
Publication Date: 2/1/2021
Citation: Zhang, X., Liu, Y., Li, S., Lichtenstein, A.H., Chen, S., Na, M., Veldheer, S., Xing, A., Wang, Y., Wu, S., Gao, X. 2021. Alcohol consumption and risk of cardiovascular disease, cancer and mortality: a prospective cohort study. Nutrition Journal. 20:13. https://doi.org/10.1186/s12937-021-00671-y.
DOI: https://doi.org/10.1186/s12937-021-00671-y

Interpretive Summary: The relation between light to moderate alcohol intake and cardiovascular disease (CVD), cancer, and mortality risk have been mixed, and most of the data have come from cohorts with Western dietary and lifestyle behaviors. To further address these relations, we assessed potential associations in a cohort of Chinese adults (N=83,732) who were free of CVD and cancer at baseline. Participants were categorized into four groups based on their self-reported alcohol intake and studied over a 10-year period. Consistent with prior observations, there was a J-shaped relation between alcohol intake and risk of CVD, cancer, and mortality. The lowest risk was for those in the light and moderate alcohol consumer groups. The conclusions did not change after the data were adjusted for age, sex, lifestyle, social economic status, and medication use. As with all observational studies, residual confounding or reverse causality could not be ruled out. These data indicate that in Chinese adults living in China light to moderate alcohol consumption was associated with lower risk of CVD, cancer and mortality than consuming no alcohol or higher amounts.

Technical Abstract: Background: Studies regarding whether light to moderate alcohol consumption is associated with a lower risk of cardiovascular diseases (CVD) have generated mixed results. Further, few studies have examined the potential impact of alcohol consumption on diverse disease outcomes simultaneously. We aimed to prospectively study the dose-response association between alcohol consumption and risk of CVD, cancer, and mortality. Methods: This study included 83,732 adult Chinese participants, free of CVD and cancer at baseline. Participants were categorized into 6 groups based on self-report alcohol consumption: 0, 1-25, 26-150, 151-350, 351-750, and > 750 g alcohol/wk. Incident cases of CVD, cancers, and mortality were confirmed by medical records. Hazard ratios (HRs) for the composite risk of these three outcomes, and each individual outcome, were calculated using Cox proportional hazard model. Results: During a median follow-up of 10.0 years, there were 6411 incident cases of CVD, 2947 cancers and 6646 deaths. We observed a J-shaped relation between alcohol intake and risk of CVD, cancer, and mortality, with the lowest risk at 25 g/wk., which is equivalent to ~ 2 servings/wk. Compared to consuming 1-25 g/wk., the adjusted HR for composite outcomes was 1.38 (95% confidence interval (CI):1.29-1.49) for non-drinker, 1.15 (95% CI: 1.04-1.27) for 26-150 g/wk., 1.22 (95% CI: 1.10-1.34) for 151-350 g/wk., 1.33 (95% CI: 1.21-1.46) for 351-750 g/wk., and 1.57 (95% CI: 1.30-1.90) for > 750 g/wk., after adjusting for age, sex, lifestyle, social economic status, and medication use. Conclusions: Light alcohol consumption at ~ 25 g/wk was associated with lower risk of CVD, cancer, and mortality than none or higher consumption in Chinese adults.