Background
Methods
Literature search and study inclusion criteria
Data synthesis
Quality assessment and publication bias
Results
First author (Year) | Study design | Study period (Follow-up duration) | Participants | Number of cases (death) | Measures of alcohol consumption | Risk estimate (Confidence Interval) | Criteria of mild drinking | |
---|---|---|---|---|---|---|---|---|
All cause mortality | ||||||||
Kim 2007 [25] | Cohort | 1995-2001 (6 years) | Aged ≥20 | 3,366 (228) | Status | Men | Women | n.r |
None: 1.0 | None: 1.0 | |||||||
Former:1.01 (0.57-1.77) | Former: 1.41 (0.62-3.05) | |||||||
Current:0.75 (0.47-1.22)
|
Current: 1.69 (1.01-2.98)
| |||||||
Rhee 2012 [26] | Cohort | 1993-2008 (15 years) | Men aged 40-59 | 14,533 (990) | Status | None; 1.0 | n.r | |
Former: 1.17 (0.98-1.39) | ||||||||
Current: 1.40 (1.07-1.83)
| ||||||||
Park 1999 [27] | Nest case–control | 1993-1997 (4–5 years) | Aged ≥40 | 38,496 (19,258) | Frequency | None: 1.0 | n.r | |
Occasional: 1.0 (0.94-1.06)
| ||||||||
Frequently: 1.17 (1.1-1.26) | ||||||||
Sull 2009 [1] | Cohort | 1985-2005 (20.8 years) | Men aged ≥55 | 2,624 (1,984) | Frequency | None: 1.0 | n.r | |
Few time a month
a
: 1.03 (0.89-1.2)
| ||||||||
Few time a week
b
: 1.04 (0.93-1.16) | ||||||||
Daily: 1.25 (1.10-1.43) | ||||||||
Yi 2004 [28] | Cohort | 1985-1999 (14 years) | Aged ≥55 | 6,292 (2,673) | Weekly amount | Men | Women | ≤70 g/week |
None; 1.0 | None: 1.0 | |||||||
Low: 1.06 (0.92-1.23)
|
Low: 0.94 (0.77-1.15)
| |||||||
Moderate:1.09 (0.96-1.23) | Moderate:1.16 (0.77-1.74) | |||||||
Heavy: 1.35 (1.14-1.60) | ||||||||
Khang 2009 [30] | Cohort | 1998-2001 (3 years) | Aged ≥30 | 8,366 (310) | Monthly amount | None: 1.0 | n.r | |
Former: 2.03(1.42-2.91) | ||||||||
Minimal: 0.60 (0.39-0.93)
| ||||||||
Q1: 1.04 (0.62-1.68) | ||||||||
Q2: 1.09 (0.71-1.67) | ||||||||
Q3: 1.17 (0.78-1.76) | ||||||||
Q4: 1.23 (0.82-1.84) | ||||||||
Kim 2010 [31] | Cohort | 2000-2005 (5 years) | Aged 40-69 | 1,341,393 (19,375) | Daily amount | Men | Women | <30 g/day for men |
None: 1.0 | None: 1.0 | <15 g/day for women | ||||||
1-14.9 g: 0.87 (0.84-0.91)
|
1-14.9 g: 0.99 (0.85-1.15)
| |||||||
15-29.9 g:0.88 (0.84-0.92) | ≥15 g: 1.39 (1.08-1.79) | |||||||
30-89.9 g:1.07 (1.02-1.13) | ||||||||
≥90 g: 1.29 (1.22-1.37) | ||||||||
Jeong 2012 [29] | Cohort | 2005-2006 (1 year) | Aged ≥65 | 997 (113) | Weekly amount | None: 1.0 | ≤7drinks/week | |
Light: 0.08 (0.01-0.58)
| ||||||||
Moderate: 1.15 (0.46-2.85) | ||||||||
Heavy: 1.44 (0.81-2.56) | ||||||||
Jung 2012 [24] | Cohort | 1993-2004 (11 years) | Aged ≥20 | 16,320 (1,122) | Weekly amount | None: 1.18 (0.96-1.45) | ≤90 g/week | |
0.1-90 g: 1.0
| ||||||||
90.1-252 g: 1.29 (0.99-1.66) | ||||||||
252.1-504 g: 1.31 (1.00-1.71) | ||||||||
≥504.1 g: 1.39 (1.05-1.83) | ||||||||
Cancer-related mortality | ||||||||
Lim 2008 c [32] | Cohort | 1993-1996 1995–2002 (2–7 years) | Aged ≥65 | 14,304 (112) | Status | None:1.0 | ≤24 g/day | |
Ex: 1.47 (0.87-2.47) | ||||||||
Current: 0.83 (0.53-1.31)
| ||||||||
Lee 2002 [34] | Cohort | 1985-1998 (13 years) | Aged ≥55 | 2,681 (253) | Weekly amount | None: 1.0 | 1-4 times/month | |
Light: 0.98 (0.64-1.50)
| ||||||||
Moderate: 1.01 (0.69-1.48) | ||||||||
Heavy: 1.2 (0.89-1.62) | ||||||||
Jee 2004 d [36] | Cohort | 1993-2002 (7–9 years) | Aged 30-95 | 1,283,112 (3,807) | Daily amount | Men | Women | 1-24.9 g/day |
None: 1.0 | None: 1.0 | |||||||
1-24.9 g: 1.0 (0.9-1.1)
|
Drinker: 1.2 (0.9-1.5)
| |||||||
25-49.9 g: 1.0 (0.9-1.2) | ||||||||
50-99.9 g: 1.1 (0.9-1.4) | ||||||||
≥100 g: 1.4 (1.0-1.8) | ||||||||
Park 2006 [35] | Cohort | 1996-2004 (9 years) | Men aged ≥ 20 | 14,578 (7,271) | Weekly amount | None: 1.0 | n.r | |
1-124.1 g: 0.94 (0.88-1.00)
| ||||||||
≥124.2 g: 1.05 (0.98-1.12) | ||||||||
Kim 2010 [31] | Cohort | 2000-2005 (5 years) | Aged 40-69 | 1,341,393 (19,375) | Daily amount | Men | Women | <30 g/day for men |
None: 1.0 | None: 1.0 | <15 g/day for women | ||||||
1-14.9 g: 0.91 (0.85-0.97)
|
1-14.9 g: 0.99 (0.85-1.15)
| |||||||
15-29.9 g: 0.93 (0.87-1.0) | ≥15 g: 1.39 (1.08-1.79) | |||||||
