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Alcohol consumption in later life and reaching longevity: the Netherlands Cohort Study

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Background: whether light-to-moderate alcohol intake is related to reduced mortality remains a subject of intense research and controversy. There are very few studies available on alcohol and reaching longevity. Methods: we investigated the relationship of alcohol drinking characteristics with the probability to reach 90 years of age. Analyses were conducted using data from the Netherlands Cohort Study. Participants born in 1916-1917 (n = 7,807) completed a questionnaire in 1986 (age 68-70 years) and were followed up for vital status until the age of 90 years (2006-07). Multivariable Cox regression analyses with fixed follow-up time were based on 5,479 participants with complete data to calculate risk ratios (RRs) of reaching longevity (age 90 years). Results: we found statistically significant positive associations between baseline alcohol intake and the probability of reaching 90 years in both men and women. Overall, the highest probability of reaching 90 was found in those consuming 5- < 15 g/d alcohol, with RR = 1.36 (95% CI, 1.20-1.55) when compared with abstainers. The exposure-response relationship was significantly non-linear in women, but not in men. Wine intake was positively associated with longevity (notably in women), whereas liquor was positively associated with longevity in men and inversely in women. Binge drinking pointed towards an inverse relationship with longevity. Alcohol intake was associated with longevity in those without and with a history of selected diseases. Conclusions: the highest probability of reaching 90 years was found for those drinking 5- < 15 g alcohol/day. Although not significant, the risk estimates also indicate to avoid binge drinking.
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Age and Ageing 2020; 49: 395402
doi: 10.1093/ageing/afaa003
Published electronically 9 February 2020
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society.
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RESEARCH PAPER
Alcohol consumption in later life and reaching
longevity: the Netherlands Cohort Study
P A.   B1,2, L B1
1Department of Epidemiology, Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology,
Maastricht, The Netherlands
2Department of Epidemiology, Maastricht University Medical Centre, Care and Public Health Research Institute (CAPHRI),
Maastricht, The Netherlands
Address correspondence to: Piet A. van den Brandt, Depar tment of Epidemiology, Maastricht University Medical Centre,
PO Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 (0)43 3882361; Fax number : +31(0)433884128.
Email: PA.vandenBrandt@maastrichtuniversity.nl
Abstract
Background: whether light-to-moderate alcohol intake is related to reduced mortality remains a subject of intense research
and controversy. ere are very few studies available on alcohol and reaching longevity.
Methods: we investigated the relationship of alcohol drinking characteristics with the probability to reach 90 years of age.
Analyses were conducted using data from the Netherlands Cohort Study. Participants born in 1916–1917 (n=7,807)
completed a questionnaire in 1986 (age 68–70 years) and were followed up for vital status until the age of 90 years (2006–
07). Multivariable Cox regression analyses with fixed follow-up time were based on 5,479 participants with complete data to
calculate risk ratios (RRs) of reaching longevity (age 90 years).
Results: we found statistically significant positive associations between baseline alcohol intake and the probability of reaching
90 years in both men and women. Overall, the highest probability of reaching 90 was found in those consuming 5– <15 g/d
alcohol, with RR =1.36 (95% CI, 1.20–1.55) when compared with abstainers. e exposure-response relationship was
significantly non-linear in women, but not in men. Wine intake was positively associated with longevity (notably in women),
whereas liquor was positively associated with longevity in men and inversely in women. Binge drinking pointed towards an
inverse relationship with longevity. Alcohol intake was associated with longevity in those without and with a history of selected
diseases.
Conclusions: the highest probability of reaching 90 years was found for those drinking 5– <15 g alcohol/day. Although not
significant, the risk estimates also indicate to avoid binge drinking.
Keywords: alcohol, longevity, aging, doseresponse relationship, mortality, cohort s tudies, older people
Key points
• e highest probability of reaching 90 years of age (longevity) was found for men and women drinking 5– <15 g
alcohol/day (or 0.5–1.5 glass/day); the exposure–response relationship was significantly non-linear in women.
Usual drinking pattern and binge drinking were not significantly associated with longevity, but the risk estimates indicate
to avoid binge drinking.
e estimated modest risk ratios (RRs) should not be used as motivation to start drinking if one does not drink alcoholic
beverages.
P. A. van den Brandt and L. Brandts
Introduction
Whether light-to-moderate alcohol intake is related to
reduced mortality remains a subject of intense research and
controversy, e.g. [1,2]. Whereas alcohol consumption has
been studied frequently in relation to mortality (especially
CVD), the findings were inconsistent. Many studies have
reported J-shaped curves relating alcohol to mortality,
suggesting the lowest risk for light-moderate drinkers [2
5], while others found non-significant associations or linear
associations [1,6,7]. Many early cohort studies may
have suffered from ‘abstainer bias’ where ex-drinkers are
misclassified as abstainers and related inclusion of subjects
with chronic diseases (sick quitters), and limited confounder
adjustment [5,6,8]. A recent meta-analysis addressing
these issues [6] found no protective effect of low-moderate
drinking in the subset of studies that controlled for these
biases, but this selection was criticized [9]. While mortality
studies investigate risk factors for premature death (i.e. earlier
than average), longevity studies investigate determinants of
attaining exceptionally high ages (exceeding life expectancy).
e relationship between alcohol and longevity has been
investigated rarely, with survival cut-off ages of 85 [10,11]
or younger [12] in early cohort studies, and 90 in recent
studies [13,14]. Furthermore, most studies involved men
only [10,11,13], did not exclude ex-drinkers and results
were inconsistent.
