The relationship between alcohol consumption and health: J-shaped or less is more?

In the July issue of the BMC Medicine, Tian and colleagues confirmed the J-shaped relationship between alcohol consumption and health based on analyzing 918,529 adults from the repeated National Health Interview Survey (NHIS) from 1997 to 2014. In addition to several cause-specific mortality, the researchers findings are largely confirmatory to previous studies using NHIS and several large systematic review and meta-analysis on this issue.
The “J-shaped” relationship refers to a protective health effect at a lower level of consumption; while above a certain threshold, it greatly increases health risks. This study found that compared with lifetime abstainers, current infrequent, light, and moderate drinkers had a lower risk of all-cause mortality (current infrequent: − 13%; light: − 23%; moderate: − 18%) and cardio-vascular disease mortality (infrequent: − 14%; light: − 24%; moderate: − 22%), respectively. However, it is important to address several methodological issues when interpreting the J-shaped association which the authors explore.
In conclusion, while some studies have suggested a J-shaped relationship, there are limitations in the study design, confounding factors, and individual variability that challenge the generalizability and interpretation of these findings. More recent studies with advanced methodological designs have challenged the J-shape association. It is also important to consider societal/population-level harmful effects of alcohol use and alternative health-promoting strategies when evaluating the implications of the J-shaped relationship.
Source: Tsai, MK., Gao, W. & Wen, CP. The relationship between alcohol consumption and health: J-shaped or less is more?. BMC Med 21, 228 (2023).