All cause mortality and the case for age specific alcohol consumption guidelines(bmj.com)
bmj.com
All cause mortality and the case for age specific alcohol consumption guidelines
http://www.bmj.com/content/350/bmj.h384
11 comments
"In summary, the study is grossly underpowered to convincingly prove a plausible protection, and they have committed the cardinal sin of saying that non-significance is the same as 'no effect' in a study lacking sufficient events, in this case, deaths in non-drinkers. Maybe epidemiological studies should include power calculations, which make sure there is a reasonable chance of detecting a plausible effect, and which became standard in clinical trials after too-small studies were being used to claim that drugs did not work."
http://understandinguncertainty.org/misleading-conclusions-a...
http://understandinguncertainty.org/misleading-conclusions-a...
Looking through this study it becomes clear that any positive effects of alcohol consumption is probably based on wishful thinking rather than statistical evidence.
They do mention one important point: most studies consider non-drinkers a homogenous group. In this study, they show that a lot of the seemingly positive effect evaporates when former drinkers are removed from the study. I wonder what would happen if they also removed people from the study who don't drink alcohol because of health reasons.
They do mention one important point: most studies consider non-drinkers a homogenous group. In this study, they show that a lot of the seemingly positive effect evaporates when former drinkers are removed from the study. I wonder what would happen if they also removed people from the study who don't drink alcohol because of health reasons.
More like "the number of lifetime teetotalers they could find was so small that there was insufficient data to measure an effect"
I'd be interested in reading a study of drinking patterns beyond simple measurement of total consumption.
Every study I read measures volume over a time such number of units per week. But there is a difference between downing a bottle of wine in one hour every saturday night as opposed to a single glass every night. Perhaps a study based on peak blood alcohol level during the week rather than total consumption?
The OP study seems to have dealt with older people. Retirees, without jobs, might have many 'average' days resulting in a steady daily drinking pattern. Most of the younger drinkers I know go for extended periods without drinking (weekdays) only to get hammered come the weekend. Is this worse? Maybe multi-day dry periods give your system a rest and that is better than a daily pattern? I don't know.
It's all moot to me. I don't drink, which for a non-muslim non-mormon canadian means people often think I'm a recovering alcoholic. I'm not. I just don't like drinking. It;s not fun.
Every study I read measures volume over a time such number of units per week. But there is a difference between downing a bottle of wine in one hour every saturday night as opposed to a single glass every night. Perhaps a study based on peak blood alcohol level during the week rather than total consumption?
The OP study seems to have dealt with older people. Retirees, without jobs, might have many 'average' days resulting in a steady daily drinking pattern. Most of the younger drinkers I know go for extended periods without drinking (weekdays) only to get hammered come the weekend. Is this worse? Maybe multi-day dry periods give your system a rest and that is better than a daily pattern? I don't know.
It's all moot to me. I don't drink, which for a non-muslim non-mormon canadian means people often think I'm a recovering alcoholic. I'm not. I just don't like drinking. It;s not fun.
These total-factor mortality studies tend to be over large populations and long time-periods, so it's difficult to administer a test protocol like "check their blood alcohol many times a week and find a peak."
It seems almost certain that intensity of drinking has some effect on total-factor mortality, if only because if you get blind drunk you're more prone to accident than someone who drinks only to being buzzed or less.
It seems almost certain that intensity of drinking has some effect on total-factor mortality, if only because if you get blind drunk you're more prone to accident than someone who drinks only to being buzzed or less.
That's why I am so interested. I could see how getting blind drunk once a week might actually reduce total mortality. Perhaps those who get blind drunk only occasionally under planned conditions have fewer accidents than those who drink regularly and therefore spend more time under the influence.
I agree that a measurement protocol would be difficult. But the OP was based on self-reporting. They could ask "Have you, in the last week, ever been above the legal driving limit?" or "What is the most you consumed in a single sitting this week?"
I agree that a measurement protocol would be difficult. But the OP was based on self-reporting. They could ask "Have you, in the last week, ever been above the legal driving limit?" or "What is the most you consumed in a single sitting this week?"
"I just don't like drinking. It;s not fun."
I'm in my early twenties and people who find out about my non-drinking tend to suggest (surprisingly often) that I should start/try some. With me being an introvert, they seem to think it would help me "loosen up". I'm not very keen on that idea. I'm quite happy being my sober self.
