Even what many Americans consider moderate drinking is linked to an increased risk of death, disability, and chronic diseases such as cancer and heart disease, according to a new study published in the Journal of Studies on Alcohol and Drugs.
"This study provides the most comprehensive U.S. estimates to date of lifetime risks of alcohol-attributable mortality and morbidity, showing that even moderate levels of consumption increase the risk of premature death and disability," said study co-author Katherine M. Keyes, PhD, professor of Epidemiology at Columbia University Mailman School of Public Health. "No protective effect of drinking was observed even at low levels," noted Keyes, whose research focuses on alcohol use and other substances epidemiology across the life course.
"Even low levels of alcohol use come with health risks," says lead study author Kevin Shield, PhD, an associate professor at the University of Toronto and a senior scientist who leads the World Health Organization (WHO)/Pan American Health Organization (PAHO) Collaborating Centre in Addiction and Mental Health. "And that risk continues to increase the more someone drinks."
The researchers, from the United States and Canada, aimed to estimate how lifetime drinking habits affect Americans' risk of illness and death related to alcohol. After medical experts reviewed more than 7,200 scientific articles on alcohol-related diseases and injuries to determine the level of risk for each condition, the researchers applied those risks to large national health data sets. They then used statistical modeling to estimate how different drinking levels influence long-term health outcomes.
The study offers more concrete guidance than the new U.S. Dietary Guidelines, which currently advise Americans to "limit alcoholic beverages" without specifying how much alcohol is safe to drink. Previous guidelines recommended a daily limit of two alcoholic drinks for men and one for women. The definition of a 'drink' varies by beverage type, typically 12 ounces for beer, 5 ounces for wine, and 1.5 ounces for spirits, although that too can vary by alcohol concentration.
While the new U.S. Dietary Guidelines contain a useful 'less-is-best' message, they provide no quantitative framework, according to the authors. This study was designed to do just that across the drinking spectrum.
It turns out that two drinks per day, which might be considered 'moderate' from a social standpoint, is associated with a substantially elevated risk of a premature death caused by alcohol, they explain.
In addition to mortality risk, researchers examined how drinking patterns influence chronic and acute alcohol-related conditions such as cancer -- including esophageal, oral, and breast -- cardiovascular disease, liver disease, and injury.
The study overturns a common misconception that alcohol can protect health. The researchers did not observe a significant protective effect of alcohol on overall health at any level of consumption. They noted that at low levels, alcohol may be associated with a reduced risk of ischemic heart disease and stroke. But when you look across the full range of health outcomes, including cancer and other chronic diseases, those potential benefits are outweighed by the risks even at 7 drinks per week.
Statistical modeling used in the study to determine health risks was based on "the best possible data," according to the team. However, they caution one should not assume that means one person's individual health risk is the same as what is reported here -- that depends on other factors like lifestyle, genetics, drinking patterns, and other choices that differ person to person.
The researchers estimated risk for all health conditions known to be causally related to alcohol and then aggregated these estimates to determine the total health risk. Yet, new research continues to emerge that links alcohol with additional health conditions, such as pancreatic cancer. "Understanding those relationships, and how much alcohol contributes to those risks, is an area that still needs further work," says Keyes and Shield.
By finding that alcohol consumption is associated with increased risk above one drink per day for both men and women, the study offers a much-needed benchmark.
"Having a clearer threshold helps people better understand what level of drinking is associated with increased risk and make more informed decisions when drinking."
In an accompanying editorial, Robert M. Vincent, a former associate administrator for the U.S. Substance Abuse and Mental Health Services Administration, discusses his view of the behind-the-scenes environment in which the study was produced. "The Alcohol Intake and Health report was explicitly invited to inform alcohol guidance during development of the Dietary Guidelines for Americans, 2025–2030," he writes. "Despite the study's adherence to its mandate, its findings were sidelined."
See the paper for a full list of co-authors and their institutions.
The study was funded by Synergy Enterprises Inc. and the U.S. Substance Abuse and Mental Health Services Administration.
The author reports no conflicts of interest.
Columbia University Mailman School of Public Health
