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Many observational studies find associations between ‘moderate’ alcohol use and reduced mortality risk compared with abstention. Low doses of alcohol have also been associated with improvements in some biomarkers of cardiovascular health in short-term randomised studies. However, the absence of any randomised clinical trial of any morbidity or mortality outcome, and contradictory Mendelian randomisation studies,1 cast doubt on the veracity of associations found in observational studies. Goulden lists alternative explanations for the classic J-shaped curve for alcohol use and mortality risk, including selection bias, misclassification of drinkers as abstainers and residual confounding. We comment here as authors of a meta-analysis2 raising identical concerns and reporting similar findings.
Goulden examined the relationship between level of average daily alcohol consumption and risk of death …
Contributors TS made a first draft which was edited and commented on by TN. The authors discussed the paper and points to make in the commentary.
Competing interests TS is a recipient of research funds through the University of Victoria from Sweden's government retail alcohol monopoly for a study on the public health consequences of government controls.
Provenance and peer review Commissioned; internally peer reviewed.