We investigated the relationship between habitual alcohol
intake in later life and the probability of reaching 90 years
in men and women (because alcohol affects women dif-
ferently from men [15]), within the Netherlands Cohort
Study (NLCS). Given the controversies surrounding light-
to-moderate alcohol intake and mortality, we concentrated
on this category in dose–response modelling. We also aimed
to investigate beverage types, stability of drinking over time
and effect of excluding ex-drinkers, and binge drinking,
because these factors were important in mortality studies.
Methods
Study design and population
For this study, data from the ongoing NLCS were used. e
NLCS started in September 1986 as a large population-based
prospective study, with detailed information on baseline
alcohol use and many confounders available from men and
women [16,17]. Eligible subjects were men and women
living in 204 Dutch municipalities, aged 55–70 years at
cohort baseline (1986). NLCS-participants born in 1916–
1917 were selected to form the longevity cohort for the cur-
rent analyses (i.e. aged 68–70 at baseline), because younger
birth cohorts could not have reached age 90 at the end
of follow-up [14,18]. Vital status follow-up consisted of
record linkage to the Central Bureau for Genealogy and to
municipal population registries from 1986 to 2007, yielding
exact dates of death. Vital status follow-up of the longevity
cohort until age 90 (2006–07) was 99.9% complete; seven
participants were lost to follow-up due to migration. e
resulting study population consisted of 3,646 men and 4,161
women (Appendix-Figure 1).
Exposure assessment
e 11-page baseline questionnaire measured dietary intake,
detailed information on lifestyle factors and medical condi-
tions [16]. Habitual consumption of food and (alcoholic)
beverages during the year preceding baseline was assessed
using a semi-quantitative food-frequency questionnaire
(FFQ), which was validated against a 9-day diet record [19].
Consumption of alcoholic beverages was addressed by
questions on beer, red wine, white wine, sherry and other
fortified wines, liqueur types containing on average 16%
ethanol, and (Dutch) gin, brandy and whiskey. Respondents
who consumed alcoholic beverages less than once a month
were considered non-users. Four items from the question-
naire (i.e. red wine, white wine, sherry and liqueur) were
combined into one wine variable, since these items were sub-
stantially correlated [20]. Mean daily alcohol consumption
was calculated using the Dutch food composition table [21].
e FFQ has been validated and tested for reproducibility
[19,22]. For mean daily ethanol intake, Spearman corre-
lation coefficients between the 9-day diet record and the
questionnaire were 0.89 for all subjects and 0.85 for alcohol
users [19]. e absolute amount of ethanol reported in the
questionnaire by alcohol users was, on average, 86% of that
reported in the 9-day diet record [19].
e baseline questionnaire also asked about the usual pat-
tern of drinking alcoholic beverages (parties only/weekend
and parties/throughout week). To measure binge drinking,
subjects were asked how often they drank more than six
alcoholic drinks per occasion during the half year preceding
baseline. Finally, a question provided information on the
subjects’ drinking habits 5 years before baseline (Appendix
Methods). Ex-drinkers were defined as participants who were
not drinking alcohol at baseline, but who drank alcoholic
beverages 5 years before baseline.
Statistical analyses
Subjects with missing data on alcohol and confounding
variables were excluded. e associations of alcohol con-
sumption, alcoholic beverages and drinking characteristics
with the probability of reaching 90 years (longevity) were
estimated in age(sex) and multivariable-adjusted analyses
using Cox regression models with a fixed follow-up time
[18,23], in categorical and continuous exposure analyses,
correcting for potential confounders (related to longevity
and alcohol (see footnotes in Tables)). Standard errors
were calculated using the Huber–White sandwich estimator
[24]. Ex-drinkers were excluded from the main analyses to
avoid misclassification of ex-drinkers as abstainers. Beverage-
specific analyses for beer, wine and liquor were additionally
mutually adjusted to evaluate the association of each
beverage with longevity independently of other alcoholic
beverages. Analyses of the effect of pattern of drinking, and
396
Alcohol consumption in later life and reaching longevity: the Netherlands Cohort Study
binge drinking, were additionally adjusted for total intake of
alcoholic beverages.
