Derivation of tolerable upper alcohol intake levels in Germany: a systematic review of risks and benefits of moderate alcohol consumption

Introduction: Although considerable research describes the cardiovascular effects of habitual moderate and heavy alcohol consumption, the acute risks following alcohol intake have not been well characterized. Based on its physiological effects, alcohol may have markedly different effects on acute and long-term risk. We assessed the hypothesis that moderate alcohol consumption is associated with an immediately higher risk of cardiovascular events that becomes protective after 24 hours, whereas heavy alcohol drinking is associated with higher cardiovascular risk both immediately and in the following days. Methods: We searched CINAHL, Embase, PubMed and PsycINFO from inception to March 12 2015, supplemented with manual screening for observational studies assessing the association between alcohol intake and cardiovascular events in the following hours and days. We calculated pooled relative risks (RRs) and 95% confidence intervals (CIs) for the association between alcohol intake and myocardial infarction (MI), ischemic stroke (IS) and hemorrhagic stroke (HS) using DerSimonian and Laird random-effects models to model any alcohol intake or dose-response relationships of alcohol intake and cardiovascular events. Results: Among 1056 citations and 37 full-text articles reviewed, 23 studies (29457 participants) were included. Moderate alcohol consumption was associated with an acutely higher cardiovascular risk that was attenuated after 24 hours and even protective for MI and HS (≈2-4 drinks: RR=30% lower risk), and protective against IS within one week (≈6 drinks: RR=19% lower risk). In contrast, heavy alcohol drinking was associated with higher cardiovascular risk in the following day (≈6-9 drinks: RR=1.3-2.3) and week (≈19-30 drinks: RR=2.25-6.2). Conclusions: In conclusion, there appears to be a consistent finding of an acutely higher cardiovascular risk following any alcohol consumption but by 24 hours, only heavy alcohol intake conferred continued risk.

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Abstract P149: The Effect of Alcohol Consumption on Insulin Sensitivity and Glycemic Status: A Systematic Review and Meta-analysis of Intervention Studies

Circulation ◽

10.1161/circ.129.suppl_1.p149 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Ilse C Schrieks ◽

Annelijn L Heil ◽

Henk F Hendriks ◽

Kenneth J Mukamal ◽

Joline W Beulens

Keyword(s):

Systematic Review ◽

Insulin Sensitivity ◽

Alcohol Consumption ◽

Intervention Studies ◽

Meta Analysis ◽

Moderate Alcohol Consumption ◽

Fasting Insulin ◽

Glycemic Status ◽

Reduced Risk

Introduction: Moderate alcohol consumption is associated with a reduced risk of type 2 diabetes, but this relation appears stronger for women than men. The reduced risk of diabetes could be explained by improved insulin sensitivity or glycemic status, but results of intervention studies on this relation are inconsistent. Our aim was to conduct a systematic review and meta-analysis of intervention studies investigating the effect of alcohol consumption on insulin sensitivity and glycemic status. Design: Systematic review and meta-analysis of intervention studies. Data sources: PubMed and Embase were searched until May 2013 using a pre-specified search string. Methods: Intervention studies on the effect of more than 2 weeks alcohol consumption on biological markers of insulin sensitivity or glycemic status were identified and assessed on their quality. Pooled standardized mean differences (SMD) were calculated using either fixed or random effects models. Gender-stratified analyses and sensitivity analyses excluding studies with high doses of alcohol (> 40 g/day). In a meta-regression the influence of dosage and duration of intervention was tested. Results: We included 14 intervention studies in a meta-analysis on 6 glycemic endpoints. Alcohol consumption did not influence insulin sensitivity (SMD=0.06 [-0.13 to 0.26]) or fasting glucose (SMD=0.09 [-0.09 to 0.27]). Alcohol consumption reduced HbA1c (SMD=-0.62 [-1.01 to -0.23], P=0.002) and insulin concentrations (SMD=-0.17 [-0.34 to 0.00] P=0.049) compared with the control group. In women, alcohol consumption reduced fasting insulin (SMD=-0.23 [-0.41 to -0.04], P=0.019) and improved insulin sensitivity (SMD=0.19 [-0.03 to 0.41], P=0.087), but no significant differences were observed among men. Results were similar when only studies with moderate alcohol dosages were analysed and were not influenced by dosage and duration of the intervention. Conclusions: This study showed that moderate alcohol consumption may reduce fasting insulin and improve insulin sensitivity among women, but not among men. These effects may provide an explanation for the relation between alcohol consumption and type 2 diabetes. Furthermore, moderate alcohol consumption may reduce HbA1c levels among both men and women.

