Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults

Xi, Bo; Veeranki, Sreenivas P.; Zhao, Min; Ma, Chuanwei; Yan, Yinkun; Mi, Jie

doi:10.1016/j.jacc.2017.06.054

Cited by 354 publications

(241 citation statements)

References 26 publications

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“…Dr. Braillon cites one study on poor performance of hepatic steatosis index (HSI), but even this study reports HSI to have “performed well in terms of discriminative ability for the overall population,” with an area under the receiver operating characteristic curve of 0.83 for diagnosis of NAFLD Categorization of alcohol use in our study is not arbitrary and is consistent with the established literature As explained in the methods section of the study, alcohol use was defined using the average number of drinks per day over a period of 12 months, and the participants did not have to be daily or “continuous” drinkers.…”

supporting

confidence: 62%

Reply:

2020

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supporting

confidence: 62%

Reply:

2020

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“…Studies in the general population have observed lower risks of frailty and death among those who drink alcohol . However, reduced risks of death were not observed among younger individuals who drink alcohol, suggesting that changes in this behavior over time occurring with illness and aging, as well as selection bias, may result in residual confounding in these cohort studies .…”

Section: Discussionmentioning

confidence: 77%

Changes in Alcohol Use and Associations With Disease Activity, Health Status, and Mortality in Rheumatoid Arthritis

Baker

England

Mikuls

et al. 2020

Arthritis Care & Research

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Objective Better disease activity and quality of life have been observed among patients with rheumatoid arthritis (RA) who drink alcohol. This association might be explained by reverse causality. We undertook this study to identify predictors of change in alcohol use and to evaluate independent associations between alcohol use and RA activity and mortality. Methods Participants in Forward, The National Databank for Rheumatic Diseases, were asked about alcohol use (any versus none), and disease activity was collected through the Patient Activity Scale–II (PAS‐II) on semiannual surveys. We identified factors associated with changes in alcohol use and determined associations between alcohol use and disease activity and mortality using linear and logistic regression models, Cox proportional hazards models, and marginal structural models. Results A total of 121,280 observations were studied among 16,762 unique participants. Discontinuation and initiation of alcohol were common among drinkers and abstainers (8.2% and 9.2% of observations, respectively). Greater discontinuation and less initiation were observed with greater disease activity, older age, female sex, nonwhite race, obesity, greater comorbidity, low quality of life, low educational level, low income, and work disability. While alcohol users had lower PAS‐II (β = –0.15 [95% confidence interval (95% CI) –0.18, –0.11], P < 0.001) and a lower mortality (odds ratio 0.87 [95% CI 0.76, 0.98], P = 0.03) in traditional models, associations were not seen in marginal structural models. Conclusion Higher disease activity, disability, comorbidity, and poor quality of life contribute to reductions in alcohol use. Active use and changes in use were not associated with disease activity or mortality when adjusting for confounding, suggesting no clear benefit of alcohol consumption in RA.

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“…In addition, our findings are consistent with previous studies showing a delicate J-shape relationship between alcohol consumption and mortality, where an increase in alcohol intake quickly becomes harmful. (50) Although recommendations regarding health effects of alcohol remain controversial, our results can be useful when counseling the growing population of patients with NAFLD in the United States on the benefits and harms of alcohol.…”

Section: Discussionmentioning

confidence: 91%

Effect of Alcohol Consumption on Survival in Nonalcoholic Fatty Liver Disease: A National Prospective Cohort Study

2018

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Nonalcoholic fatty liver disease (NAFLD) comprises more than two thirds of patients with chronic liver disease in the United States. The effect of alcohol consumption on survival in patients with NAFLD is not clear. We gathered data on National Health and Nutrition Examination Survey participants from 1988 to 2010, and linked them to the National Death Index for follow-up of their survival. We diagnosed NAFLD based on a previously validated biochemical model (Hepatic Steatosis Index). We built multivariate Cox proportional hazards models to evaluate the effect of alcohol consumption on survival of patients with NAFLD. After excluding participants with significant alcohol use, viral hepatitis, or increased transferrin saturation, 4,568 participants with NAFLD were included in the analysis. In a Cox model adjusted for age, sex, and smoking history, drinking 0.5-1.5 drinks per day decreased the risk of overall mortality by 41% (hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.40-0.85, P = 0.005) compared with not drinking. Drinking ≥1.5 drinks per day showed a trend toward harm (HR = 1.16, 95% CI 0.99-1.36, P = 0.119). After further adjustment for race, physical activity, education level, diabetes, and fiber and polyunsaturated fatty acid intake, drinking 0.5-1.5 drinks per day continued to show a significant protective effect (HR = 0.64, 95% CI 0.42-0.97, P = 0.035), and drinking ≥1.5 drinks per day showed a significant harmful effect on mortality (HR = 1.45, 95% CI 1.01-2.10, P = 0.047). Among patients with NAFLD, modest alcohol consumption is associated with a significant decrease in all-cause mortality, whereas drinking ≥1.5 drinks per day is associated with an increase in mortality. These results help to inform the discussion of potential risks and benefits of alcohol use in patients with NAFLD.

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Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults

Abstract: Light and moderate alcohol intake might have a protective effect on all-cause and CVD-specific mortality in U.S. adults. Heavy or binge drinking was associated with increased risk of all-cause and cancer-specific mortality.

Cited by 354 publications

References 26 publications

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Changes in Alcohol Use and Associations With Disease Activity, Health Status, and Mortality in Rheumatoid Arthritis

Effect of Alcohol Consumption on Survival in Nonalcoholic Fatty Liver Disease: A National Prospective Cohort Study

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