I'm in my early twenties and people who find out about my non-drinking tend to suggest (surprisingly often) that I should start/try some. With me being an introvert, they seem to think it would help me "loosen up". I'm not very keen on that idea. I'm quite happy being my sober self.
Good for you. Stay that way. Many years ago, I was in my early twenties and being a non-drinker served me well. I have various other regrets about life, but not drinking as a young adult was, in retrospect, a wise choice--the opposite of a regret. You won't regret being your "sober self".
So 20 units per week is about 0.5L of scotch. I drink about that much, or even a bit less, and most people think i am a drinker. Is that level of consumption actually safe?
This isn't medical advice: UK recommended limits are 3 to 4 units per day, with some days alcohol free and don't save the units up.
You're drinking towards the upper range of that, but still described as "reduced risk" drinking. "Increased risk" drinking is between 3 to 4 units per day (so around 28 units a week) and 50 units a week. Over that and you're at "high risk" drinking. http://www.nhs.uk/conditions/Alcohol-misuse/Pages/Introducti...
You might want to make sure you have a couple of alcohol free days spread out in the week. You might want to make sure you're not regularly drinking more than that half liter of whiskey each week.
The NHS has a huge amount of information: http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx
You're drinking towards the upper range of that, but still described as "reduced risk" drinking. "Increased risk" drinking is between 3 to 4 units per day (so around 28 units a week) and 50 units a week. Over that and you're at "high risk" drinking. http://www.nhs.uk/conditions/Alcohol-misuse/Pages/Introducti...
You might want to make sure you have a couple of alcohol free days spread out in the week. You might want to make sure you're not regularly drinking more than that half liter of whiskey each week.
The NHS has a huge amount of information: http://www.nhs.uk/Livewell/alcohol/Pages/Alcoholhome.aspx
"Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week"
I started to question the study a when I saw self reported.
I would really like to get to the bottom of this is # of drinks a day and health. What is the true number of drinks/day that cause damage? I vaguely remember Checholvakia study that made the partipiciants bring back the cork, so the researchers knew they drank the alcohol, and didn't sell the bottles. But even then--they could have poured out the liquor? I gave a weird feeling no drinks/day is best? I should be dead--yes--antidotal.
I started to question the study a when I saw self reported.
I would really like to get to the bottom of this is # of drinks a day and health. What is the true number of drinks/day that cause damage? I vaguely remember Checholvakia study that made the partipiciants bring back the cork, so the researchers knew they drank the alcohol, and didn't sell the bottles. But even then--they could have poured out the liquor? I gave a weird feeling no drinks/day is best? I should be dead--yes--antidotal.
Direct healthcare costs estimated to account for £3.5bn by 2011-12 ($4.1bn; €3.6bn) of annual National Health Service expenditure in England.
Meanwhile :
Health problems associated with being overweight or obese cost the NHS more than £5 billion every year. [1]
[1] https://www.gov.uk/government/policies/reducing-obesity-and-...
Meanwhile :
Health problems associated with being overweight or obese cost the NHS more than £5 billion every year. [1]
[1] https://www.gov.uk/government/policies/reducing-obesity-and-...
I suspect that alcohol consumption is a significant contributor to obesity.
A little off topic, but their site makes it really hard to figure out what BMJ stands for. I clicked around until I saw a picture of an old medical journal with "British Medical Journal" on the spine. On the ten or so pages I tried, that phrase never appears.
I think its a pseudo-acronym, like BP and KFC, where the mission extends the original goal so that it becomes rebranded without standing for the original name anymore.
I doubt you will find the original name of the other two on their sites either. If there is one thing that motivates marketers, its expunging an obsoleted brand from history...
I doubt you will find the original name of the other two on their sites either. If there is one thing that motivates marketers, its expunging an obsoleted brand from history...
Basically, though, it's at the point of debating positive effects (if any) of drinking alcohol. Because there is no evidence of a negative effect.
For most Americans, I believe this concept: that drinking probably is not bad for you, would be considered pretty radical.
For most Americans, I believe this concept: that drinking probably is not bad for you, would be considered pretty radical.
What? It's radical because it's not true. Every large-sample longitudinal study into alcohol consumption has found an inverse correlation with mortality. Ignoring all questions about liver and cardio risks or benefits, alcohol is carcinogenic in a dose-dependent way.
http://www.medscape.com/viewarticle/824237
So the TLDR is if youre >= 65, decrease alcohol consumption.
