Thursday, 15 July 2021

Another day, another J-curve

From the Mayo clinic:

During a median follow-up of 8.9 years, we documented 8652 incident cases of all-cause death, including 1702 cases of cardiovascular disease death, 4960 cases of cancer death, and 1990 cases of other-cause death. After adjustment confounders and amount of alcohol consumed, higher DHS was significantly associated with a lower risk of all-cause mortality, cardiovascular disease mortality, cancer mortality, or other-cause mortality (Ptrend<.001, Ptrend=.03, Ptrend<.001, and Ptrend<.001, respectively). We observed that the amount of alcohol consumed have different relationships with the risks of all-cause mortality and cause-specific mortality among participants with distinct drinking habits, grouped by DHS. For example, in the joint analyses, a J-shaped association between the amount of alcohol consumed and all-cause mortality was observed in participants with unfavorable DHS (Pquadratic trend=.02) while the association appeared to be U-shaped in participants with favorable DHS (Pquadratic trend=.003), with lower risks in those consuming greater than or equal to 50 g/wk and less than 300 g/wk.

DHS here means a Drinking Habit Score based on whether one drinks with meals and drinking at least 3 times per week. 

So all-source mortality risks are minimised by drinking with meals at least three times per week, with consumption no less than 5 standard drinks per week and no more than 30 standard drinks per week. 

The benchmark I keep in my head, from the older DiCastelnuovo metastudy, is that risks are minimised at about a standard drink a day (a bit less for women, a bit more for men), with risk back up to abstinence-baseline at around 4 standard drinks per day (a bit less for women, a bit more for men). And remember that the "sick quitter" confound is already considered in the DiCastelnuovo work. 

The latest from Mayo is entirely consistent with what we'd expect, for those who pay attention to the literature rather than the prohibitionists. But it's great to see this work continuing to bear up in repeated studies. 

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