Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

doi:10.1016/S0140-6736(18)30134-X

. 2018 Apr 14;391(10129):1513-1523.

doi: 10.1016/S0140-6736(18)30134-X.

Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

Angela M Wood¹, Stephen Kaptoge², Adam S Butterworth², Peter Willeit³, Samantha Warnakula², Thomas Bolton², Ellie Paige⁴, Dirk S Paul², Michael Sweeting², Stephen Burgess⁵, Steven Bell², William Astle², David Stevens², Albert Koulman⁶, Randi M Selmer⁷, W M Monique Verschuren⁸, Shinichi Sato⁹, Inger Njølstad¹⁰, Mark Woodward¹¹, Veikko Salomaa¹², Børge G Nordestgaard¹³, Bu B Yeap¹⁴, Astrid Fletcher¹⁵, Olle Melander¹⁶, Lewis H Kuller¹⁷, Beverley Balkau¹⁸, Michael Marmot¹⁹, Wolfgang Koenig²⁰, Edoardo Casiglia²¹, Cyrus Cooper²², Volker Arndt²³, Oscar H Franco²⁴, Patrik Wennberg²⁵, John Gallacher²⁶, Agustín Gómez de la Cámara²⁷, Henry Völzke²⁸, Christina C Dahm²⁹, Caroline E Dale³⁰, Manuela M Bergmann³¹, Carlos J Crespo³², Yvonne T van der Schouw³³, Rudolf Kaaks²³, Leon A Simons³⁴, Pagona Lagiou³⁵, Josje D Schoufour²⁴, Jolanda M A Boer³⁶, Timothy J Key³⁷, Beatriz Rodriguez³⁸, Conchi Moreno-Iribas³⁹, Karina W Davidson⁴⁰, James O Taylor⁴¹, Carlotta Sacerdote⁴², Robert B Wallace⁴³, J Ramon Quiros⁴⁴, Rosario Tumino⁴⁵, Dan G Blazer 2nd⁴⁶, Allan Linneberg⁴⁷, Makoto Daimon⁴⁸, Salvatore Panico⁴⁹, Barbara Howard⁵⁰, Guri Skeie⁵¹, Timo Strandberg⁵², Elisabete Weiderpass⁵³, Paul J Nietert⁵⁴, Bruce M Psaty⁵⁵, Daan Kromhout⁵⁶, Elena Salamanca-Fernandez⁵⁷, Stefan Kiechl⁵⁸, Harlan M Krumholz⁵⁹, Sara Grioni⁶⁰, Domenico Palli⁶¹, José M Huerta⁶², Jackie Price⁶³, Johan Sundström⁶⁴, Larraitz Arriola⁶⁵, Hisatomi Arima⁶⁶, Ruth C Travis³⁷, Demosthenes B Panagiotakos⁶⁷, Anna Karakatsani⁶⁸, Antonia Trichopoulou⁶⁸, Tilman Kühn²³, Diederick E Grobbee³³, Elizabeth Barrett-Connor⁶⁹, Natasja van Schoor⁷⁰, Heiner Boeing³¹, Kim Overvad⁷¹, Jussi Kauhanen⁷², Nick Wareham⁷³, Claudia Langenberg⁷³, Nita Forouhi⁷³, Maria Wennberg²⁵, Jean-Pierre Després⁷⁴, Mary Cushman⁷⁵, Jackie A Cooper¹⁹, Carlos J Rodriguez⁷⁶, Masaru Sakurai⁷⁷, Jonathan E Shaw⁷⁸, Matthew Knuiman⁷⁹, Trudy Voortman²⁴, Christa Meisinger⁸⁰, Anne Tjønneland⁸¹, Hermann Brenner⁸², Luigi Palmieri⁸³, Jean Dallongeville⁸⁴, Eric J Brunner¹⁹, Gerd Assmann⁸⁵, Maurizio Trevisan⁸⁶, Richard F Gillum⁸⁷, Ian Ford⁸⁸, Naveed Sattar⁸⁸, Mariana Lazo⁸⁹, Simon G Thompson², Pietro Ferrari⁹⁰, David A Leon¹⁵, George Davey Smith⁹¹, Richard Peto³⁷, Rod Jackson⁹², Emily Banks⁴, Emanuele Di Angelantonio², John Danesh⁹³; Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group

