Mediterranean drinking patterns and mortality risk Original paper

In this cohort study among alcohol drinkers, the participants with low adherence to Mediterranean alcohol-drinking patterns had higher digestive-system and cancer mortality risks compared to participants with high adherence to Mediterranean alcohol-drinking patterns.

The association between Mediterranean alcohol-drinking patterns, Mediterranean diet adherence, and mortality risk. The outcomes included all-cause mortality, as well as mortality from cancer, cardiovascular disease, and digestive system diseases (e.g., gastrointestinal cancer, hepatitis).

3,411 Italian adults (57% women and 43% men), with an average age of 51 at baseline.

A prospective cohort study with an average follow-up period of 16.8 years was performed.

Mediterranean diet adherence was assessed using the Relative Mediterranean Score (rMED), which considers the intake of foods such as fruits, vegetables, fish, grains, nuts, olive oil, meats, and dairy products as a portion of total energy intake.

Alcohol consumption patterns were assessed using the Mediterranean Alcohol-drinking Pattern Index (MADP). The Mediterranean alcohol-drinking pattern is characterized by moderate total alcohol intake, spread evenly across the week, without binge drinking. It also includes a preference for wine (especially red wine) rather than spirits and a preference for the consumption of alcohol during meals. The participants were then classified as having low, moderate, or high MADP adherence based on total MADP scores (0–3 for low, 4–6 for moderate, and 7–9 for high)

The analyses were adjusted for confounders such as smoking habits, gender, comorbidity, BMI, and triglycerides.

Compared to participants with high MADP adherence, the participants with low MADP adherence had higher risks of mortality from cancer (+125%) and digestive system diseases (+177%).

Compared to participants with high rMED adherence, the participants with low rMED adherence had a higher risk of mortality from cancer (+83%).

The mortality risks did not differ significantly between the moderate and high adherence groups on either scale (MADP or rMED).

Compared to participants with both high MADP and high rMED adherence, the participants with both low MADP and low rMED adherence had higher risks of mortality from all causes (+129%) and digestive system diseases (+338%).

A limitation of this study is that only 93 participants (less than 3% of the cohort) were classified as having low MADP adherence. This is a problem because a small sample size reduces the accuracy of the analyses and reduces the ability to detect a “true effect”.^[1][2] The participants with low MADP adherence were 86% men, had a higher BMI on average, and tended towards lower rMED adherence. They also had notably higher alcohol intake and consumed 4–6 times more alcohol of each type (wine, beer, and spirits) than the moderate adherence group. Another limitation of this study is that the analyses were not adjusted for many potentially important confounders, such as physical activity