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OWE-33 Can moderate alcohol consumption decrease pancreatic ductal adenocarcinoma (PDAC) risk? a systematic review and meta-analysis

10.1136/gutjnl-2019-bsgabstracts.293 ◽

2019 ◽

Author(s):

Thomas Payne ◽

Stephen Lam ◽

Andrew Hart

Keyword(s):

Systematic Review ◽

Alcohol Consumption ◽

Pancreatic Ductal Adenocarcinoma ◽

Meta Analysis ◽

Ductal Adenocarcinoma ◽

Moderate Alcohol Consumption

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The Effects of Alcohol Consumption on Cardiometabolic Health Outcomes Following Weight Loss in Premenopausal Women with Obesity: A Pilot Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155302 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5302

Author(s):

John W. Apolzan ◽

Robbie A. Beyl ◽

Corby K. Martin ◽

Frank L. Greenway ◽

Ursula White

Keyword(s):

Weight Loss ◽

Alcohol Consumption ◽

Alcohol Intake ◽

Controlled Trial ◽

Pilot Trial ◽

Metabolic Effects ◽

Cardiometabolic Health ◽

Moderate Alcohol Consumption ◽

Randomized Controlled ◽

Metabolic Outcomes

Alcohol (i.e., ethanol) is consumed regularly by much of the adult population; yet, the health effects associated with its use are not well-characterized. Clinical interventions to investigate the effects of moderate alcohol consumption on metabolic outcomes, including adiposity and cardiovascular risk factors, are limited and have yielded conflicting data. In addition, no study has reported the effects of routine alcohol intake during weight loss in a controlled feeding trial. We present the first randomized controlled pilot trial to investigate the effects of moderate alcohol consumption on metabolic outcomes during weight loss in women with obesity. Both groups consumed 30% energy restricted diets and were randomized to either an ethanol-free control (CTL) group or a group (EtOH) that consumed 35 g ethanol daily for eight weeks. Our findings demonstrate that, despite similar weight loss, the decrease in mean arterial pressure was attenuated in the EtOH group, relative to the CTL group (p = 0.02). In addition, decreases in other outcomes, including visceral adipose tissue (p = 0.23), circulating lipids (triglycerides (p = 0.11) and cholesterol (p = 0.11)), and uric acid (p = 0.07) tended to be attenuated with alcohol consumption. These pilot data provide potential evidence that moderate alcohol consumption may mitigate the beneficial effects of weight loss and support the need for larger Randomized Controlled Trials (RCTs) to better investigate the metabolic effects of moderate alcohol intake in humans.

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The Effect of Alcohol Consumption on Insulin Sensitivity and Glycemic Status: A Systematic Review and Meta-analysis of Intervention Studies

Diabetes Care ◽

10.2337/dc14-1556 ◽

2015 ◽

Vol 38 (4) ◽

pp. 723-732

Author(s):

Ilse C. Schrieks ◽

Annelijn L.J. Heil ◽

Henk F.J. Hendriks ◽

Kenneth J. Mukamal ◽

Joline W.J. Beulens

Keyword(s):

Systematic Review ◽

Insulin Sensitivity ◽

Alcohol Consumption ◽

Intervention Studies ◽

Meta Analysis ◽

Moderate Alcohol Consumption ◽

Fasting Insulin ◽

Improve Insulin Sensitivity ◽

Glycemic Status ◽

Reduced Risk

OBJECTIVE Moderate alcohol consumption is associated with a reduced risk of type 2 diabetes. This reduced risk might be explained by improved insulin sensitivity or improved glycemic status, but results of intervention studies on this relation are inconsistent. The purpose of this study was to conduct a systematic review and meta-analysis of intervention studies investigating the effect of alcohol consumption on insulin sensitivity and glycemic status. RESEARCH DESIGN AND METHODS PubMed and Embase were searched up to August 2014. Intervention studies on the effect of alcohol consumption on biological markers of insulin sensitivity or glycemic status of at least 2 weeks' duration were included. Investigators extracted data on study characteristics, outcome measures, and methodological quality. RESULTS Fourteen intervention studies were included in a meta-analysis of six glycemic end points. Alcohol consumption did not influence estimated insulin sensitivity (standardized mean difference [SMD] 0.08 [−0.09 to 0.24]) or fasting glucose (SMD 0.07 [−0.11 to 0.24]) but reduced HbA1c (SMD −0.62 [−1.01 to −0.23]) and fasting insulin concentrations (SMD −0.19 [−0.35 to −0.02]) compared with the control condition. Alcohol consumption among women reduced fasting insulin (SMD −0.23 [−0.41 to −0.04]) and tended to improve insulin sensitivity (SMD 0.16 [−0.04 to 0.37]) but not among men. Results were similar after excluding studies with high alcohol dosages (>40 g/day) and were not influenced by dosage and duration of the intervention. CONCLUSIONS Although the studies had small sample sizes and were of short duration, the current evidence suggests that moderate alcohol consumption may decrease fasting insulin and HbA1c concentrations among nondiabetic subjects. Alcohol consumption might improve insulin sensitivity among women but did not do so overall.

