Na het nieuws dat bier niet is vermeld in de nieuwe schijf van vijf, maar weliswaar 3 to 5 keer per dag mag worden gedronken, kwam dit nieus binnen. Een stevige kritiek op de J-shape:
Drinking alcohol offers no net health benefits, review finds
Claims about alcohol's health benefits warrant skepticism
Tim Stockwell of the University of Victoria's Centre for Addictions Research in British Columbia has taken another look at published studies on alcohol and mortality on nearly four million people, including more than 367,000 deaths (www.cbc.ca/news/health/alcohol-health-1.3501314)
Een groep Canadese wetenschappers heeft 87 studies naar de positieve gezondheidseffecten van alcohol bij elkaar gezocht en toen ze die nog eens goed bekeken bleken alle positieve effecten verdwenen.
Dat komt, volgens hoofdonderzoeker Tim Stockwell, door de geheelonthouder. In de meeste van die 87 studies wordt de matige drinker (meestal 2 glazen gemiddeld per dag) vergeleken met de geheelonthouder. En onder die geheelonthouders bevindt zich een grote groep die om gezondheidsredenen gestopt is. De matige drinker steekt daar vanzelfsprekend altijd gezond bij af.
De 13 studies waarin wel rekening werd gehouden met de achtergrond van de geheelonthouders konden geen enkel gezondheidseffect aan alcohol toeschrijven. Uit de analyse volgt dat hooguit de incidentele gebruiker (minder dan 1 keer per week 1 glas) voordeel heeft van de alcohol.
De onderzoekers vinden het dan ook veel logischer om van een lineair verband uit te gaan: hoe meer alcohol, des te groter de schade.
"Het idee leeft dat alcohol goed voor ons is, want dat is wat je altijd hoort", aldus Stockwell. "Maar er zijn vele redenen om sceptisch te zijn."
Artikel: Stockwell, T., Zhao, J., Panwar, S., Roemer, A., Naimi, T., & Chikritzhs, T. (March 2016). Do "moderate" drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality. Journal of Studies on Alcohol and Drugs, 77(2), 185-198 (www.stap.nl/nl/nieuws/laatste-nieuws.html/3454/4760/matig-alcoholgebruik-is-helemaal-niet-goed-voor-je#p3454).
Do “Moderate” Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality
Journal of Studies on Alcohol and Drugs, 77(2), 185–198 (2016).
Tim Stockwell, Ph.D.,a,d * Jinhui Zhao, Ph.D.,a Sapna Panwar, M.S.,b Audra Roemer, M.Sc.,a Timothy Naimi, M.D.,c & Tanya Chikritzhs, Ph.D.b,d
Affiliations
aCentre for Addictions Research of BC, University of Victoria, Victoria, British Columbia, Canada
bInstitute for Scientific Analysis, San Francisco, California
cBoston University Schools of Medicine and Public Health, Boston, Massachusetts
dNational Drug Research Institute, Curtin University, Perth, WA 6845, Australia (www.jsad.com/doi/10.15288/jsad.2016.77.185)
Many people believe a glass of wine with dinner will help them live longer and healthier--but the scientific evidence is shaky at best, according to a new research analysis. The findings, published in the March 2016 issue of the Journal of Studies on Alcohol and Drugs, may sound surprising: Countless news stories have reported on research tying moderate drinking to a range of health benefits--including a lower heart disease risk and a longer life.
But the new analysis took a deeper look at those studies, 87 in all. And it found that many were flawed, with designs suggesting benefits where there were likely none.
A key issue is how studies have defined "abstainers," explained Tim Stockwell, Ph.D., the lead researcher on the analysis and director of the University of Victoria's Centre for Addictions Research in British Columbia, Canada.
Most often, studies have compared moderate drinkers (people who have up to two drinks per day) with "current" abstainers. The problem is that this abstainer group can include people in poor health who've cut out alcohol.
"A fundamental question is, who are these moderate drinkers being compared against?" Stockwell said.
When his team corrected for those abstainer "biases" and certain other study-design issues, moderate drinkers no longer showed a longevity advantage. Further, only 13 of the 87 studies avoided biasing the abstainer comparison group--and these showed no health benefits.
What's more, Stockwell said, before those corrections were made, it was actually "occasional" drinkers--people who had less than one drink per week--who lived the longest. And it's unlikely that such an infrequent drinking would be the reason for their longevity.
"Those people would be getting a biologically insignificant dose of alcohol," Stockwell said.