Collaborators, Affiliations

Collaborators

Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group:
Angela M Wood, Stephen Kaptoge, Adam Butterworth, Peter Willeit, Samantha Warnakula, Thomas Bolton, Ellie Paige, Dirk S Paul, Michael Sweeting, Stephen Burgess, Steven Bell, William Astle, David Stevens, Albert Koulman, Randi M Selmer, Monique Verschuren, Shinichi Sato, Inger Njølstad, Mark Woodward, Salomaa Veikko, Børge G Nordestgaard, Bu B Yeap, Astrid Flecther, Olle Melander, Lewis H Kuller, Beverley Balkau, Michael Marmot, Wolfgang Koenig, Edoardo Casiglia, Cyrus Cooper, Volker Arndt, Oscar H Franco, Patrik Wennberg, John Gallacher, Agustín Gómez de la Cámara, Henry Völzke, Christina C Dahm, Caroline E Dale, Manuela Bergmann, Carlos Crespo, Yvonne T van der Schouw, Rudolf Kaaks, Leon A Simons, Pagona Lagiou, Josje D Schoufour, Jolanda M A Boer, Timothy J Key, Beatriz Rodriguez, Conchi Moreno-Iribas, Karina W Davidson, James O Taylor, Carlotta Sacerdote, Robert B Wallace, J Ramon Quiros, Eric B Rimm, Rosario Tumino, Dan G Blazer Iii, Allan Linneberg, Makoto Daimon, Salvatore Panico, Barbara Howard, Guri Skeie, Veikko Salomaa, Timo Strandberg, Elisabete Weiderpass, Paul J Nietert, Bruce M Psaty, Daan Kromhout, Elena Salamanca-Fernandez, Stefan Kiechl, Harlan M Krumholz, Sara Grioni, Domenico Palli, José M Huerta, Jackie Price, Johan Sundström, Larraitz Arriola, Hisatomi Arima, Ruth C Travis, Demosthenes B Panagiotakos, Anna Karakatsani, Antonia Trichopoulou, Tilman Kühn, Diederick E Grobbee, Elizabeth Barrett-Connor, Natasja van Schoor, Heiner Boeing, Kim Overvad, Jussi Kauhanen, Nick Wareham, Claudia Langenberg, Nita Forouhi, Maria Wennberg, Jean-Pierre Després, Mary Cushman, Jackie A Cooper, Carlos J Rodriguez, Masaru Sakurai, Jonathan E Shaw, Matthew Knuiman, Trudy Voortman, Christa Meisinger, Anne Tjønneland, Hermann Brenner, Luigi Palmieri, Jean-Pierre Dallongeville, Eric J Brunner, Gerd Assmann, Maurizio Trevisan, Richard F Gillumn, Ian Ford Ford, Naveed Sattar, Mariana Lazo, Simon Thompson, Pietro Ferrari, David A Leon, George Davey Smith, Richard Peto, Rod Jackson, Emily Banks, Emanuele Di Angelantonio, John Danesh