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Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-019490 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019490 ◽

Cited By ~ 5

Author(s):

María del Mar Fernández ◽

Jurgita Saulyte ◽

Hazel M Inskip ◽

Bahi Takkouche

Keyword(s):

Systematic Review ◽

Alcohol Consumption ◽

Premenstrual Syndrome ◽

Alcohol Intake ◽

Meta Analysis ◽

Harmful Effect ◽

Personal Contact ◽

Bibliographic Databases ◽

Moderate Increase ◽

Cross Sectional

ObjectivePremenstrual syndrome (PMS) is a very common disorder worldwide which carries an important economic burden. We conducted a systematic review and a meta-analysis to assess the role of alcohol in the occurrence of PMS.MethodsWe searched MEDLINE, EMBASE, the five regional bibliographic databases of the WHO, the Proceedings database and the Open Access Thesis and Dissertations (OATD) from inception to May 2017. We also reviewed the references of every article retrieved and established personal contact with researchers to trace further publications or reports. We did not include any language limitations. Studies were included if: (1) they presented original data from cohort, case-control or cross-sectional studies, (2) PMS was clearly defined as the outcome of interest, (3) one of the exposure factors was alcohol consumption, (4) they provided estimates of odds ratios, relative risks, or any other effect measure and their confidence intervals, or enough data to calculate them.ResultsWe identified 39 studies of which 19 were eligible. Intake of alcohol was associated with a moderate increase in the risk of PMS (OR=1.45, 95% CI: 1.17 to 1.79). Heavy drinking yielded a larger increase in the risk than any drinking (OR=1.79, 95% CI: 1.39 to 2.32).DiscussionOur results suggest that alcohol intake presents a moderate association with PMS risk. Future studies should avoid cross-sectional designs and focus on determining whether there is a threshold of alcohol intake under which the harmful effect on PMS is non-existent.

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How alcohol consumption influences obesity in middle-aged men: A systematic review

The Journal of Health Design ◽

10.21853/jhd.2021.130 ◽

2021 ◽

Vol 6 (1) ◽

pp. 360-379

Author(s):

Laura Sayers

Keyword(s):

Systematic Review ◽

Alcohol Consumption ◽

Alcohol Intake ◽

Current Practice ◽

Research Study ◽

Overweight And Obesity ◽

Obesity Epidemic ◽

Heavy Drinkers ◽

Total Alcohol ◽

Robust Evidence

Total alcohol intake may influence overweight and obesity in some (particularly heavy) drinkers, but the magnitude of weight gain appears clinically marginal. Robust evidence to support that reducing alcohol consumption may address the obesity epidemic is lacking and warrants further research. Study findings nonetheless favour current practice, encouraging clinicians to recognise and address drinking behaviours as one of many lifestyle factors pertinent to individual weight management.

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Does moderate alcohol consumption accelerate the progression of liver disease in NAFLD? A systematic review and narrative synthesis

BMJ Open ◽

10.1136/bmjopen-2021-049767 ◽

2022 ◽

Vol 12 (1) ◽

pp. e049767

Author(s):

Helen Jarvis ◽

Hannah O'Keefe ◽

Dawn Craig ◽

Daniel Stow ◽

Barbara Hanratty ◽

...