In addition, he noted, studies have linked moderate drinking to an implausibly wide range of health benefits. Compared with abstainers, for instance, moderate drinkers have shown lower risks of deafness and even liver cirrhosis.
"Either alcohol is a panacea," Stockwell said, "or moderate drinking is really a marker of something else."
The study did not look at whether certain types of alcohol, such as red wine, are tied to longer life. But if that were the case, Stockwell said, it would be unlikely that the alcohol content itself deserved the credit.
"There's a general idea out there that alcohol is good for us, because that's what you hear reported all the time," Stockwell said. "But there are many reasons to be skeptical."
###
Stockwell, T., Zhao, J., Panwar, S., Roemer, A., Naimi, T., & Chikritzhs, T. (March 2016). Do "moderate" drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality. Journal of Studies on Alcohol and Drugs, 77(2), 185-198. http://dx.doi.org/10.15288/jsad.2016.77.185 (www.eurekalert.org/pub_releases/2016-03/joso-imd031616.php)
In addition to being Director of the Centre for Addiction Research of BC (www.carbc.ca ), Tim Stockwell is a Professor in the Department of Psychology at the University of Victoria. Dr. Stockwell has published over 300 research papers, book chapters and monographs, plus several books on prevention and treatment issues relating to alcohol and other substance use.
Dr. Stockwell is a psychologist who accomplished both clinical and research work in the UK before spending 16 years with Australia's National Drug Research Institute as Deputy Director and then Director. He studied Psychology and Philosophy at Oxford University and obtained a PhD at the Institute of Psychiatry, University of London. He was President of the international Kettil Bruun Society for Social and Epidemiological Research on Alcohol, 2005-7. He was the recipient of the prestigious international E.M. Jellinek Memorial Award for Outstanding Research on Social, Cultural and Policy Studies of Alcohol in 2013 and is a Fellow of the Canadian Academy of Health Sciences.
He is committed to the advancement of public policy on substance use issues in BC. He has established CARBC as a research centre which aims to shed light on the social, cultural and psychological determinants of harmful substance use, which applies rigorous measures of patterns of use and related harms and which advances knowledge of effective policy and practice (https://www.uvic.ca/socialsciences/psychology/people/faculty-directory/stockwelltimothy.php).
There has been increasing discussion within the field of alcohol epidemiology regarding the scientific status of claimed health benefits from the consumption of alcohol in relatively low doses (Chikritzhs et al., 2015; Holmes et al., 2014). The status of the hypothesis that alcohol in moderation confers health benefits has implications for estimations of the global burden of disease from alcohol (Lim et al., 2012) and the development of public health policies to reduce alcohol’s harm (Babor et al., 2010) and national guidelines for low-risk alcohol use (Stockwell & Room, 2012).
It has been suggested that the epidemiological (Ronksley et al., 2011) and physiological evidence (Brien et al., 2011) for both an association and a causal mechanism is sufficiently compelling to recommend consideration of advising abstainers to drink. However, an increasing number of questions have been raised about the quality of the studies contained in these meta-analyses. We first summarize some reasons for skepticism and then present new meta-analyses that explore the extent to which alternative study designs enhance or minimize associations indicative of health benefits.
...
Evidence of health benefits from alcohol use has been reported for implausible types and numbers of health conditions in observational longitudinal studies. Fekjaer (2013) identified a long list of such conditions (including deafness, hip fractures, the common cold, cancers, birth complications, dementia, and liver cirrhosis) in which the classic J-shape curve was observed, with lower risk for low-volume drinkers compared with abstainers. In some cases—notably a reduced likelihood of alcoholic liver cirrhosis among low-volume drinkers (Rehm et al., 2010) and of developmental disorders of infants born of low-volume drinking mothers (Kelly et al., 2009)—a causal basis for such associations is highly unlikely. These findings raise the question as to whether a range of lifestyle and/or genetic confounding factors that favor “moderate drinkers” over abstainers are responsible.
Naimi et al. (2005) reported that 27 (90%) of 30 potential adverse confounders for coronary heart disease were more prevalent among abstainers than among moderate drinkers. Fillmore et al. (2006) classified prospective studies on alcohol and health according to their definition of “an abstainer” (i.e., the reference group that all classes of drinker are typically compared with in these studies). They reported that when studies explicitly excluded former and occasional drinkers from the abstainer reference group, there was limited evidence of protection from moderate alcohol consumption. The underlying theory was that as people age and become unwell, they are more likely to quit or substantially reduce their alcohol consumption, leading to an exaggeration of the already poor health profiles of abstainers (Kerr et al., 2002; Shaper et al., 1988).
