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Potential health benefits of moderate alcohol consumption: current perspectives in research

  • E. Nova (a1), G. C. Baccan (a1) (a2), A. Veses (a1), B. Zapatera (a1) and A. Marcos (a1)...
Abstract

The benefits of moderate amounts of alcohol for a better health and longer life expectancy compared with abstinence have been suggested by the findings of numerous studies. However, controversies have emerged regarding the influence of confounding factors and the systematic errors that might have been inadvertently disregarded in the early studies. This review includes a description of the findings of those research studies published in the last 5 years on the effects of moderate alcohol consumption on all-cause mortality, CVD and inflammation, the immune system, insulin sensitivity, non-alcoholic fatty liver disease (NAFLD) and cancer. Promising evidences exist from both animal studies and human clinical trials regarding intermediate end-points of CHD and insulin sensitivity, such as HDL, adiponectin or fibrinogen. However, controversies and inconsistent findings exist regarding many of these diseases and related functions and biomarkers. Further research and human randomised-controlled trials with adequate standardisation of the study conditions are necessary in order to draw a comparison between studies, establish the causal effect of moderate alcohol intake on disease protection and reach consensus on the circumstances that allow the recommendation of moderate alcohol habitual intakes as a strategy for health maintenance.

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Corresponding author
*Corresponding author: Dr Esther Nova, fax +34 915493627, email enova@ictan.csic.es
References
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1.Pearl, R (1923) Alcohol and mortality. In The Action of Alcohol on Man, pp. 213286 [Starling, E]. London: Longmans, Green and Co.
2.Fillmore, KM, Golding, JM, Graves, KL et al. (1998) Alcohol consumption and mortality. I. Characteristics of drinking groups. Addiction 93, 183203.
3.Naimi, TS, Brown, DW, Brewer, RD et al. (2005) Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med 28, 369373.
4.Lee, SJ, Sudore, RL, Williams, BA et al. (2009) Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. J Am Geriatr Soc 57, 955962.
5.Sun, W, Schooling, CM, Chan, WM et al. (2009) Moderate alcohol use, health status, and mortality in a prospective Chinese elderly cohort. Ann Epidemiol 19, 396403.
6.French, MT & Zavala, SK (2007) The health benefits of moderate drinking revisited: alcohol use and self-reported health status. Am J Health Promot 21, 484491.
7.Fillmore, KM, Stockwell, T, Chikritzhs, T et al. (2007) Moderate alcohol use and reduced mortality risk: systematic error in prospective studies and new hypotheses. Ann Epidemiol 17, Suppl. 5, S16S23.
8.Maraldi, C, Harris, TB, Newman, AB et al. (2009) Moderate alcohol intake and risk of functional decline: the Health, Aging, and Body Composition study. J Am Geriatr Soc 57, 17671775.
9.Fuller, TD (2011) Moderate alcohol consumption and the risk of mortality. Demography 48, 11051125.
10.Djoussé, L, Lee, IM, Buring, JE et al. (2009) Alcohol consumption and risk of cardiovascular disease and death in women: potential mediating mechanisms. Circulation 21, 237244.
11.Au Yeung, SL, Jiang, C, Zhang, W et al. (2010) Moderate alcohol use and cognitive function in the Guangzhou Biobank Cohort study. Ann Epidemiol 20, 873882.
12.Alatalo, PI, Koivisto, HM, Hietala, JP et al. (2009) Gender-dependent impacts of body mass index and moderate alcohol consumption on serum uric acid – an index of oxidant stress status? Free Radical Biol Med 15, 12331238.
13.Verbaten, MN (2009) Chronic effects of low to moderate alcohol consumption on structural and functional properties of the brain: beneficial or not? Hum Psychopharmacol 24, 199205.
14.Sachdev, PS, Chen, X, Wen, W et al. (2008) Light to moderate alcohol use is associated with increased cortical gray matter in middle-aged men: a voxel-based morphometric study. Psychiatry Res 30, 6169.
15.Stott, DJ, Falconer, A, Kerr, GD et al. (2008) Does low to moderate alcohol intake protect against cognitive decline in older people? J Am Geriatr Soc 56, 22172224.
16.Henderson, J, Gray, R & Brocklehurst, P (2007) Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome. BJOG 114, 243252.
17.Huizink, AC (2009) Moderate use of alcohol, tobacco and cannabis during pregnancy: new approaches and update on research findings. Reprod Toxicol 28, 143151.