Tests for trends were assessed using Wald tests, by fitting
median values of intake per intake category as continuous
terms. Restricted cubic spline regression analyses using four
knots (at the midpoints of the categories used in categorical
analyses) and Wald test were performed to test for non-
linearity. We conducted sensitivity analyses, by restricting
analyses to participants who reported to have had the same
alcohol intake 5 years before baseline, including abstainers
on both occasions (i.e. the stable subgroup). To evaluate
potential residual confounding by other risk factors, and
effect modification, analyses of alcohol and longevity were
also conducted within strata of covariables. Interactions were
tested using Wald tests and cross-product terms. Analyses
were performed using Stata 14; presented P-values are two-
sided.
e NLCS study was approved by the Medisch-Ethische
Toetsinngscommissie (METC), Maastricht University Med-
ical Centre, Maastricht, the Netherlands.
Results
Amongst the 2,591 men, 433 (16.7%) survived until
90 years, and there were 994 survivors (34.4%) amongst
the 2,888 women. In the total group, 40 men and 32
women were ex-drinkers. When excluding ex-drinkers,
the proportion of alcohol abstainers was higher amongst
non-survivors than survivors in both men (15.6% versus
10.6%) and women (37.4% and 30.1%). Amongst male
alcohol consumers, mean intake (SD) was 16.5 (15.8) g/day
in non-survivors and 15.9 (14.9) g/day in survivors. For
women, these numbers were 8.0 (10.5) and 7.2 (9.0) g/day,
respectively. Appendix Table 1 also shows these comparisons
for beverage types (glasses/week), pattern of drinking, stable
drinking and binge drinking. e proportion of binge
drinkers was higher amongst non-survivors than survivors,
and higher in men: 18.5% versus 14.2% in men, and 6.1%
versus 4.0% in women, respectively. Alcohol consumption
was positively associated with smoking, educational level
and energy intake in both sexes, with physical activity in
women, and with BMI and height in men (Appendix Table
2). ere was no clear association with history of selected
diseases. Ex-drinkers more often had a history of selected
diseases than those in other drinking categories. Excluded
subjects with missings had a lower likelihood of reaching 90,
were less often smokers and less highly educated (Appendix
Table 3).
Alcohol intake was positively associated with the
probability of reaching 90 years in men and women in
multivariable-adjusted analyses (Table 1). In analyses of men
and women combined, those drinking 5– <10 g alcohol/day
had a RR of 1.41 (95%CI, 1.21–1.63) of reaching 90,
compared to abstainers. is probability remained elevated
at higher alcohol intake levels (P-trend = 0.014). Ex-drinkers
had a decreased probability of reaching 90, when compared
to abstainers. Ex-drinkers were excluded from subsequent
analyses. When alcohol was analysed as continuous variable,
the RR per increment of 10 g/d was 1.05 (95%CI 1.01–
1.09). In analyses limited to the stable subgroup, similar
associations were seen as in the overall group. ere was no
statistically significant interaction between men and women
(P= 0.168). However, the estimated associations showed
differences: whereas in men the probability of reaching 90
remained elevated at higher alcohol consumption levels
(e.g. RR = 1.64 (1.15–2.34) for men drinking 30+g/day
compared to abstainers), this was not seen in women with
RR = 0.99 (0.69–1.44). is difference in dose–response
was also noticed in restricted cubic splines analyses, where a
significantly non-linear relationship was observed in women
(Pfor non-linearity =0.004), but not in men (Figure 1). We
therefore continued with sex-specific analyses.
In beverage-specific analyses, we found no association
with beer intake (Table 2). Wine intake was associated
with higher chances of reaching 90 amongst women,
with RRs of 1.43 (95%CI 1.21–1.68) and 1.35 (1.14–
1.59) for women drinking 3.5– <7and7+glasses/week,
respectively, when compared to non-drinkers of wine (P-
trend <0.001, and P-trend = 0.049 amongst wine drinkers).
For men, the weakly positive associations with wine were
non-significant. Liquor intake was significantly positively
associated with longevity amongst men in several drinking
categories compared to non-drinkers of liquor, but the trend
test and continuous analyses were not significant. In women,
however, higher liquor intake was inversely associated with
longevity (P-trend = 0.044, and P-trend = 0.018 amongst
liquor drinkers).
ere was no significant association with pattern of drink-
ing (Appendix Table 4). Although binge drinkers seemed
to have a lower probability of reaching 90 than non-binge
drinkers, especially in women, the multivariable-adjusted
associations were non-significant. is may be due to the
small proportion of binge drinking women. When binge
drinking was further categorized according to frequency,
lower chances of longevity were found in more frequently
binge drinking men, but the trend test was not significant.
In subgroup analyses of alcohol and longevity, categorical
(or continuous) alcohol intake showed no significant inter-
actions with smoking status, BMI, physical activity, level of
education or history of diseases at baseline (Appendix Table
5). Significant associations between alcohol and probability
of reaching 90 were seen in many subgroups, including never
and current smokers, and those with or without a history of
selected diseases. e highest RRs were generally observed in
those drinking 5– <15 g/day.