Consistent with this view, Mäkelä et al. (2005) showed that reclassifying former drinkers as abstainers, thereby placing them in the reference group, markedly lowered the relative risk (RR) estimates for all active drinkers. Taking a more rigorous approach to the role of potential bias caused by former drinkers, Liang and Chikritzhs (2013) argued that former drinkers should be combined with current drinkers when drinking groups are compared with lifelong abstainers and that bias is not eliminated by merely separating former drinkers from abstainers.
A recent investigation of a large cohort from the European Prospective Investigation into Cancer (EPIC; Bergmann et al., 2013) used an analysis that took into account mortality risks from multiple and competing causes at multiple points over the life course. A reduced risk of death from heart disease was associated with alcohol consumption, but only when study participants with a history of ill health were excluded from analysis. Such exclusions are often conducted to mitigate confounding but may also be a source of selection bias. The authors concluded: “The apparent health benefit of low to moderate alcohol-use found in observational studies could therefore in large part be due to various selection biases and competing risks, which are related to both lifetime alcohol use and risk of disease, usually occurring later in life” (Bergmann et al., p. 1789).
Competing risks are also an issue for studies of all-cause mortality because the comparative risk of different diseases varies across the life course (e.g., coronary disease usually occurs later in life than does injury, cancer, or liver disease). This in turn creates selection bias in the sampling of individuals available to participate in cohort studies, especially in older cohorts (Stockwell & Chikritzhs, 2013).
The kinds of methodological problems identified above are quite common in this literature, in particular the practice of misclassifying former and occasional drinkers as abstainers (Stockwell et al., 2012) (www.jsad.com/doi/10.15288/jsad.2016.77.185).
Met andere woorden: alle onderzoeken tot nog toe waren fout, want alcoholgebruik door gezonde mensen werd vergeleken met zieke geheelonthouders. Dan kom je er altijd goed vanaf...
The complexity inherent in the question, “Do ‘moderate’ drinkers have reduced mortality risk?”(Stockwell et al., 2016—this issue) arises from our reliance on cohort studies for evidence and the range of methodological weaknesses that bedevil them. These have been best articulated in discussions of alcohol and cardiovascular risk (Chikritzhs et al., 2009; Jackson et al., 2005; Naimi et al., 2005), where much of the putative mortality benefit would arise. Some sources of error—such as the timing, reliability, and dimensions of alcohol measurement; the categorization of drinkers; and the control of confounding—allow us to differentiate the quality of cohort studies. Others are intrinsic to the design itself, such as residual confounding from a plethora of lifestyle variables. These problems are not mitigated by combining studies in a meta-analysis, which is why skepticism about meta-analysis of observational studies is still warranted (Egger et al., 1998).
The J-shaped curve of average alcohol consumption and mortality risk is biologically counterintuitive. Stockwell and colleagues have zeroed in on one important methodological flaw in existing studies—the nature of the reference group used to generate the curve—and their meta-analysis moves understanding forward substantially. It produces two important findings, the first being the new risk estimates that indicate lack of mortality benefit for low-volume drinkers when compared with an appropriate reference group and adjusted for some study-level variables. One could debate how well other sources of error are dealt with, but the indisputable second message is how sensitive the estimates are to improving classification of abstainers and, therefore, how plausible it is that there is an alternative explanation for the putative benefits of alcohol (www.jsad.com/doi/10.15288/jsad.2016.77.201).
This new evidence is important but is not the final word on the topic. It shows how sensitive studies are to misclassification affecting the reference group, while other researchers have focused on different weaknesses in the evidence, using different methods. For example, a meta-analysis by Roerecke and Rehm (2012) showed substantial heterogeneity in associations of low-volume drinking with cardiovascular disease when stratified by sex and outcome, and a Mendelian randomization study (Holmes et al., 2014) supported residual confounding and selection biases as an explanation for the observed effect. In combination, these studies suggest that effects of moderate alcohol on cardiovascular disease and total mortality are poorly estimated and that evidence for causality is weak. There will be value in continuing to pursue this scientific question to put it beyond debate and to better estimate the health impact of alcohol use in populations. The information will also allow individuals to make informed decisions about their own health (www.jsad.com/doi/10.15288/jsad.2016.77.201)...