18.Schneider, ML, Moore, CF, Barr, CS et al. (2011) Moderate prenatal alcohol exposure and serotonin genotype interact to alter CNS serotonin function in rhesus monkey offspring. Alcohol Clin Exp Res 35, 912920.
19.Meyer-Leu, Y, Lemola, S, Daeppen, JB et al. (2011) Association of moderate alcohol use and binge drinking during pregnancy with neonatal health. Alcohol Clin Exp Res 35, 16691677.
20.Klatsky, AL (2010) Alcohol and cardiovascular health. Physiol Behav 100, 7681.
21.Di Castelnuovo, A, Costanzo, S, Donati, MB et al. (2010) Prevention of cardiovascular risk by moderate alcohol consumption: epidemiologic evidence and plausible mechanisms. Intern Emerg Med 5, 291297.
22.Brien, SE, Ronksley, PE, Turner, BJ et al. (2011) Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ 22, 342357.
23.Brügger-Andersen, T, Pönitz, V, Snapinn, S et al. (2009) OPTIMAAL study group. Moderate alcohol consumption is associated with reduced long-term cardiovascular risk in patients following a complicated acute myocardial infarction. Int J Cardiol 133, 229232.
24.Bos, S, Grobbee, DE, Boer, JM et al. (2010) Alcohol consumption and risk of cardiovascular disease among hypertensive women. Eur J Cardiovasc Prev Rehabil 17, 119126.
25.Ronksley, PE, Brien, SE, Turner, BJ et al. (2011) Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 342, d671.
26.McNeill, E, Channon, KM & Greaves, DR (2010) Inflammatory cell recruitment in cardiovascular disease: murine models and potential clinical applications. Clin Sci (Lond) 118, 641655.
27.Espinola-Klein, C, Gori, T, Blankenberg, S et al. (2011) Inflammatory markers and cardiovascular risk in the metabolic syndrome. Front Biosci 16, 16631674.
28.Sitia, S, Tomasoni, L, Atzeni, F et al. (2010) From endothelial dysfunction to atherosclerosis. Autoimmun Rev 9, 830834.
29.Mangalmurti, SS & Davidson, MH (2011) The incremental value of lipids and inflammatory biomarkers in determining residual cardiovascular risk. Curr Atheroscler Rep 13, 373380.
30.Wang, JJ, Tung, TH, Yin, WH et al. (2008) Effects of moderate alcohol consumption on inflammatory biomarkers. Acta Cardiol 63, 6572.
31.Romeo, J, González-Gross, M, Wärnberg, J et al. (2008) Effects of moderate beer consumption on blood lipid profile in healthy Spanish adults. Nutr Metab Cardiovasc Dis 18, 365372.
32.Raum, E, Gebhardt, K, Buchner, M et al. (2007) Long-term and short-term alcohol consumption and levels of C-reactive protein. Int J Cardiol 121, 224226.
33.Pomp, ER, Rosendaal, FR & Doggen, CJ (2008) Alcohol consumption is associated with a decreased risk of venous thrombosis. Thromb Haemost 99, 5963.
34.Imhof, A, Blagieva, R, Marx, N et al. (2008) Drinking modulates monocyte migration in healthy subjects: a randomised intervention study of water, ethanol, red wine and beer with or without alcohol. Diab Vasc Dis Res 5, 4853.
35.Suzuki, K, Elkind, MS, Boden-Albala, B et al. (2009) Moderate alcohol consumption is associated with better endothelial function: a cross sectional study. BMC Cardiovasc Disord 9, 8–12.
36.Hamed, S, Alshiek, J, Aharon, A et al. (2010) Red wine consumption improves in vitro migration of endothelial progenitor cells in young, healthy individuals. Am J Clin Nutr 92, 161169.
37.Kavitha, G, Damodara Reddy, V, Paramahamsa, M et al. (2008) Role of nitric oxide in alcohol-induced changes in lipid profile of moderate and heavy alcoholics. Alcohol 42, 4753.
38.Huang, PH, Chen, YH, Tsai, HY et al. (2010) Intake of red wine increases the number and functional capacity of circulating endothelial progenitor cells by enhancing nitric oxide bioavailability. Arterioscler Thromb Vasc Biol 30, 869877.
39.Gil-Bernabe, P, Boveda-Ruiz, D, D'Alessandro-Gabazza, C et al. (2011) Atherosclerosis amelioration by moderate alcohol consumption is associated with increased circulating levels of stromal cell-derived factor-1. Circ J 75, 22692279.
40.Bertelli, AA & Das, DK (2009) Grapes, wines, resveratrol, and heart health. J Cardiovasc Pharmacol 54, 468476.