Discussion
In this large prospective study, we found statistically signif-
icant positive associations between alcohol intake and the
probability of reaching 90 years in both men and women.
Overall, the highest probability was found in those con-
suming 5– <15 g/d alcohol, which corresponds to 0.5–1.5
glass of alcoholic beverage per day. e exposure–response
397
P. A. van den Brandt and L. Brandts
Tabl e 1 . Age- and multivariable-adjustedaRRs for reaching longevity according to alcohol intake in birth cohort 1916–17; Netherlands Cohort Study (1986–2007)
Alcohol (g/day) Continuousb,
per 10 g/d
Pfor
interactionb
Ex, 0 g/d Abstainers >0– <5g/d 5<10 g/d 10– <15 g/d 15– <30 g/d 30+g/d Pfor trendb
...............................................................................................................
Men and women
Overall
Median intake (g/day) 0.0 0.0 1.6 7.2 12.1 21.4 39.5
N72 1391 1710 597 520 742 447
Survivors(90+)11 345 507 181 131 166 86
Age-sex-adjusted RR 0.74 1 1.26 1.49 1.32 1.24 1.15 0.391 1.01
(95 %CI) (0.43–1.30) (Ref.) (1.13–1.42) (1.28–1.73) (1.11–1.56) (1.06–1.46) (0.93–1.43) (0.97–1.05)
Multivariable-adjusted RRa0.84 1 1.19 1.41 1.30 1.29 1.31 0.014 1.05 0.168
(95 %CI) (0.48–1.47) (Ref.) (1.07–1.33) (1.21–1.63) (1.10–1.55) (1.10–1.52) (1.06–1.63) (1.01–1.09)
Stable subgroup
Median intake (g/day) 0.0 1.8 7.2 12.1 22.0 40.0
N 1180 907 364 319 467 292
Survivors(90+) 288 287 114 83 109 60
Age-sex-adjusted RR 1 1.37 1.52 1.34 1.28 1.18 0.364 1.01
(95 %CI) (Ref.) (1.20–1.57) (1.27–1.82) (1.09–1.64) (1.05–1.55) (0.92–1.52) (0.97–1.06)
Multivariable-adjusted RRa1 1.25 1.42 1.30 1.31 1.36 0.024 1.05 0.468
(95 %CI) (Ref.) (1.09–1.43) (1.18–1.70) (1.05–1.60) (1.08–1.59) (1.05–1.76) (1.00–1.11)
Men
Median intake (g/day) 0.0 0.0 2.1 7.4 12.1 22.4 40.6
N40 383 618 335 332 527 356
Survivors(90+)646 106 75 52 84 64
Age-adjusted RR 1.24 1 1.43 1.86 1.31 1.33 1.50 0.453 1.01
(95 %CI) (0.56–2.72) (Ref.) (1.04–1.97) (1.33–2.61) (0.90–1.89) (0.95–1.86) (1.06–2.13) (0.96–1.07)
Multivariable-adjusted RRa1.49 1 1.39 1.81 1.37 1.43 1.64 0.100 1.04
(95 %CI) (0.69–3.23) (Ref.) (1.01–1.90) (1.30–2.53) (0.95–1.97) (1.02–1.99) (1.15–2.34) (0.98–1.10)
Wom en
Median intake (g/day) 0.0 0.0 1.4 7.2 12.1 20.7 35.6
N32 1008 1092 262 188 215 91
Survivors(90+)5299 401 106 79 82 22
Age-adjusted RR 0.53 1 1.24 1.36 1.42 1.29 0.81 0.526 1.01
(95 %CI) (0.23–1.18) (Ref.) (1.09–1.40) (1.14–1.62) (1.17–1.72) (1.06–1.56) (0.56–1.19) (0.96–1.07)
Multivariable-adjusted RRa0.62 1 1.17 1.28 1.38 1.31 0.99 0.078 1.05
(95 %CI) (0.27–1.38) (Ref.) (1.03–1.32) (1.08–1.52) (1.13–1.68) (1.08–1.60) (0.69–1.44) (0.99–1.11)
aMultivariable analyses were adjusted for: age at baseline (continuous, in years), tobacco smoking status (coded as never, former, current smoker), number of cigarettes smoked per day, and years of smoking (both
continuous, centered), body height (continuous, m), BMI (<18.5, 18.5– <25, 25– <30, 30 kg/m2), non-occupational physical activity (<30, 30–60, 61–90, 90 min/day), history of selected diseases at baseline
(physician-diagnosed myocardial infarction, angina pectoris, stroke, cancer (excluding skin cancer), diabetes and hypertension; categorized as 0,1,2,3+diseases), highest level of education (primary school or lower
vocational, secondary or medium vocational, and higher vocational or university), energy intake (continuous, kcal/day). bExcluding ex-drinkers
398
Alcohol consumption in later life and reaching longevity: the Netherlands Cohort Study
Tabl e 2 . Age- and multivariable-adjusted RRs for reaching longevity according to intake of specific alcoholic beverages in birth cohort 1916–17; Netherlands Cohort
Study (1986–2007)
Men Women
Alcoholic beverage Median
(gl/wk)
N90+RRa(95% CI) RRb(95% CI) Median
(gl/wk)
N90+RRa(95% CI) RRb(95% CI)
...............................................................................................................