Affiliations

¹ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Electronic address: amw79@medschl.cam.ac.uk.
² Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
³ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Medical University Innsbruck, Innsbruck, Austria.
⁴ National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
⁵ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
⁶ NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK.
⁷ Norwegian Institute of Public Health, Oslo, Norway.
⁸ National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
⁹ Chiba Prefectural Institute of Public Health, Chiba, Japan.
¹⁰ Department of Community Medicine, University of Tromsø, Tromsø, Norway.
¹¹ Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹² THL-National Institute for Health and Welfare, Helsinki, Finland.
¹³ Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁴ School of Medicine, University of Western Australia, Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia.
¹⁵ London School of Hygiene & Tropical Medicine, London, UK.
¹⁶ Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
¹⁷ Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁸ CESP INSERM UMRS 1018, Villejuif Cedex, France.
¹⁹ Department of Epidemiology and Public Health, University College London, London, UK.
²⁰ 92 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; University of Ulm Medical Center, Ulm, Germany.
²¹ Department of Medicine, University of Padua, Padua, Italy.
²² MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
²³ German Cancer Research Center (DKFZ), Heidelberg, Germany.
²⁴ Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
²⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
²⁶ Department of Primary Care and Public Health, Cardiff University, Cardiff, UK.
²⁷ 12 de Octubre Research Institute, CIBERESP, Madrid, Spain.
²⁸ Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
²⁹ Department of Public Health, Aarhus University, Aarhus, Denmark.
³⁰ Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK.
³¹ German Institute of Human Nutrition, Potsdam-Rehbrüke, Germany.
³² School of Community Health, Portland State University, Portland, OR, USA.
³³ Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
³⁴ St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
³⁵ Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece; Harvard TH Chan School of Public Health, Boston, MA, USA.
³⁶ National Institute for Public Health and the Environment, Bilthoven, Netherlands.
³⁷ Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
³⁸ Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA.
³⁹ Instituto de Salud Pública de Navarra, IdiSNA - Navarra Institute for Health Research, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain.
⁴⁰ Columbia University Irving Medical Center, New York, NY, USA.
⁴¹ East Boston Neighborhood Health Center, Boston, MA, USA.
⁴² Città della Salute e della Scienza di Torino Hospital, Turin, Italy.
⁴³ College of Public Health, The University of Iowa, Iowa City, IA, USA.
⁴⁴ Consejería de Sanidad del Principado de Asturias, Oviedo, Asturias, Spain.
⁴⁵ Civic - M. Arezzo Hospital, ASP Ragusa, Italy.
⁴⁶ Duke Divinity School, Duke University, Durham, NC, USA.
⁴⁷ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴⁸ Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁴⁹ Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
⁵⁰ Department of Biology, Tuskegee University, AL, USA.
⁵¹ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁵² University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland.
⁵³ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁵⁴ Medical University of South Carolina, Charleston, SC, USA.
⁵⁵ Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
⁵⁶ Department of Agrotechnology and Food Sciences, University of Wageningen, Wageningen, Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands.
⁵⁷ Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁵⁸ Medical University Innsbruck, Innsbruck, Austria.
⁵⁹ School of Medicine, Yale University, New Haven, CT, USA.
⁶⁰ Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁶¹ Cancer Research and Prevention Institute (ISPO), Florence, Italy.
⁶² CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
⁶³ Usher Institute, University of Edinburgh, Edinburgh, UK.
⁶⁴ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁶⁵ CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto BIO-Donostia, Basque Government, San Sebastian, Spain.
⁶⁶ The University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Preventive Medicine and Public Health, Kyushu University, Fukuoka, Japan.
⁶⁷ School of Health Science and Education, Harokopio University, Athens, Greece.
⁶⁸ Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece.
⁶⁹ Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
⁷⁰ EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
⁷¹ Department of Public Health, Aarhus University, Aarhus, Denmark; Aalborg University Hospital, Aalborg, Denmark.
⁷² Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
⁷³ Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
⁷⁴ Department of Kinesiology, Laval University, Quebec City, QC, Canada.
⁷⁵ Department of Medicine, University of Vermont, Burlington, VT, USA.
⁷⁶ Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
⁷⁷ Department of Social and Environmental Medicine, Kanazawa Medical University, Ishikawa, Japan.
⁷⁸ Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
⁷⁹ Busselton Population Medical Research Institute, Busselton, WA, Australia; School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
⁸⁰ Helmholtz Zentrum München German Research Center for Environmental Health, Germany.
⁸¹ Danish Cancer Society Research Center, Copenhagen, Denmark.
⁸² German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, University of Heidelberg, Heidelberg, Germany.
⁸³ Istituto Superiore di Sanità, Rome, Italy.
⁸⁴ Institut Pasteur de Lille, Lille, France.
⁸⁵ Assmann-Stiftung für Prävention, Münster, Germany.
⁸⁶ The City College of New York, New York, NY, USA.
⁸⁷ Howard University Hospital, Washington DC, USA.
⁸⁸ Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
⁸⁹ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁹⁰ International Agency for Research on Cancer, Lyon, France.
⁹¹ MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.
⁹² School of Population Health, The University of Auckland, Auckland, New Zealand.
⁹³ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Electronic address: jd292@medschl.cam.ac.uk.

PMID: 29676281
PMCID: PMC5899998
DOI: 10.1016/S0140-6736(18)30134-X

Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

Angela M Wood et al. Lancet. 2018.

. 2018 Apr 14;391(10129):1513-1523.

doi: 10.1016/S0140-6736(18)30134-X.