If you're <65 optimal range is 15-20 units per week, better if it's even consumption per day.
"One unit of alcohol is about equal to: half a pint of ordinary strength beer, lager or cider (3-4% alcohol by volume); or. a small pub measure (25 ml) of spirits (40% alcohol by volume); or. a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume)"[1]
So in short: have 2 weak pints of beer xor 1 strong pint of beer xor 150ml of 13% wine.
Can someone confirm,refute this understanding of the text.
[1]:http://www.patient.co.uk/health/Recommended-Safe-Limits-of-A...
"One unit of alcohol is about equal to: half a pint of ordinary strength beer, lager or cider (3-4% alcohol by volume); or. a small pub measure (25 ml) of spirits (40% alcohol by volume); or. a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume)"[1]
So in short: have 2 weak pints of beer xor 1 strong pint of beer xor 150ml of 13% wine.
Can someone confirm,refute this understanding of the text.
[1]:http://www.patient.co.uk/health/Recommended-Safe-Limits-of-A...
The study is suggesting that the heretofore observed beneficial effects of moderate alcohol consumption (the "J" curve wherein there appears to be a "sweet spot" for health benefits at moderate consumption levels) may be greatly exaggerated thanks to selection bias and failure to account for confounders in prior studies.
That is, the benefits of any alcohol consumption may be greatly exaggerated (if not completely nonexistent) for most of the population.
The BMJ has an editorial on this topic[0] which is entitled "Alcohol’s evaporating health benefits" and refers to this study (I figured people on HN would be more interested in the study itself). That editorial heavily implies that the prior (potentially flawed) studies received widespread notoriety due to the alcohol industry's media influence.
[0] http://www.bmj.com/content/350/bmj.h407
That is, the benefits of any alcohol consumption may be greatly exaggerated (if not completely nonexistent) for most of the population.
The BMJ has an editorial on this topic[0] which is entitled "Alcohol’s evaporating health benefits" and refers to this study (I figured people on HN would be more interested in the study itself). That editorial heavily implies that the prior (potentially flawed) studies received widespread notoriety due to the alcohol industry's media influence.
[0] http://www.bmj.com/content/350/bmj.h407
why would the bmj take such a strong stance when they simply don't have the evidence to back it up? the linked study does not show that moderate consumption is harmful or demonstrate that previous results are exaggerated...
Did you read the article? The whole point seems to be the opposite of this. There was some small benefit to drinking alcohol to women over 65, none in other groups.
Not none
"Among younger men, the range of protective effects was minimal, with a significant reduction in hazards present only among those who reported consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to 0.87)"
A hazard ratio of 0.49 means your chance of dying is halved. That seems like a very significant benefit to me. As a comparison in this study the hazard ratio for all-cause mortality for engaging in a very high volume of exercise is 0.65 http://www.hivdent.org/_nutrition_/2011/PIIS0140673611607496...
(the 95% confidence interval for the exercise study is much narrower though)
"Among younger men, the range of protective effects was minimal, with a significant reduction in hazards present only among those who reported consuming 15.1-20.0 units/average week (hazard ratio 0.49, 95% confidence interval 0.26 to 0.91) or 0.1-1.5 units on the heaviest day (0.43, 0.21 to 0.87)"
A hazard ratio of 0.49 means your chance of dying is halved. That seems like a very significant benefit to me. As a comparison in this study the hazard ratio for all-cause mortality for engaging in a very high volume of exercise is 0.65 http://www.hivdent.org/_nutrition_/2011/PIIS0140673611607496...
(the 95% confidence interval for the exercise study is much narrower though)
I did, hence my ability to quote very specific stats from it. I will admit that 1) my article reading skills are not strong and 2) I was hurried this morning.
I'm sorry, but this is one research result I won't drink to.
~~ What is already known on this topic ~~
- It is unclear from existing evidence whether the protective effect of moderate alcohol consumption is both real and applicable to older populations
~~ What this study adds ~~
- When compared with self reported never drinkers, protective associations were largely limited to women drinkers aged 65 years or more
- Little to no protection was present in other age-sex groups
*
I'm not a woman over 65, and I doubt the majority of people on HN are either. The study is still useful, though, since it indicates what not to do for health promotion! Drink alcohol.
Edit: not much markdown works... boo.