Beer (glasses/week)
No 0.0 1388 221 1 (reference) 1 (reference) 0.0 2665 919 1 (reference) 1 (reference)
>0– <3.5 1.0 764 144 1.18 (0.98–1.43) 1.03 (0.85–1.25) 0.5 173 63 1.06 (0.86–1.30) 1.00 (0.82–1.22)
3.5– <7 5.0 198 33 1.05 (0.75–1.46) 1.00 (0.71–1.39) 5.0 13 6 1.33 (0.74–2.41) 1.22 (0.70–2.12)
7+gl/wk 13.0 201 29 0.91 (0.63–1.29) 0.92 (0.64–1.31) 13.0 5 1 0.58 (0.10–3.32) 0.61 (0.09–4.09)
Pfor trend 0.493 0.611 0.970 0.857
Ptrend, beer drinkers 0.140 0.545 0.768 0.913
Continuous, per 7 gl/wk 2551 427 0.98 (0.85–1.13) 1.01 (0.86–1.18) 2856 989 1.00 (0.59–1.70) 0.97 (0.55–1.73)
Pfor interaction by sex 0.739
Wine (glasses/week)
No 0.0 1149 159 1 (reference) 1 (reference) 0.0 1099 321 1 (reference) 1 (reference)
>0– <3.5 1.0 881 167 1.37 (1.12–1.67) 1.17 (0.95–1.44) 1.0 1135 413 1.25 (1.10–1.40) 1.16 (1.03–1.30)
3.5– <7 5.0 236 49 1.50 (1.12–2.00) 1.15 (0.85–1.55) 5.1 265 116 1.50 (1.27–1.77) 1.43 (1.21–1.68)
7+gl/wk 13.0 285 52 1.32 (0.99–1.76) 1.08 (0.81–1.46) 13.0 357 139 1.33 (1.14–1.56) 1.35 (1.14–1.59)
Pfor trend 0.087 0.880 0.001 <0.001
Ptrend, wine drinkers 0.825 0.400 0.287 0.049
Continuous, per 7 gl/wk 2551 427 1.08 (0.99–1.19) 1.04 (0.94–1.16) 2856 989 1.09 (1.02–1.16) 1.11 (1.04–1.19)
Pfor interaction by sex 0.555
Liquor (glasses/week)
No 0.0 1011 156 1 (reference) 1 (reference) 0.0 2531 889 1 (reference) 1 (reference)
>0– <3.5 1.2 603 120 1.29 (1.04–1.60) 1.34 (1.08–1.67) 1.0 185 70 1.08 (0.89–1.31) 1.02 (0.85–1.24)
3.5– <7 5.0 365 55 0.98 (0.74–1.30) 1.12 (0.83–1.49) 6.5 81 19 0.67 (0.45–0.99) 0.72 (0.49–1.07)
7+gl/wk 13.0 572 96 1.09 (0.86–1.37) 1.30 (1.02–1.66) 13.0 59 11 0.53 (0.31–0.91) 0.67 (0.40–1.15)
Pfor trend 0.956 0.172 0.003 0.044
Ptrend, liquor drinkers 0.257 0.919 0.003 0.018
Continuous, per 7 gl/wk 2551 427 0.97 (0.89–1.07) 1.05 (0.95–1.16) 2856 989 0.69 (0.54–0.89) 0.78 (0.60–1.01)
Pfor interaction by sex 0.062
aAge-adjusted analyses.
bMultivariable analyses were adjusted for: age at baseline (continuous, in years), tobacco smoking status (coded as never, former, current smoker), number of cigarettes smoked per day, and years of smoking (both
continuous, centered), body height (continuous, m), BMI (<18.5, 18.5– <25, 25– <30, 30 kg/m2), non-occupational physical activity (<30, 30–60, 61–90, 90 min/day), history of selected diseases at baseline
(physician-diagnosed myocardial infarction, angina pectoris, stroke, cancer (excluding skin cancer), diabetes and hypertension; categorized as 0,1,2,3+diseases), highest level of education (primary school or lower
vocational, secondary or medium vocational, and higher vocational or university), energy intake (continuous, kcal/day), intake of the other two types of alcoholic beverages (each categorical).