Zou bier daarom niet in de (nieuwe) schijf van vijf zitten?
Drinking alcohol offers no net health benefits, review finds
Claims about alcohol's health benefits warrant skepticism
Tim Stockwell of the University of Victoria's Centre for Addictions Research in British Columbia has taken another look at published studies on alcohol and mortality on nearly four million people, including more than 367,000 deaths (www.cbc.ca/news/health/alcohol-health-1.3501314)
Een groep Canadese wetenschappers heeft 87 studies naar de positieve gezondheidseffecten van alcohol bij elkaar gezocht en toen ze die nog eens goed bekeken bleken alle positieve effecten verdwenen.
Dat komt, volgens hoofdonderzoeker Tim Stockwell, door de geheelonthouder. In de meeste van die 87 studies wordt de matige drinker (meestal 2 glazen gemiddeld per dag) vergeleken met de geheelonthouder. En onder die geheelonthouders bevindt zich een grote groep die om gezondheidsredenen gestopt is. De matige drinker steekt daar vanzelfsprekend altijd gezond bij af.
De 13 studies waarin wel rekening werd gehouden met de achtergrond van de geheelonthouders konden geen enkel gezondheidseffect aan alcohol toeschrijven. Uit de analyse volgt dat hooguit de incidentele gebruiker (minder dan 1 keer per week 1 glas) voordeel heeft van de alcohol.
De onderzoekers vinden het dan ook veel logischer om van een lineair verband uit te gaan: hoe meer alcohol, des te groter de schade.
"Het idee leeft dat alcohol goed voor ons is, want dat is wat je altijd hoort", aldus Stockwell. "Maar er zijn vele redenen om sceptisch te zijn."
Artikel: Stockwell, T., Zhao, J., Panwar, S., Roemer, A., Naimi, T., & Chikritzhs, T. (March 2016). Do "moderate" drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality. Journal of Studies on Alcohol and Drugs, 77(2), 185-198 (www.stap.nl/nl/nieuws/laatste-nieuws.html/3454/4760/matig-alcoholgebruik-is-helemaal-niet-goed-voor-je#p3454).
Do “Moderate” Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality
Journal of Studies on Alcohol and Drugs, 77(2), 185–198 (2016).
Tim Stockwell, Ph.D.,a,d * Jinhui Zhao, Ph.D.,a Sapna Panwar, M.S.,b Audra Roemer, M.Sc.,a Timothy Naimi, M.D.,c & Tanya Chikritzhs, Ph.D.b,d
Affiliations
aCentre for Addictions Research of BC, University of Victoria, Victoria, British Columbia, Canada
bInstitute for Scientific Analysis, San Francisco, California
cBoston University Schools of Medicine and Public Health, Boston, Massachusetts
dNational Drug Research Institute, Curtin University, Perth, WA 6845, Australia (www.jsad.com/doi/10.15288/jsad.2016.77.185)
Many people believe a glass of wine with dinner will help them live longer and healthier--but the scientific evidence is shaky at best, according to a new research analysis. The findings, published in the March 2016 issue of the Journal of Studies on Alcohol and Drugs, may sound surprising: Countless news stories have reported on research tying moderate drinking to a range of health benefits--including a lower heart disease risk and a longer life.
But the new analysis took a deeper look at those studies, 87 in all. And it found that many were flawed, with designs suggesting benefits where there were likely none.
A key issue is how studies have defined "abstainers," explained Tim Stockwell, Ph.D., the lead researcher on the analysis and director of the University of Victoria's Centre for Addictions Research in British Columbia, Canada.
Most often, studies have compared moderate drinkers (people who have up to two drinks per day) with "current" abstainers. The problem is that this abstainer group can include people in poor health who've cut out alcohol.
"A fundamental question is, who are these moderate drinkers being compared against?" Stockwell said.
When his team corrected for those abstainer "biases" and certain other study-design issues, moderate drinkers no longer showed a longevity advantage. Further, only 13 of the 87 studies avoided biasing the abstainer comparison group--and these showed no health benefits.
What's more, Stockwell said, before those corrections were made, it was actually "occasional" drinkers--people who had less than one drink per week--who lived the longest. And it's unlikely that such an infrequent drinking would be the reason for their longevity.
"Those people would be getting a biologically insignificant dose of alcohol," Stockwell said.
In addition, he noted, studies have linked moderate drinking to an implausibly wide range of health benefits. Compared with abstainers, for instance, moderate drinkers have shown lower risks of deafness and even liver cirrhosis.
