A recent study published in Nature Medicine evaluates the associations between alcohol consumption and the danger of diseases in Chinese adults.

Study: Alcohol consumption and risks of greater than 200 diseases in Chinese men. Image Credit: ENZELEN / Shutterstock.com

Rising alcohol use throughout the world

Alcohol consumption is a risk factor for poor health and globally accounts for over three million deaths annually. Notably, alcohol consumption rates have increased in low- and middle-income countries because the Nineteen Nineties. Likewise, the proportion of Chinese adult males reporting alcohol consumption previously 12 months increased from 59% in 1990 to 85% in 2017.

Epidemiologic studies involving Western populations have reported the hazards of consuming alcohol for varied diseases, including cancers, cirrhosis, heart problems (CVD), and infectious diseases. Nevertheless, studies conducted in Western populations may not apply to the Chinese population as a consequence of marked heterogeneity in disease patterns and alcohol consumption.

In regards to the study

Over 512,000 adults between 30 and 79 years of age were recruited between 2004 and 2008 from 10 regions throughout China. At baseline, participants were asked to point their alcohol consumption frequency previously 12 months.

Accordingly, the study participants were classified as non-, ex-, occasional, and current drinkers. Participants’ vital status was periodically assessed from local death registries and extra records.

Morbidity data were obtained from disease registries and the medical health insurance system. All recorded injuries and diseases were reviewed. The most important diseases more likely to be causally linked with alcohol consumption, in accordance with the World Health Organization (WHO), were also analyzed for associations with consumption.

The researchers genotyped the East Asian genetic variants of alcohol dehydrogenase 1 B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2), namely ADH1B-rs1229984 and ALDH2-rs671, and derived a genetic instrument for alcohol consumption. Nine genotypic combos were studied, and the alcohol intake for every genotype was calculated.

Study findings

At baseline, the common age of participants was 52, 56% of whom were from rural areas, and 41% were male. Amongst males, 33% were current drinkers, with a mean consumption rate of 286 g/week.

Ex- and non-drinkers were more often older with poor self-rated health as in comparison with current or occasional drinkers. Heavy drinkers were primarily rural residents with lower education, unhealthier lifestyle, and better average blood pressure than moderate drinkers, the latter of whom consumed lower than 140 g/week.

About 62% of current male drinkers reported each day consumption, and 37% engaged in heavy episodic drinking. Only 2% of females reported drinking a minimum of weekly.

Greater than 134,000 males and 198,400 females had a minimum of one hospitalization during a median follow-up duration of 12.1 years. Over 1.1 million hospitalizations were reported throughout the study period, including 333,541 from 207 diseases amongst males and 476,986 from 48 diseases amongst females.

Alcohol consumption in males was significantly related to elevated risks for 61 disease outcomes. Only 28 of those 61 diseases were considered by the WHO as alcohol-related, of which included six cancers, tuberculosis, diabetes, hypertensive disorders, cerebrovascular diseases, pneumonia, pancreatitis, cirrhosis, alcoholic liver disease, myopathy, chronic ischemic heart disease (IHD), and external causes of harm.

The remaining 33 recent alcohol-associated diseases included stomach or lung cancer, six digestive diseases, three musculoskeletal conditions, circulatory diseases, in addition to behavioral and psychiatric conditions. Overall, 44 diseases exhibited dose-response associations with alcohol intake. Notably, inguinal hernia, non-toxic goiter, and prostate hyperplasia showed significant inverse associations with alcohol consumption after adjusting for false-rate discovery.  

Every day or heavy episodic consumption and drinking spirits were related to increased risks for alcohol-related diseases amongst current drinkers in males. As a result of the lower proportion of current drinkers amongst females and, because of this, the dearth of statistical power, the associations between alcohol consumption and disease risks couldn’t be evaluated.

ALDH2-rs671 and ADH1B-rs1229984 showed a robust association in males with alcohol consumption. The genetic instrument predicted a 60-fold difference in the common alcohol consumption across genetic categories in males. The expected average alcohol consumption was positively related to established and recent alcohol-associated diseases amongst males.

In males, the genetic associations were stronger for stroke, cirrhosis, and gout. No dose-response genotypic associations were significant for IHD, prostate hyperplasia, and inguinal hernia.

Hospitalizations for any cause were higher amongst male ever-regular drinkers than occasional drinkers, especially for cancer. These differences increased with age, apart from CVD hospitalizations.

Conclusions

The researchers of the present study comprehensively assessed the impact of alcohol intake on disease outcomes amongst Chinese adults. To this end, alcohol consumption in males was significantly related to increased risks of 61 diseases and hospitalizations, with 33 diseases identified as recent alcohol-associated diseases.

Taken together, these observations emphasize the importance of reducing alcohol intake in China as a public health priority.