399
P. A. van den Brandt and L. Brandts
Figure 1. Spline regression curves for the association of alcohol consumption with the probability of reaching longevity in men
and women separately. Red lines: men. Blue lines: women. Solid lines represent point estimates and dashed lines represent 95%
confidence intervals. Multivariate HRs are calculated by restricted cubic spline regression adjusting for: age at baseline (continuous,
in years), tobacco smoking status (coded as never, former, current smoker), number of cigarettes smoked per day, and years of
smoking (both continuous, centered), body height (continuous, m), BMI (<18.5, 18.5– <25, 25– <30, 30 kg/m2), non-
occupational physical activity (<30, 30–60, 61–90, 90 min/day), history of selected diseases at baseline (physician-diagnosed
myocardial infarction, angina pectoris, stroke, cancer (excluding skin cancer), diabetes and hypertension; categorized as 0,1,2,3+
diseases), highest level of education (primary school or lower vocational, secondary or medium vocational, and higher vocational or
university), energy intake (continuous, kcal/day).
relationship was significantly non-linear in women, but not
in men. Whereas the probability of longevity was decreasing
in women with alcohol intakes above 15 g/d, it remained
elevated at higher alcohol consumption levels in men. In
beverage-specific analyses, wine intake was positively asso-
ciated with longevity (notably in women), whereas liquor
was positively associated with longevity in men and inversely
in women. Binge drinking was not significantly associated
with longevity, but the risk estimates indicate to avoid binge
drinking. In subgroup analyses, alcohol intake was associated
with longevity in those with or without a history of selected
diseases.
Previous prospective studies on longevity from the US
and France that reported on alcohol were rather limited (no
alcohol focus) and found no significant associations using
longevity cut-offs of 75 [12] and 90 years [13,25]. However,
higher alcohol intakes were seen in survivors compared
to non-survivors [25], and in subsequent analyses (85+
years) of the Framingham Heart Study [26]. e Physicians
Health Study amongst US male physicians (survival cut-off
90) reported small and non-significantly increased chances
of longevity for various drinking categories compared to
rarely/never alcohol drinkers, with no dose–response rela-
tionship [13]. e association between alcohol drinking and
longevity was studied twice in the Honolulu Heart Program
(HHP) amongst Japanese-American men using 85 years as
longevity cut-off [10,11]. Heavy alcohol intake, measured at
baseline age 45–68 years, was significantly inversely related
to longevity (OR = 0.63, for 3+drinks/day versus drinking
less) [10]. In the second analysis, moderate-heavy alcohol
intake around 75 years was also significantly inversely related
to longevity (OR = 0.66, for drinking >14.5 g/day versus
less) [11]. e fact that the HHP study was conducted
amongst men of Japanese ancestry may (partly) explain the
more negative association of alcohol with longevity, and
suggests a potential mechanism. It is known that East Asians
are less efficient alcohol metabolizers due to a common loss-
of-function variant of the ALDH2-gene, which decreases
breakdown of acetaldehyde, the first, toxic alcohol metabo-
lite [27]. It could be that those who nevertheless drink
experience a higher mortality risk.
Overall, the results of previous longevity studies seem
quite limited. Our detailed analyses show significantly pos-
itive associations between alcohol and longevity in both
men and women, which is in agreement with the PHS
[13]. Overall in men and women combined in the NLCS,
the highest probability of reaching 90 was found in those
consuming 5– <15 g/d alcohol, with a HR of 1.36 com-
pared to abstainers. Women experience higher blood alcohol
concentrations than men of similar weight due to lower
total body water [15]. us, adverse effects of higher alcohol
intakes may appear earlier in women. is might explain
400
Alcohol consumption in later life and reaching longevity: the Netherlands Cohort Study
the non-linear exposure–response relationship in women
and not in men. We also found that wine intake was posi-
tively associated with longevity, whereas liquor was positively
associated with longevity in men, and inversely in women.
Before speculating on reasons for these beverage differences,
future longevity studies are needed to replicate these sex-
specific findings, with those on pattern and binge drinking.
In mortality studies, there was no clear indication for sex
differences [2,5], and although beneficial associations with
wine have been described for mortality, e.g. [2], this topic
remains controversial.
As in observational studies on alcohol and mortality
[1,2,8], studies on alcohol and longevity may be ham-
pered by possible biases (selection and residual confounding
biases). Here, selection bias can refer to abstainer bias (when
the reference category of non-drinkers also includes sick
quitters), the healthy drinker/survivor bias (when cohorts
of older participants may be overrepresented by healthier
drinkers who may have survived adverse effects of alcohol).
Reverse causation may occur because health status may
influence alcohol drinking [8], which could be addressed by
restricting analyses to healthy people at baseline. Incomplete
adjustment for confounding factors may lead to residual
confounding. In our longevity analysis, we tried to address
these possible biases by: (i) excluding ex-drinkers from the
reference category; (ii) limiting analyses to stable drinkers
and abstainers by taking alcohol consumption 5 years before
baseline into account; (iii) restricting analyses to participants
without prevalent diseases and (iv) adjusting for a large range
of possible confounders with detailed information. ese
analysis strategies do not necessarily provide a full remedy
against all possible biases [8], but these were the possibilities
with the available data from our cohort. For example, we
had no information on lifetime alcohol consumption or
consumption on various ages during lifetime, so our anal-
ysis of past consumption was limited. After excluding ex-
drinkers from the reference category, the analyses in the
stable subgroup were essentially similar to what was seen
overall. We also found that alcohol intake was associated
with longevity in the subgroup without a history of selected
diseases. Still, other diseases might have affected alcohol use
or longevity. Residual confounding by socioeconomic status
is also possible, because we only controlled for educational
level.