Authors

Collaborators

Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group:
Angela M Wood, Stephen Kaptoge, Adam Butterworth, Peter Willeit, Samantha Warnakula, Thomas Bolton, Ellie Paige, Dirk S Paul, Michael Sweeting, Stephen Burgess, Steven Bell, William Astle, David Stevens, Albert Koulman, Randi M Selmer, Monique Verschuren, Shinichi Sato, Inger Njølstad, Mark Woodward, Salomaa Veikko, Børge G Nordestgaard, Bu B Yeap, Astrid Flecther, Olle Melander, Lewis H Kuller, Beverley Balkau, Michael Marmot, Wolfgang Koenig, Edoardo Casiglia, Cyrus Cooper, Volker Arndt, Oscar H Franco, Patrik Wennberg, John Gallacher, Agustín Gómez de la Cámara, Henry Völzke, Christina C Dahm, Caroline E Dale, Manuela Bergmann, Carlos Crespo, Yvonne T van der Schouw, Rudolf Kaaks, Leon A Simons, Pagona Lagiou, Josje D Schoufour, Jolanda M A Boer, Timothy J Key, Beatriz Rodriguez, Conchi Moreno-Iribas, Karina W Davidson, James O Taylor, Carlotta Sacerdote, Robert B Wallace, J Ramon Quiros, Eric B Rimm, Rosario Tumino, Dan G Blazer Iii, Allan Linneberg, Makoto Daimon, Salvatore Panico, Barbara Howard, Guri Skeie, Veikko Salomaa, Timo Strandberg, Elisabete Weiderpass, Paul J Nietert, Bruce M Psaty, Daan Kromhout, Elena Salamanca-Fernandez, Stefan Kiechl, Harlan M Krumholz, Sara Grioni, Domenico Palli, José M Huerta, Jackie Price, Johan Sundström, Larraitz Arriola, Hisatomi Arima, Ruth C Travis, Demosthenes B Panagiotakos, Anna Karakatsani, Antonia Trichopoulou, Tilman Kühn, Diederick E Grobbee, Elizabeth Barrett-Connor, Natasja van Schoor, Heiner Boeing, Kim Overvad, Jussi Kauhanen, Nick Wareham, Claudia Langenberg, Nita Forouhi, Maria Wennberg, Jean-Pierre Després, Mary Cushman, Jackie A Cooper, Carlos J Rodriguez, Masaru Sakurai, Jonathan E Shaw, Matthew Knuiman, Trudy Voortman, Christa Meisinger, Anne Tjønneland, Hermann Brenner, Luigi Palmieri, Jean-Pierre Dallongeville, Eric J Brunner, Gerd Assmann, Maurizio Trevisan, Richard F Gillumn, Ian Ford Ford, Naveed Sattar, Mariana Lazo, Simon Thompson, Pietro Ferrari, David A Leon, George Davey Smith, Richard Peto, Rod Jackson, Emily Banks, Emanuele Di Angelantonio, John Danesh