"Either alcohol is a panacea," Stockwell said, "or moderate drinking is really a marker of something else."
The study did not look at whether certain types of alcohol, such as red wine, are tied to longer life. But if that were the case, Stockwell said, it would be unlikely that the alcohol content itself deserved the credit.
"There's a general idea out there that alcohol is good for us, because that's what you hear reported all the time," Stockwell said. "But there are many reasons to be skeptical."
###
Stockwell, T., Zhao, J., Panwar, S., Roemer, A., Naimi, T., & Chikritzhs, T. (March 2016). Do "moderate" drinkers have reduced mortality risk? A systematic review and meta-analysis of alcohol consumption and all-cause mortality. Journal of Studies on Alcohol and Drugs, 77(2), 185-198. http://dx.doi.org/10.15288/jsad.2016.77.185 (www.eurekalert.org/pub_releases/2016-03/joso-imd031616.php)
In addition to being Director of the Centre for Addiction Research of BC (www.carbc.ca ), Tim Stockwell is a Professor in the Department of Psychology at the University of Victoria. Dr. Stockwell has published over 300 research papers, book chapters and monographs, plus several books on prevention and treatment issues relating to alcohol and other substance use.
Dr. Stockwell is a psychologist who accomplished both clinical and research work in the UK before spending 16 years with Australia's National Drug Research Institute as Deputy Director and then Director. He studied Psychology and Philosophy at Oxford University and obtained a PhD at the Institute of Psychiatry, University of London. He was President of the international Kettil Bruun Society for Social and Epidemiological Research on Alcohol, 2005-7. He was the recipient of the prestigious international E.M. Jellinek Memorial Award for Outstanding Research on Social, Cultural and Policy Studies of Alcohol in 2013 and is a Fellow of the Canadian Academy of Health Sciences.
He is committed to the advancement of public policy on substance use issues in BC. He has established CARBC as a research centre which aims to shed light on the social, cultural and psychological determinants of harmful substance use, which applies rigorous measures of patterns of use and related harms and which advances knowledge of effective policy and practice (https://www.uvic.ca/socialsciences/psychology/people/faculty-directory/stockwelltimothy.php).
There has been increasing discussion within the field of alcohol epidemiology regarding the scientific status of claimed health benefits from the consumption of alcohol in relatively low doses (Chikritzhs et al., 2015; Holmes et al., 2014). The status of the hypothesis that alcohol in moderation confers health benefits has implications for estimations of the global burden of disease from alcohol (Lim et al., 2012) and the development of public health policies to reduce alcohol’s harm (Babor et al., 2010) and national guidelines for low-risk alcohol use (Stockwell & Room, 2012).
It has been suggested that the epidemiological (Ronksley et al., 2011) and physiological evidence (Brien et al., 2011) for both an association and a causal mechanism is sufficiently compelling to recommend consideration of advising abstainers to drink. However, an increasing number of questions have been raised about the quality of the studies contained in these meta-analyses. We first summarize some reasons for skepticism and then present new meta-analyses that explore the extent to which alternative study designs enhance or minimize associations indicative of health benefits.
...
Evidence of health benefits from alcohol use has been reported for implausible types and numbers of health conditions in observational longitudinal studies. Fekjaer (2013) identified a long list of such conditions (including deafness, hip fractures, the common cold, cancers, birth complications, dementia, and liver cirrhosis) in which the classic J-shape curve was observed, with lower risk for low-volume drinkers compared with abstainers. In some cases—notably a reduced likelihood of alcoholic liver cirrhosis among low-volume drinkers (Rehm et al., 2010) and of developmental disorders of infants born of low-volume drinking mothers (Kelly et al., 2009)—a causal basis for such associations is highly unlikely. These findings raise the question as to whether a range of lifestyle and/or genetic confounding factors that favor “moderate drinkers” over abstainers are responsible.
Naimi et al. (2005) reported that 27 (90%) of 30 potential adverse confounders for coronary heart disease were more prevalent among abstainers than among moderate drinkers. Fillmore et al. (2006) classified prospective studies on alcohol and health according to their definition of “an abstainer” (i.e., the reference group that all classes of drinker are typically compared with in these studies). They reported that when studies explicitly excluded former and occasional drinkers from the abstainer reference group, there was limited evidence of protection from moderate alcohol consumption. The underlying theory was that as people age and become unwell, they are more likely to quit or substantially reduce their alcohol consumption, leading to an exaggeration of the already poor health profiles of abstainers (Kerr et al., 2002; Shaper et al., 1988).