It should be noted that the percentages of never drinkers
were relatively high in the NLCS: 15% in men and 35% in
women, making this common behaviour a logical reference
category. ese percentages were substantially higher than in
other cohorts, e.g. 8% in male and 16% in female PLCO-
participants [2], and 6% in male and 16% in female EPIC-
participants [28]. Strengths of the NLCS are the prospective
design and high completeness of follow-up, making
information bias and selection bias due to differential follow-
up unlikely. e validation study of the food frequency
questionnaire has shown that it performs relatively well
with respect to alcohol [19], but measurement error may
still have attenuated associations. e lack of possibilities
to update alcohol intake or other lifestyle data during
follow-up may have resulted in some attenuated associations
too. Our study was aimed at measuring alcohol intake at 68–
70 years. erefore, our study results are limited to alcohol
drinking in later life; future longevity studies preferably
include lifetime consumption. e alcohol measures in our
study were not aimed to get an all-encompassing indication
of risky drinking, like in the Alcohol Use Disorders Identifi-
cation Test/AUDIT [29]. Our cut-off for binge drinking
(>6 drinks per occasion) as used in the 1980s/1990s
[29,30] is somewhat higher than current cut-offs [29].
Because we were interested in the association of late life
drinking with longevity, our study likely examined a resilient
population that survived already until 68 years despite
possible earlier risky drinking.
While older people perceive themselves as controlled
responsible drinkers, according to a recent thematic synthesis
of qualitative studies, they consider alcohol use often as
important part of social occasions, and report that alcohol
helps creating feelings of relaxation [31]. A possible ben-
eficial effect of light-moderate alcohol intake on longevity
(with inverted J-shaped dose-response on longevity) may
also be related to hormesis [32,33]. With higher con-
sumption in older people, medication may be negatively
affected by alcohol, and there is decreased physiological
tolerance [34].
In conclusion, in this prospective study of men and
women aged 68–70 years at baseline, we found the highest
probability of reaching 90 years of age for those drinking
5– <15 g alcohol/day. is does not necessarily mean that
light-to-moderate drinking improves health. e estimated
RR of 1.36 implies a modest absolute increase in this proba-
bility and should not be used as motivation to start drinking
if one does not drink alcoholic beverages. Although no
significant association was found, the risk estimates also
indicate to avoid binge drinking.
Supplementary data: Supplementary data mentioned in
the text are available to subscribers in Age and Ageing online.
Declaration of conflicts of interest: None.
Acknowledgements: e authors wish to thank the partic-
ipants of this study, Statistics Netherlands, and the Central
Bureau for Genealogy (CBG) for providing data and the
staff of the Netherlands Cohort Study for their valuable
contributions.
Declaration of sources of funding: None.
References
1. Wood AM, Kaptoge S, Butterworth AS et al. Risk thresholds
for alcohol consumption: combined analysis of individual-
participant data for 599 912 current drinkers in 83 prospective
studies. Lancet 2018; 391: 1513–23.
2. Kunzmann AT, Coleman HG, Huang WY et al. e associa-
tion of lifetime alcohol use with mortality and cancer risk in
older adults: a cohort study. PLoS Med 2018; 15: e1002585.
401
P. A. van den Brandt and L. Brandts
3. Di A, Costanzo S, Bagnardi V et al. Alcohol dosing and
total mortality in men and women: an updated meta-analysis
of 34 prospective studies. Arch Intern Med 2006; 166:
2437–45.
4. Bergmann MM, Rehm J, Klipstein-Grobusch K et al. e
association of pattern of lifetime alcohol use and cause of death
in the European prospective investigation into cancer and
nutrition (EPIC) study. Int J Epidemiol 2013; 42: 1772–90.
5. Xi B, Veeranki SP, Zhao M et al. Relationship of alcohol
consumption to all-cause, cardiovascular, and cancer-related
mortality in U.S adults. J Am Coll Cardiol 2017; 70: 913–22.
6. Stockwell T, Zhao J, Panwar S et al. Do "moderate" drinkers
have reduced mortality risk? A systematic review and meta-
analysis of alcohol consumption and all-cause mortality. J Stud
Alcohol Drugs 2016; 77: 185–98.
7. Knott CS, Coombs N, Stamatakis E et al. All cause mortality
and the case for age specific alcohol consumption guidelines:
pooled analyses of up to 10 population based cohorts. BMJ
2015; h384: 350.