Affiliations

¹ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Electronic address: amw79@medschl.cam.ac.uk.
² Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
³ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Medical University Innsbruck, Innsbruck, Austria.
⁴ National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
⁵ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
⁶ NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK.
⁷ Norwegian Institute of Public Health, Oslo, Norway.
⁸ National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
⁹ Chiba Prefectural Institute of Public Health, Chiba, Japan.
¹⁰ Department of Community Medicine, University of Tromsø, Tromsø, Norway.
¹¹ Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹² THL-National Institute for Health and Welfare, Helsinki, Finland.
¹³ Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁴ School of Medicine, University of Western Australia, Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia.
¹⁵ London School of Hygiene & Tropical Medicine, London, UK.
¹⁶ Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
¹⁷ Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁸ CESP INSERM UMRS 1018, Villejuif Cedex, France.
¹⁹ Department of Epidemiology and Public Health, University College London, London, UK.
²⁰ 92 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; University of Ulm Medical Center, Ulm, Germany.
²¹ Department of Medicine, University of Padua, Padua, Italy.
²² MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
²³ German Cancer Research Center (DKFZ), Heidelberg, Germany.
²⁴ Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
²⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
²⁶ Department of Primary Care and Public Health, Cardiff University, Cardiff, UK.
²⁷ 12 de Octubre Research Institute, CIBERESP, Madrid, Spain.
²⁸ Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
²⁹ Department of Public Health, Aarhus University, Aarhus, Denmark.
³⁰ Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK.
³¹ German Institute of Human Nutrition, Potsdam-Rehbrüke, Germany.
³² School of Community Health, Portland State University, Portland, OR, USA.
³³ Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
³⁴ St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
³⁵ Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece; Harvard TH Chan School of Public Health, Boston, MA, USA.
³⁶ National Institute for Public Health and the Environment, Bilthoven, Netherlands.
³⁷ Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.
³⁸ Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA.
³⁹ Instituto de Salud Pública de Navarra, IdiSNA - Navarra Institute for Health Research, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain.
⁴⁰ Columbia University Irving Medical Center, New York, NY, USA.
⁴¹ East Boston Neighborhood Health Center, Boston, MA, USA.
⁴² Città della Salute e della Scienza di Torino Hospital, Turin, Italy.
⁴³ College of Public Health, The University of Iowa, Iowa City, IA, USA.
⁴⁴ Consejería de Sanidad del Principado de Asturias, Oviedo, Asturias, Spain.
⁴⁵ Civic - M. Arezzo Hospital, ASP Ragusa, Italy.
⁴⁶ Duke Divinity School, Duke University, Durham, NC, USA.
⁴⁷ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴⁸ Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁴⁹ Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
⁵⁰ Department of Biology, Tuskegee University, AL, USA.
⁵¹ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁵² University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland.
⁵³ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁵⁴ Medical University of South Carolina, Charleston, SC, USA.
⁵⁵ Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
⁵⁶ Department of Agrotechnology and Food Sciences, University of Wageningen, Wageningen, Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands.
⁵⁷ Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁵⁸ Medical University Innsbruck, Innsbruck, Austria.
⁵⁹ School of Medicine, Yale University, New Haven, CT, USA.
⁶⁰ Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
⁶¹ Cancer Research and Prevention Institute (ISPO), Florence, Italy.
⁶² CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
⁶³ Usher Institute, University of Edinburgh, Edinburgh, UK.
⁶⁴ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁶⁵ CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto BIO-Donostia, Basque Government, San Sebastian, Spain.
⁶⁶ The University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Preventive Medicine and Public Health, Kyushu University, Fukuoka, Japan.
⁶⁷ School of Health Science and Education, Harokopio University, Athens, Greece.
⁶⁸ Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece.
⁶⁹ Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
⁷⁰ EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
⁷¹ Department of Public Health, Aarhus University, Aarhus, Denmark; Aalborg University Hospital, Aalborg, Denmark.
⁷² Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
⁷³ Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK.
⁷⁴ Department of Kinesiology, Laval University, Quebec City, QC, Canada.
⁷⁵ Department of Medicine, University of Vermont, Burlington, VT, USA.
⁷⁶ Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
⁷⁷ Department of Social and Environmental Medicine, Kanazawa Medical University, Ishikawa, Japan.
⁷⁸ Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
⁷⁹ Busselton Population Medical Research Institute, Busselton, WA, Australia; School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
⁸⁰ Helmholtz Zentrum München German Research Center for Environmental Health, Germany.
⁸¹ Danish Cancer Society Research Center, Copenhagen, Denmark.
⁸² German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, University of Heidelberg, Heidelberg, Germany.
⁸³ Istituto Superiore di Sanità, Rome, Italy.
⁸⁴ Institut Pasteur de Lille, Lille, France.
⁸⁵ Assmann-Stiftung für Prävention, Münster, Germany.
⁸⁶ The City College of New York, New York, NY, USA.
⁸⁷ Howard University Hospital, Washington DC, USA.
⁸⁸ Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
⁸⁹ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁹⁰ International Agency for Research on Cancer, Lyon, France.
⁹¹ MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.
⁹² School of Population Health, The University of Auckland, Auckland, New Zealand.
⁹³ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Electronic address: jd292@medschl.cam.ac.uk.

PMID: 29676281
PMCID: PMC5899998
DOI: 10.1016/S0140-6736(18)30134-X

Erratum in

Department of Error.
[No authors listed] [No authors listed] Lancet. 2018 Jun 2;391(10136):2212. doi: 10.1016/S0140-6736(18)31168-1. Epub 2018 Jun 1. Lancet. 2018. PMID: 29893221 Free PMC article. No abstract available.

Abstract

Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies.

Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively.

Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

Funding: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.

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Figures

**Figure 1**
Associations of usual alcohol consumption with all-cause mortality and the aggregate of cardiovascular disease in current drinkers Cardiovascular disease was defined as an aggregate of myocardial infarction, coronary heart disease, and stroke. Hazard ratios are adjusted for age, smoking, and history of diabetes, and stratified by sex and EPIC centre. The reference category is the lowest baseline alcohol consumption category (between 0 and 25 g/week). HRs are plotted against the mean usual alcohol consumption in each category. Sizes of the boxes are proportional to the inverse of the variance of the log-transformed hazard ratios. Vertical lines represent 95% CIs.

