Type of Alcohol

Correlational studies suggest that there may be different effects of the different types of alcoholic beverages. They have shown that mortality from coronary heart disease is lower in countries where wine is the predominant type of alcohol than in countries where beer or spirits are the beverages mainly ingested. These results have been supported from population studies from many countries, suggesting that wine drinkers are at lower risk of death from all causes, including coronary heart disease and cancer, than beer and spirits drinkers (Figures 4-6).

One way in which the different types of beverages may exert their different effects on the development of coronary heart disease is via abdominal obesity. It has been suggested that beer drinkers are at a higher risk of developing abdominal obesity than wine drinkers (Figure 7). These beverage-specific differences may be explained by either the traits of the drinker or the different substances in the different beverages. Wine consumption in many populations is related to higher socioeconomic status, higher education, and more optimal health behaviour in general compared with beer and spirits consumption. Because these factors are negatively associated a

Non-frequent Frequent a

Women

Non-frequent Frequent

Non-frequent Frequent

0 <1 1-6 7-13 14+ Alcohol intake (drinks per week)

<1 1-6 7-13 14-20 Alcohol intake (drinks per week)

Figure 3 Hazard ratios for all-cause mortality according to quantity and frequency of alcohol intake in men and women (* = P<0.05 compared to reference, frequent = at least 2 drinking days per week; nonfrequent = less than 2 drinking days per week). Adjusted for education, smoking, body mass index, physical activity, diet, and diseases before baseline. Reference category is drinkers of less than one but more than zero drinks per week. (Reproduced with permission from Tolstrup J et al. (2004) Drinking pattern and mortality in middle-aged men and women. Addiction 99: 323-330.)

0 1-7 8-21 22-35 >35 Alcohol consumption, drinks/wk

Figure 4 Relative risk of death from all causes according to type of alcohol intake. Data pertain to non-wine drinkers (crosses), wine drinkers (triangles), drinkers for whom wine made up 1-30% of their total alcohol consumption (circles), and drinkers for whom wine made up more than 30% of their total alcohol intake (squares). Relative risk is set at 1.00 among nondrinkers (<1 drink/week). Estimates were adjusted for age, sex, educational level, smoking status, body mass index, and physical activity. (Reproduced with permission from Gronbsk M et al. (2000) Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Annals of Internal Medicine 133: 411-419.)

with mortality, it has been proposed that an unequal distribution according to beverage type may explain the beverage-specific differences in mortality observed in some studies. Several of the components in wine may have antioxidant properties. Hence, flavonoids such as quercetin, rutin, catechin, and epicatechin are present in red wine, responsible for the color of the wine. These compounds have been found to inhibit eicosanoid synthesis and platelet aggregation in vitro. Frankel et al. found flavonoids to be 10-20 times more potent than vitamin E, and they found an inhibition of low-density lipoprotein oxidation in humans by these phenolic substances. Hertog et al. found a preventive effect of dietary flavonoids on risk of developing ischemic heart disease. A high intake of fruits, vegetables, and fish and a low intake of saturated fat have been suggested to reduce the risk of cardiovascular disease. The Mediterranean diet, which includes fruits and vegetables, has been found to have a weak protective effect on cardiovascular disease in 6 of 10 cohort studies. Therefore, diet may play a role in the complex

Alcohol consumption, drinks/wk

Figure 5 Relative risk of death from coronary heart disease (CHD) according to type of alcohol intake. Data pertain to non-wine drinkers (crosses) and wine drinkers (triangles). Relative risk is set at 1.00 among nondrinkers (<1 drink/week). Estimates were adjusted for age, sex, educational level, smoking status, body mass index, and physical activity. (Reproduced with permission from Gronbffik M et al. (2000) Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Annals of Internal Medicine 133: 411-419.)

relation between alcoholic beverage type and coronary heart disease mortality. In the Danish Diet Cancer and Health Study, preference of wine was associated with a higher intake of fruit, fish, vegetables, and salad and a higher frequency of use of olive oil for cooking compared with preference of beer or spirits in both men and women. However, sensitivity analysis of the effect of a potential con-founder shows that such a confounder, or conglomerate of confounders, should be very strong to explain the previous findings.

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