41.Vazquez-Prieto, MA, Renna, NF, Diez, ER et al. (2011) Effect of red wine on adipocytokine expression and vascular alterations in fructose-fed rats. Am J Hypertens 24, 234240.
42.Messingham, KAN, Faunce, DE & Kovacs, EJ (2002) Alcohol, injury, and cellular immunity. Alcohol 28, 137149.
43.Diaz, LE, Montero, A, González-Gross, M et al. (2002) Influence of alcohol consumption on immunological status: a review. Eur J Clin Nutr 56, 5053.
44.Sibley, DA, Osna, N, Kusynski, C et al. (2001) Alcohol consumption is associated with alterations in macrophage responses to interferon-gamma and infection by Salmonella Typhimurium. Immunol Med Microbiol 32, 7383.
45.Lau, A, Von, DV, Sander, M et al. (2009) Alcohol use disorder and perioperative immune dysfunction. Anesth Analg 108, 916920.
46.Romeo, J, Wärnberg, J, Nova, E et al. (2007) Moderate alcohol consumption and the immune system: a review. Br J Nutr 98, Suppl. 1, S111S115.
47.Cohen, S, Tyrrell, DA, Russell, MA et al. (1993) Smoking, alcohol consumption, and susceptibility to the common cold. Am J Public Health 83, 12771283.
48.Takkouche, B, Regueira-Méndez, C, García-Closas, R et al. (2002) Intake of wine, beer, and spirits and the risk of clinical common cold. Am J Epidemiol 155, 853858.
49.Badía, E, Sacanella, E, Fernández-Solá, J et al. (2004) Decreased tumor necrosis factor-induced adhesion of human monocytes to endothelial cells after moderate alcohol consumption. Am J Clin Nutr 80, 225230.
50.Estruch, R, Sacanella, E, Badia, E et al. (2004) .Different effects of red wine and gin consumption on inflammatory biomarkers of atherosclerosis: a prospective randomized crossover trial: effects of wine on inflammatory markers. Atherosclerosis 175, 117–1123.
51.Winkler, C, Wirleitner, B, Schroecksnadel, K et al. (2006) Beer down-regulates activated peripheral blood mononuclear cells in vitro. Int Immunopharmacol 6, 390395.
52.Mandrekar, P, Catalano, D, White, B et al. (2006) Moderate alcohol intake in humans attenuates monocyte inflammatory responses: inhibition of nuclear regulatory factor kappa B and induction of interleukin 10. Alcohol Clin Exp Res 30, 135139.
53.Romeo, J, Wärnberg, J, Nova, E et al. (2007) Changes in the immune system after moderate beer consumption. Ann Nutr Metab 51, 359366.
54.Romeo, J, Wärnberg, J, Díaz, LE et al. (2007) Effects of moderate beer consumption on first-line immunity of healthy adults. J Physiol Biochem 63, 153159.
55.Djurovic, S, Berge, KE, Birkenes, B et al. (2007) The effect of red wine on plasma leptin levels and vasoactive factors from adipose tissue: a randomized crossover trial. Alcohol Alcohol 42, 525528.
56.Vázquez-Agell, M, Sacanella, E, Tobias, E et al. (2007) Inflammatory markers of atherosclerosis are decreased after moderate consumption of cava (sparkling wine) in men with low cardiovascular risk. J Nutr 137, 22792284.
57.Vinson, JA, Mandarano, M, Hirst, M et al. (2003) Phenol antioxidant quantity and quality in foods: beers and the effect of two types of beer on an animal model of atherosclerosis. J Agric Food Chem 51, 55285533.
58.Boscolo, P, del Signore, A, Sabbioni, E et al. (2003) Effects of resveratrol on lymphocyte proliferation and cytokine release. Ann Clin Lab Sci 33, 226231.
59.Magrone, T & Jirillo, E (2010) Polyphenols from red wine are potent modulators of innate and adaptive immune responsiveness. Proc Nutr Soc 69, 279285.
60.Gao, X, Deeb, D, Liu, Y et al. (2009) Immunomodulatory activity of xanthohumol: inhibition of T cell proliferation, cell-mediated cytotoxicity and Th1 cytokine production through suppression of NF-kappaB. Immunopharmacol Immunotoxicol 31, 477484.
61.Mahyar-Roemer, M, Katsen, A, Mestres, P et al. (2001) Resveratrol induces colon tumor cell apoptosis independently of p53 and precede by epithelial differentiation, mitochondrial proliferation and membrane potential collapse. Int J Cancer 94, 615622.
