Monday, 29 August 2022 12:46

No alcohol is not always the solution – health benefits of moderate consumption for adults over the age of 40

The 2022 Global Burden of Disease (GBD) study (1) is a meta-analysis and modelling study, where 22 alcohol-related health risks in 204 countries were examined. Unlike the study results released in 2018, the alcohol-related health risks in every country were taken into account this time. The results show that the risks from the consumption of alcoholic beverages vary greatly depending on the disease, age, and region. The study confirms a J-shaped risk association between heart attack and stroke mortality – the main causes of death in the industrialised world – and the consumption of alcoholic beverages. The lowest risk was at 1-2 drinks/day for ischemic stroke and 3-4 drinks/day for the ischemic heart attack. 1 drink is the equivalent of 10 g of alcohol.

Globally and averaged for all regions of the world, all age groups and both men and women, the theoretical lowest risk for alcohol-related diseases is 0.5 drinks/day, however, at 1.5 drinks, the risk would be the same as with abstinence.

However, such “global“ calculations do not consider the cultural differences, lifestyle factors, drinking pattern, type of alcoholic beverage, the exactness of consumption levels and many other influencing factors;  these numbers can therefore not be applied to anyone.

The new GBD study demonstrates abundantly clear that the results depend considerably on the respective calculation methods, estimates and assumptions that were used. But the new modelling calculations confirm the previous data that young people do not have measurable health benefits from alcohol consumption; these benefits only show up from the age of 45 and older, when the age-related health risks start to increase.

According to the current calculations, a 45-year-old woman in Western Europe in the year 2020, for example, would have the lowest theoretical risk for an alcohol-related health problem with half a drink daily. However, she could also have one drink daily without having a higher risk than non-drinkers. In men of the same age, the respective lowest risk would also be at 0.5 drinks daily but with 1.4 drinks their risk would not be higher than an abstinent individual.

In contrast, the lowest risk of a 70-year-old woman would be at 0.7 drinks per day but with 4.2 drinks, she would have the same risk as a non-drinker in her age group. For a 70-year-old man, the respective number would be 0.7 drinks and up to 4.3 drinks per day.

Thus, study results show that a moderate consumption of alcoholic beverages for individuals above 40 years of age can provide health benefits, such as a lower risk of cardiovascular diseases and diabetes. The influence of alcohol on health is described by a J-shaped curve. Based on their results, the authors recommend drinking guidelines varying according to age and location.


GBD scientists correct their own data

The new Lancet publication (1) and the respective press release made the headlines. The reason was the quote of one of the authors: Dr. Emmanuela Gakidou (professor, Health Metrics Sciences at the Medical Faculty of the University of Washington): “Our message is simple: young people should not drink, but older people may benefit from drinking small amounts”. The same scientists contradict/correct their own data from the publication of 2018 (2), where the existence of a J-curve was denied and consequently, no safe level of alcohol existed.


Limitations of the study:

Already in 2018, the authors presented the limitations of their study:

  1. Estimation of sales data:

The actual alcohol consumption was not measured or received through questionnaires; it was estimated from sales data (illicit production/unrecorded consumption). This lack of raw data was corrected with comprehensive modelling of the data (alcohol consumption of tourists, stored alcohol which wasn’t consumed, etc.). 

  1. Drinking pattern, cultural context, eating pattern and lifestyle factors were not considered:

Drinking pattern were not considered. The study assumes that all individuals drink the same way (no differentiation between binge drinking and moderate regular consumption with the meals).

  1. No differentiation between alcoholic beverages:

The different health effect of distilled and fermented beverages because of the non-alcoholic compounds – polyphenols has not been considered.

  1. Data regarding alcohol-related accidents is restricted to the US.
  2. Lack of robust data about alcohol-related violence
  3. Lack of data of the age group < 15 years
  4. "End points" according to the “comparative risk assessment approach“ of the GBD study:

The 22 alcohol-related health risks are no medical end points (such as death, heart attack, stroke, diabetes complications), but associations. It is not possible to set these against each other.

  1. Relative vs. absolute risk:

To assess the health risk or impact, the absolute risk is necessary and not the relative risk. Relative risk is only suitable to compare the risk of non-drinkers and drinkers WITHIN an age group but not BETWEEN age groups.



(1) GBD 2020 Collaborators, Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020, Lancet 2022,

 For more information about this abstract, click here.

(2) GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7. Epub 2018 Nov 8. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. PMID: 30496104; PMCID: PMC6227754.




(**) Definitions:

DALY (disability adjusted life years): lost years due to disability and death

NDE (non-drinker equivalent): measures the level of alcohol consumption at which the risk of health loss for a drinker is equivalent to that of a non-drinker; this NDE is considered as safe level of drinking.

TMREL (theoretical minimum exposure level) – lowest level of the curve, where the risk is the lowest.

Standard drink: 10g alcohol/day



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