Effects of alcohol at low dose in the context of a Mediterranean dietary pattern

Sandra Helinski

Giovanni de Gaetano, Simona Costanzo, Augusto Di Castelnuovo, Maria Benedetta Donati and Licia Iacoviello

Department of Epidemiology and Prevention, IRCCS IstitutoNeurologicoMediterraneoNeuromed, Pozzilli, Italy.

A Mediterranean dietary style is associated with a healthier and longer life in Western societies, when compared with other dietary patterns. Moderate alcohol consumption is part of the Mediterranean diet, with wine as the typical alcoholic beverage choice. A number of updated, large meta-analyses on the relationship between alcohol consumption and cardiovascular outcomes including cardiovascular mortality or all-cause mortality have been performed in the past years. These meta-analyses provide consistent evidence of J-shaped relationships between both wine and beer intake and vascular risk, with maximal protection (of about one fifth-one third) at moderate consumption (around 25 g/day of alcohol/day). A statistically significant association between spirits intake and vascular disease was not usually found. The lack of a similar J-shaped association for spirits may be due to different drinking patterns (e.g., more binge drinking among consumers of spirits), as the pattern of drinking is less frequently included as a confounder in the analyses. In summary, for drinkers having one to two drinks per drinking day, without episodic heavy drinking, there is substantial and consistent evidence from epidemiological and short-term experimental studies for a beneficial association with fatal and non fatal cardiovascular risk and all-cause mortality when compared to lifetime abstainers. Such protection is not seen when drinking is beyond moderation, i.e. 30 grams or more of alcohol per day or largely irregular (binge drinking).
The finding of a similar inverse association between the consumption of alcohol in relation to cardiovascular outcomes may be explained in two different ways: 1) the alcohol in these beverages is the main responsible protective factor or 2) the key effects on cardiovascular disease are primarily due to different but similarly beneficial polyphenols in beer and wine (one may speculate that consuming alcoholic beverages especially during meals, favors some synergistic effects between polyphenols in these two alcoholic beverages and other similar compounds of the Mediterranean diet).
More recently, data from the Moli-sani study showed that moderate alcohol consumption, among the food groups of a traditional Mediterranean diet, appeared to significantly contribute to the reduction of total mortality associated with a high adherence to the Mediterranean diet observed in patients with type 2 diabetes or history of ischemic cardiovascular disease.