62.Fujita, Y, Islam, R, Sakai, K et al. (2011) Aza-derivatives of resveratrol are potent macrophage migration inhibitory factor inhibitors. Invest New Drugs (In the Press).
63.Goldberg, DM (1996) More on antioxidant activity of resveratrol in red wine. Clin Chem 42, 113114.
64.Sánchez-Fidalgo, S, Cárdeno, A, Villegas, I et al. (2010) Dietary supplementation of resveratrol attenuates chronic colonic inflammation in mice. Eur J Pharmacol 633, 7884.
65.Wirleitner, B, Schroecksnadel, K, Winkler, C et al. (2005) Resveratrol suppresses interferon-gamma-induced biochemical pathways in human peripheral blood mononuclear cells in vitro. Immunol Lett 100, 159163.
66.Jiménez-Ortega, V, Fernández-Mateos, MP, Barquilla, PC et al. (2011) Continuous versus discontinuous drinking of an ethanol liquid diet in peripubertal rats: effect on 24-h variation of lymph node and splenic mitogenic responses and lymphocyte subset populations. Alcohol 45, 183192.
67.Davies, MJ, Baer, DJ, Judd, JT et al. (2002) Effects of moderate alcohol intake on fasting insulin and glucose concentrations and insulin sensitivity in postmenopausal women: a randomized controlled trial. JAMA 287, 25592562.
68.Sierksma, A, Patel, H, Ouchi, N et al. (2004) Effect of moderate alcohol consumption on adiponectin, tumor necrosis factor-alpha, and insulin sensitivity. Diabetes Care 27, 184189.
69.Koppes, LL, Dekker, JM, Hendriks, HF et al. (2005) Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies. Diabetes Care 28, 719725.
70.Kiechl, S, Willeit, J, Poewe, W et al. (1996) Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study (Bruneck study). Br Med J 313, 10401044.
71.Bell, RA, Mayer-Davis, EJ, Martin, MA et al. (2000) Associations between alcohol consumption and insulin sensitivity and cardiovascular disease risk factors: the Insulin Resistance and Atherosclerosis Study. Diabetes Care 23, 16301636.
72.Cordain, L, Bryan, ED, Melby, CL et al. (1997) Influence of moderate daily wine consumption on body weight regulation and metabolism in healthy free-living males. J Am Coll Nutr 16, 134139.
73.Cordain, L, Melby, CL, Hamamoto, AE et al. (2000) Influence of moderate chronic wine consumption on insulin sensitivity and other correlates of syndrome X in moderately obese women. Metabolism 49, 14731478.
74.Zilkens, RR, Burke, V, Watts, G et al. (2003) The effect of alcohol intake on insulin sensitivity in men: a randomized controlled trial. Diabetes Care 26, 608612.
75.Beulens, JW, van Beers, RM, Stolk, RP et al. (2006) The effect of moderate alcohol consumption on fat distribution and adipocytokines. Obesity (Silver Spring) 14, 6066.
76.Magis, DC, Jandrain, BJ & Scheen, AJ (2003) Alcohol, insulin sensitivity and diabetes. Rev Med Liege 58, 501507.
77.Napoli, R, Cozzolino, D, Guardasole, V et al. (2005) Red wine consumption improves insulin resistance but not endothelial function in type 2 diabetic patients. Metabolism 54, 306313.
78.Kim, SH, Abbasi, F, Lamendola, C et al. (2009) Effect of moderate alcoholic beverage consumption on insulin sensitivity in insulin-resistant, nondiabetic individuals. Metabolism 58, 387392.
79.Beulens, JW, de Zoete, EC, Kok, FJ et al. (2008) Effect of moderate alcohol consumption on adipokines and insulin sensitivity in lean and overweight men: a diet intervention study. Eur J Clin Nutr 62, 10981105.
80.Landgren, S, Berglund, K, Jerlhag, E et al. (2011) Reward-related genes and personality traits in alcohol-dependent individuals: a pilot case control study. Neuropsychobiology 64, 3846.
81.Joosten, MM, Witkamp, RF & Hendriks, HF (2011) Alterations in total and high-molecular-weight adiponectin after 3 weeks of moderate alcohol consumption in premenopausal women. Metabolism 60, 10581063.
82.Imhof, A, Plamper, I, Maier, S et al. (2009) Effect of drinking on adiponectin in healthy men and women: a randomized intervention study of water, ethanol, red wine, and beer with or without alcohol. Diabetes Care 32, 11011103.