30-89.9 g:1.06 (0.98-1.15) | ||||||||
≥90 g: 1.21 (1.11-1.33) | ||||||||
Kimm 2010e [33] | Cohort | 1993-2006 (14 years) | Aged 30-93 | 782,632 (996) | Daily amount | None: 1.0 | ≤24 g/day | |
1-24 g: 1.9 (1.6-2.3)
| ||||||||
25-49 g: 2.7 (2.1-3.5) | ||||||||
50-99 g: 3.7 (2.8-5.0) | ||||||||
≥100 g: 3.4 (2.2-5.3) | ||||||||
Yi 2010 f [37] | Cohort | 1985-2005 (20.8 years) | Aged ≥55 | 6,291 (360) | Weekly amount | Men | Women | <138 g/week for men, <12 g/week for women |
None: 1.0 | None: 1.0 | |||||||
Low: 1.18 (0.83-1.69)
|
Low: 1.15 (0.53-2.51)
| |||||||
Moderate:1.06(0.73-1.56) | High: 1.63 (0.83-3.19) | |||||||
High: 1.26 (0.88-1.82) | ||||||||
Jung 2012 [24] | Cohort | 1993-2004 (11 years) | Aged ≥20s | 16,320 (1,122) | Weekly amount | None: 1.55 (1.15-2.11) | ≤90 g/week | |
0.1-90 g: 1.0
| ||||||||
90.1-252 g: 1.7 (1.16-2.49) | ||||||||
252.1-504 g: 1.84 (1.24-2.72) | ||||||||
≥504.1 g: 2.07 (1.39-3.09) | ||||||||
Cardiovascular mortality | ||||||||
Meng 1987 [38] | Case–control study | 1982-1983 | Aged 35-65 | 910 (190) | Frequency | None: 1.0 | 1-2 times/month | |
1-2 times/month: 0.92
| ||||||||
1-2 times/week: 1.09 | ||||||||
3-4 times/week: 2.27 | ||||||||
Everyday: 2.17 | ||||||||
Sull 2009 [1] | Cohort | 1985-2005 (20.8 years) | Men aged ≥55 | 2,624 (1,984) | Frequency | None: 1.0 | n.r | |
Few times a month
a
: 0.98 (0.67-1.42)
| ||||||||
Few times a week
b
: 1.06 (0.82-1.37) | ||||||||
Daily: 1.36 (1.0-1.84) | ||||||||
Yi 2004 [28] | Cohort | 1985-1999 (14 years) | Aged ≥55 | 6,292 (672) | Weekly amount | Men | Women | ≤70 g/week |
None: 1.0 | None: 1.0 | |||||||
<70 g: 0.98 (0.69-1.37)
|
<70 g: 0.92 (0.61-1.38)
| |||||||
70-503.9 g: 1.06 (0.8-1.39) | ≥70 g: 0.89 (0.33-2.4) | |||||||
≥504 g: 1.52 (1.06-2.19) |
Mortality
-
Of the two studies using drinking status as a criterion, one reported a significantly high risk only among women [25], and the other showed a significant effect on mortality in current drinkers compared with non-drinkers [26]. Two studies using frequency as a drinker classification criterion showed no significant results [1, 27]. In the five studies using amount of alcohol consumed, mild drinkers showed no significant mortality risk in two studies [24, 28], while three reported a significantly lower risk among men [29‐31].
-
To analyze the risk of mild drinking, only five studies measuring the amount of alcohol consumed were included in the meta-analysis. The results of the meta-analysis did not show favorable effects of mild alcohol drinking on total mortality (OR: 0.85, 95 % CI: 0.72, 1.01) (Fig. 2).
-
Of eight studies in total, one study assessed drinking status and seven studies assessed alcohol amount. The study using drinking status showed non-significant results [32]. Of seven studies using alcohol amount for mild drinking classification, three reported significant results. Although Kimm et al. reported high mortality in mild drinkers [33], another two studies found lower mortality in mild drinkers compared with non-drinkers [24, 31].
-
Four reported the effects of alcohol consumption on all mortality from cancer [24, 31, 34, 35], and another four assessed the effect of alcohol on hepatocellular carcinoma [36], colorectal cancer [32], esophageal cancer [33], and digestive cancer [37]. Pooled results of mild drinking from four studies using all-cancer mortality showed beneficial effect (OR: 0.89, 95 % CI: 0.85, 0.94), however, it was not significant when adding three studies [33, 36, 37] assessing risk of mild drinking on specific type of cancer (OR: 1.02, 95 % CI: 0.90, 1.15) (Fig. 3).×
-
Three studies assessed the cardiovascular risk related to drinking alcohol. Although two studies using frequency and one study using alcohol amount as drinking criterion reported lower cardiovascular mortality in occasional or mild drinkers compared with non-drinkers [1, 28, 38], none of the results were statistically significant. Owing to the lack of studies, a meta-analysis of mild drinking as a risk factor for cardiovascular mortality could not be conducted.