Keyword(s):

Systematic Review ◽

Liver Disease ◽

Alcohol Consumption ◽

Disease Progression ◽

Meta Analysis ◽

Alcohol Exposure ◽

Cochrane Library ◽

Narrative Synthesis ◽

Moderate Alcohol Consumption ◽

Liver Disease Progression

ObjectivesLiver disease is a leading cause of premature death, partly driven by the increasing incidence of non-alcohol-related fatty liver disease (NAFLD). Many people with a diagnosis of NAFLD drink moderate amounts of alcohol. There is limited guidance for clinicians looking to advise these patients on the effect this will have on their liver disease progression. This review synthesises the evidence on moderate alcohol consumption and its potential to predict liver disease progression in people with diagnosed NAFLD.MethodsA systematic review of longitudinal observational cohort studies was conducted. Databases (Medline, Embase, The Cochrane Library and ClinicalTrials.gov) were searched up to September 2020. Studies were included that reported progression of liver disease in adults with NAFLD, looking at moderate levels of alcohol consumption as the exposure of interest. Risk of bias was assessed using the Quality in Prognostic factor Studies tool.ResultsOf 4578 unique citations, 6 met the inclusion criteria. Pooling of data was not possible due to heterogeneity and studies were analysed using narrative synthesis. Evidence suggested that any level of alcohol consumption is associated with worsening of liver outcomes in NAFLD, even for drinking within recommended limits. Well conducted population based studies estimated up to a doubling of incident liver disease outcomes in patients with NAFLD drinking at moderate levels.ConclusionsThis review found that any level of alcohol intake in NAFLD may be harmful to liver health.Study heterogeneity in definitions of alcohol exposure as well as in outcomes limited quantitative pooling of results. Use of standardised definitions for exposure and outcomes would support future meta-analysis.Based on this synthesis of the most up to date longitudinal evidence, clinicians seeing patients with NAFLD should currently advise abstinence from alcohol.PROSPERO registration numberThe protocol was registered with PROSPERO (#CRD42020168022).

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Abstract P043: Alcohol Consumption, Transferrin Saturation and Risk of All-Cause Mortality in The National Health and Nutrition Examination Surveys

Circulation ◽

10.1161/circ.131.suppl_1.p043 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Laurence O James ◽

James N Kiage ◽

Loren Lipworth ◽

Uchechukwu K Sampson ◽

Edmond K Kabagambe

Keyword(s):

Alcohol Consumption ◽

National Health ◽

Alcohol Intake ◽

Iron Status ◽

Transferrin Saturation ◽

Moderate Alcohol Consumption ◽

Health And Nutrition ◽

Heavy Drinkers ◽

All Cause Mortality ◽

Reduced Risk

Background: Moderate alcohol consumers have a reduced risk for cardiovascular and all-cause mortality. Alcohol intake improves iron absorption and also has a profound effect on iron metabolism and thus could in part explain the observed inverse association between moderate alcohol intake and mortality. We sought to investigate whether moderate alcohol confers mortality benefits in part through improvement in iron status. Methods: Publicly available data from two consecutive National Health and Nutrition Examination Survey (NHANES) cycles (1999/2000 and 2001/2002) were obtained and linked to public data on all-cause mortality. Study participants were grouped as never, past, moderate (≤2 drinks/day for men, ≤ 1 drink/day for women) and heavy drinkers (>2 drinks/day for men, >1 drink/day for women). To assess the quality of alcohol data in NHANES, we tested whether self-reported alcohol consumption was associated with biomarkers of alcohol intake (HDL-C and γ-glutamyl transferase (GGT)). Cox-models, weighted using four-year sampling weights, were fitted to determine whether alcohol intake was associated with all-cause mortality. Measures of iron status, particularly serum ferritin, transferrin saturation, hemoglobin and free erythrocyte protoporphyrin were evaluated as potential mediators of the association between alcohol consumption and risk of all-cause mortality. Results: Among 7,532 men and women with complete data, 17% were never drinkers, 20% were past drinkers, 30% were moderate drinkers and 33% were heavy drinkers. We found an increase in HDL-C and GGT with increased alcohol intake, suggesting that self-reported alcohol intake is reliable in this population. In the weighted analysis, the hazard ratio (95% CI) for all-cause mortality among moderate alcohol users compared to never users was 0.56 (0.37-0.85), in models adjusted for age, race, smoking, statin use and history of diabetes, among other variables. Adjustment for transferrin saturation as a measure of iron status attenuated the benefit from moderate alcohol (HR = 0.69; 95% CI: 0.41-1.14), suggesting that moderate alcohol consumption may in part confer a benefit on mortality through improvement in iron status. These results warrant further evaluation in rigorous formal mediation analyses. Conclusions: Moderate alcohol consumption was associated with higher transferrin saturation and with reduced risk of mortality. Adjusting for iron status attenuated the association between moderate alcohol consumption and all-cause mortality suggesting that the effects of moderate alcohol on mortality may in part be via improvement in iron status.

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