Consistent with this view, Mäkelä et al. (2005) showed that reclassifying former drinkers as abstainers, thereby placing them in the reference group, markedly lowered the relative risk (RR) estimates for all active drinkers. Taking a more rigorous approach to the role of potential bias caused by former drinkers, Liang and Chikritzhs (2013) argued that former drinkers should be combined with current drinkers when drinking groups are compared with lifelong abstainers and that bias is not eliminated by merely separating former drinkers from abstainers.
A recent investigation of a large cohort from the European Prospective Investigation into Cancer (EPIC; Bergmann et al., 2013) used an analysis that took into account mortality risks from multiple and competing causes at multiple points over the life course. A reduced risk of death from heart disease was associated with alcohol consumption, but only when study participants with a history of ill health were excluded from analysis. Such exclusions are often conducted to mitigate confounding but may also be a source of selection bias. The authors concluded: “The apparent health benefit of low to moderate alcohol-use found in observational studies could therefore in large part be due to various selection biases and competing risks, which are related to both lifetime alcohol use and risk of disease, usually occurring later in life” (Bergmann et al., p. 1789).
Competing risks are also an issue for studies of all-cause mortality because the comparative risk of different diseases varies across the life course (e.g., coronary disease usually occurs later in life than does injury, cancer, or liver disease). This in turn creates selection bias in the sampling of individuals available to participate in cohort studies, especially in older cohorts (Stockwell & Chikritzhs, 2013).
The kinds of methodological problems identified above are quite common in this literature, in particular the practice of misclassifying former and occasional drinkers as abstainers (Stockwell et al., 2012) (www.jsad.com/doi/10.15288/jsad.2016.77.185).
Met andere woorden: alle onderzoeken tot nog toe waren fout, want alcoholgebruik door gezonde mensen werd vergeleken met zieke geheelonthouders. Dan kom je er altijd goed vanaf...
The complexity inherent in the question, “Do ‘moderate’ drinkers have reduced mortality risk?”(Stockwell et al., 2016—this issue) arises from our reliance on cohort studies for evidence and the range of methodological weaknesses that bedevil them. These have been best articulated in discussions of alcohol and cardiovascular risk (Chikritzhs et al., 2009; Jackson et al., 2005; Naimi et al., 2005), where much of the putative mortality benefit would arise. Some sources of error—such as the timing, reliability, and dimensions of alcohol measurement; the categorization of drinkers; and the control of confounding—allow us to differentiate the quality of cohort studies. Others are intrinsic to the design itself, such as residual confounding from a plethora of lifestyle variables. These problems are not mitigated by combining studies in a meta-analysis, which is why skepticism about meta-analysis of observational studies is still warranted (Egger et al., 1998).
The J-shaped curve of average alcohol consumption and mortality risk is biologically counterintuitive. Stockwell and colleagues have zeroed in on one important methodological flaw in existing studies—the nature of the reference group used to generate the curve—and their meta-analysis moves understanding forward substantially. It produces two important findings, the first being the new risk estimates that indicate lack of mortality benefit for low-volume drinkers when compared with an appropriate reference group and adjusted for some study-level variables. One could debate how well other sources of error are dealt with, but the indisputable second message is how sensitive the estimates are to improving classification of abstainers and, therefore, how plausible it is that there is an alternative explanation for the putative benefits of alcohol (www.jsad.com/doi/10.15288/jsad.2016.77.201).
This new evidence is important but is not the final word on the topic. It shows how sensitive studies are to misclassification affecting the reference group, while other researchers have focused on different weaknesses in the evidence, using different methods. For example, a meta-analysis by Roerecke and Rehm (2012) showed substantial heterogeneity in associations of low-volume drinking with cardiovascular disease when stratified by sex and outcome, and a Mendelian randomization study (Holmes et al., 2014) supported residual confounding and selection biases as an explanation for the observed effect. In combination, these studies suggest that effects of moderate alcohol on cardiovascular disease and total mortality are poorly estimated and that evidence for causality is weak. There will be value in continuing to pursue this scientific question to put it beyond debate and to better estimate the health impact of alcohol use in populations. The information will also allow individuals to make informed decisions about their own health (www.jsad.com/doi/10.15288/jsad.2016.77.201)...
Zou bier daarom niet in de (nieuwe) schijf van vijf zitten?