83.Yamauchi, T, Kamon, J, Waki, H et al. (2001) The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 7, 941946.
84.Pischon, T, Girman, CJ, Rifain, N et al. (2005) Association between dietary factors and plasma adiponectin concentrations in men. Am J Clin Nutr 81, 780786.
85.Shai, I, Rimm, EB, Schulze, MB et al. (2004) Moderate alcohol intake and markers of inflammation and endothelial dysfunction among diabetic men. Diabetologia 47, 17601767.
86.Suzuki, A, Angulo, P, St Sauver, J et al. (2007) Light to moderate alcohol consumption is associated with lower frequency of hypertransaminasemia. Am J Gastroenterol 102, 19121919.
87.Angulo, P (2002) Nonalcoholic fatty liver disease. N Engl J Med 346, 12211231.
88.Matteoni, CA, Younossi, ZM, Gramlich, T et al. (1999) Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 116, 14131419.
89.Gunji, T, Matsuhashi, N, Sato, H et al. (2009) Light and moderate alcohol consumption significantly reduces the prevalence of fatty liver in the Japanese male population. Am J Gastroenterol 104, 21892195.
90.Hiramine, Y, Imamura, Y, Uto, H et al. (2011) Alcohol drinking patterns and the risk of fatty liver in Japanese men. J Gastroenterol 46, 519528.
91.Dixon, JB, Bhathal, PS & O'Brien, PE (2001) Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 121, 91–100.
92.Dunn, W, Xu, R & Schwimmer, JB (2008) Modest wine drinking and decreased prevalence of suspected nonalcoholic fatty liver disease. Hepatology 47, 19471954.
93.Alatalo, PI, Koivisto, HM, Hietala, JP et al. (2008) Effect of moderate alcohol consumption on liver enzymes increases with increasing body mass index. Am J Clin Nutr 88, 10971103.
94.Sato, KK, Hayashi, T, Nakamura, Y et al. (2008) Liver enzymes compared with alcohol consumption in predicting the risk of type 2 diabetes: the Kansai Healthcare Study. Diabetes Care 31, 12301236.
95.Hézode, C, Lonjon, I, Roudot-Thoraval, F et al. (2003) Impact of moderate alcohol consumption on histological activity and fibrosis in patients with chronic hepatitis C, and specific influence of steatosis: a prospective study. Aliment Pharmacol Ther 17, 10311037.
96.Wang, Y, Seitz, HK & Wang, XD (2009) Moderate alcohol consumption aggravates high-fat diet induced steatohepatitis in rats. Alcohol Clin Exp Res 34, 567573.
97.Moriya, A, Iwasaki, Y, Ohguchi, S et al. (2011) Alcohol consumption appears to protect against non-alcoholic fatty liver disease. Aliment Pharmacol Ther 33, 378388.
98.WHO (1988) Alcohol Drinking. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 44. Lyon, 1988 (Last updated 1998).
99.Baan, R, Straif, K, Grosse, Y et al. . (2007) WHO International Agency for Research on Cancer Monograph Working Group: carcinogenicity of alcoholic beverages. Lancet Oncol 8, 292293.
100.Boffetta, P & Hashibe, M (2006) Alcohol and cancer. Lancet Oncol 7, 149156.
101.Allen, NE, Beral, V, Casabonne, D et al. (2009) Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst 101, 296305.
102.Boyle, P & Boffetta, P (2009) Alcohol consumption and breast cancer risk. Breast Cancer Res 11, Suppl. 3, S3.
103.Lew, JQ, Freedman, ND, Leitzmann, MF et al. (2009) Alcohol and risk of breast cancer by histologic type and hormone receptor status in postmenopausal women: the NIH–AARP Diet and Health Study. Am J Epidemiol 170, 308317.
104.Mill, CP, Chester, JA & Riese, DJ (2009) EGFR may couple moderate alcohol consumption to increased breast cancer risk. Breast Cancer (London) 1, 3138.
105.Crockett, SD, Long, MD, Dellon, ES et al. (2011) Inverse relationship between moderate alcohol intake and rectal cancer: analysis of the North Carolina Colon Cancer Study. Dis Colon Rectum 54, 887894.
106.Hu, J, Chen, Y, Mao, Y et al. (2008) Alcohol drinking and renal cell carcinoma in Canadian men and women. Cancer Detect Prev 32, 7–14.
107.Shai, I, Wainstein, J, Harman-Boehm, I et al. (2007) Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: a multicenter, randomized, clinical intervention trial. Diabetes Care 30, 30113016.
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