**Figure 2**
Associations of usual alcohol consumption with cardiovascular subtypes in alcohol drinkers Hazard ratios are adjusted for age, smoking, and history of diabetes, and stratified by sex and EPIC centre. The reference category is the lowest baseline alcohol consumption category (between 0 and 25g/week). Hazard ratios are plotted against the mean usual alcohol consumption in each category. Studies with fewer than five events of any outcome were excluded from the analysis of that outcome. Sizes of the boxes are proportional to the inverse of the variance of the log-transformed hazard ratios. Vertical lines represent 95% CIs. Deaths from other cardiovascular disease include the following outcomes: cardiac dysrhythmia, hypertensive disease, sudden death, and aortic aneurysm.

**Figure 3**
Hazard ratios for subtypes of cardiovascular outcomes in current drinkers, per 100 g per week higher usual alcohol consumption Hazard ratios are adjusted for age, smoking, and history of diabetes, and stratified by sex and centre. Studies with fewer than five events of any outcome were excluded from the analysis of that outcome.

**Figure 4**
Estimated future years of life lost by extent of reported baseline alcohol consumption compared with those who reported consuming >0–≤100 g per week The estimates of cumulative survival from 40 years of age onwards in the alcohol-drinking groups were calculated by applying hazard ratios (specific to age at risk) for all-cause mortality associated with categorised baseline alcohol consumption to US death rates at the age of 40 years or older. Mean usual levels of alcohol consumption within each baseline alcohol consumption category were 56, 123, 208 and 367 g per week, respectively, for the groups >0–≤100 g per week, >100–≤200 g per week, >200–≤350 g per week, and >350 g per week.

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Comment in

Thresholds for safer alcohol use might need lowering.
Connor J, Hall W. Connor J, et al. Lancet. 2018 Apr 14;391(10129):1460-1461. doi: 10.1016/S0140-6736(18)30545-2. Lancet. 2018. PMID: 29676264 No abstract available.
Consuming 100 g/week or less of alcohol was associated with the lowest risk of all-cause mortality.
Xuan Z. Xuan Z. BMJ Evid Based Med. 2019 Jun;24(3):117-118. doi: 10.1136/bmjebm-2018-111049. Epub 2018 Sep 3. BMJ Evid Based Med. 2019. PMID: 30177544 No abstract available.
Risk thresholds for alcohol consumption.
Astrup A, Costanzo S, de Gaetano G. Astrup A, et al. Lancet. 2018 Nov 17;392(10160):2165-2166. doi: 10.1016/S0140-6736(18)32192-5. Lancet. 2018. PMID: 30496094 No abstract available.
Risk thresholds for alcohol consumption.
Schernhammer E. Schernhammer E. Lancet. 2018 Nov 17;392(10160):2166-2167. doi: 10.1016/S0140-6736(18)32202-5. Lancet. 2018. PMID: 30496095 No abstract available.
Risk thresholds for alcohol consumption.
Thompson W. Thompson W. Lancet. 2018 Nov 17;392(10160):2167. doi: 10.1016/S0140-6736(18)32197-4. Lancet. 2018. PMID: 30496097 No abstract available.

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References

1. Department of Health Alcohol Guidelines Review: Report from the guidelines development group to the UK Chief Medical Officers. 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (accessed Feb 5, 2018).
1. Kalinowski A, Humphreys K. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction. 2016;111:1293–1298. - PubMed
1. Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988;319:267–273. - PubMed
1. Boffetta P, Garfinkel L. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology. 1990;1:342–348. - PubMed
1. Thun MJ, Peto R, Lopez AD. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337:1705–1714. - PubMed

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[1] Department of Health Alcohol Guidelines Review: Report from the guidelines development group to the UK Chief Medical Officers. 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (accessed Feb 5, 2018).

[2] Department of Health Alcohol Guidelines Review: Report from the guidelines development group to the UK Chief Medical Officers. 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (accessed Feb 5, 2018).

[3] Kalinowski A, Humphreys K. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction. 2016;111:1293–1298. - PubMed

[4] Kalinowski A, Humphreys K. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction. 2016;111:1293–1298. - PubMed

[5] Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988;319:267–273. - PubMed

[6] Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988;319:267–273. - PubMed

[7] Boffetta P, Garfinkel L. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology. 1990;1:342–348. - PubMed

[8] Boffetta P, Garfinkel L. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology. 1990;1:342–348. - PubMed

[9] Thun MJ, Peto R, Lopez AD. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337:1705–1714. - PubMed

[10] Thun MJ, Peto R, Lopez AD. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337:1705–1714. - PubMed

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Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

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Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies

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