8. Ortola R, Garcia-Esquinas E, Lopez-Garcia E et al. Alcohol
consumption and all-cause mortality in older adults in Spain:
an analysis accounting for the main methodological issues.
Addiction 2019; 114: 59–68.
9. Barrett-Connor E, de G, Djousse L et al. Comments on
moderate alcohol consumption and mortality. J Stud Alcohol
Drugs 2016; 77: 834–6.
10. WillcoxBJ,HeQ,ChenRet al. Midlife risk factors and
healthy survival in men. JAMA 2006; 296: 2343–50.
11. Bell CL, Chen R, Masaki K et al. Late-life factors associated
with healthy aging in older men. J Am Geriatr Soc 2014; 62:
880–8.
12. Goldberg RJ, Larson M, Levy D. Factors associated with
survival to 75 years of age in middle-aged men and women.
e Framingham Study. Arch Intern Med 1996; 156: 505–9.
13. Yates LB, Djousse L, Kurth T et al. Exceptional longevity in
men: modifiable factors associated with survival and function
to age 90 years. Arch Intern Med 2008; 168: 284–90.
14. Brandts L, van den Brandt PA. Body size, non-occupational
physical activity and the chance of reaching longevity in men
and women: findings from the Netherlands cohort study. J
Epidemiol Community Health 2019; 73: 239–49.
15. Mumenthaler MS, Taylor JL, O’Hara R et al. Gender differ-
ences in moderate drinking effects. Alcohol Res Health 1999;
23: 55–64.
16. van den Brandt PA, Goldbohm RA, van ’t Veer P et al. A
large-scale prospective cohort study on diet and cancer in the
Netherlands. J Clin Epidemiol 1990; 43: 285–95.
17. van den Brandt PA, Schouten LJ, Goldbohm RA et al. Devel-
opment of a record linkage protocol for use in the Dutch
cancer registry for epidemiological research. Int J Epidemiol
1990; 19: 553–8.
18. Brandts L, van den Brandt PA. Sex-specific associations
between smoking habits and reaching longevity: Netherlands
cohort study. Geriatr Gerontol Int 2018; 18: 1249–58.
19. Goldbohm RA, van den Brandt PA, Brants HA et al. Valida-
tion of a dietary questionnaire used in a large-scale prospective
cohort study on diet and cancer. Eur J Clin Nutr 1994; 48:
253–65.
20. Goldbohm RA, van den Brandt PA, Van ’t Veer P et al.
Prospective study on alcohol consumption and the risk of
cancer of the colon and rectum in the Netherlands. Cancer
Causes Control 1994; 5: 95–104.
21. Nevo-Table. Dutch Food Composition Table 1986–1987;
Nederlands voedingsstoffenbestand 1986–1987; 1986.
22. Goldbohm RA, van ’t Veer P, van den Brandt PA et al.
Reproducibility of a food frequency questionnaire and stabil-
ity of dietary habits determined from five annually repeated
measurements. Eur J Clin Nutr 1995; 49: 420–9.
23. Breslow N. Covariance analysis of censored survival data.
Biometrics 1974; 30: 89–99.
24. Barros AJ, Hirakata VN. Alternatives for logistic regression
in cross-sectional studies: an empirical comparison of models
that directly estimate the prevalence ratio. BMC Med Res
Methodol 2003; 3: 21.
25. Edjolo A, Helmer C, Barberger-Gateau P et al. Becoming a
nonagenarian: factors associated with survival up to 90 years
old in 70+men and women. Results from the PAQUID
longitudinal cohort. J Nutr Health Aging 2013; 17: 881–92.
26. Terry DF, Pencina MJ, Vasan RS et al. Cardiovascular risk
factors predictive for survival and morbidity-free survival in
the oldest-old Framingham heart study participants. J Am
Geriatr Soc 2005; 53: 1944–50.
27. Edenberg HJ, McClintick JN. Alcohol dehydrogenases, alde-
hyde dehydrogenases, and alcohol use disorders: a critical
review. Alcohol Clin Exp Res 2018; 42: 2281–97.
28. Muller DC, Murphy N, Johansson M et al. Modifiable causes
of premature death in middle-age in Western Europe: results
from the EPIC cohort study. BMC Med 2016; 14: 87.
29. Aalto M, Alho H, Halme JT et al. AUDIT and its abbreviated
versions in detecting heavy and binge drinking in a general
population survey. Drug Alcohol Depend 2009; 103: 25–9.
30. Haines M, Spear SF. Changing the perception of the norm: a
strategy to decrease binge drinking among college students. J
Am Coll Health 1996; 45: 134–40.
31. Bareham BK, Kaner E, Spencer LP et al. Drinking in later
life: a systematic review and thematic synthesis of qualitative
studies exploring older people’s perceptions and experiences.
Age Ageing 2019; 48: 134–46.
32. Hayes DP. Nutritional hormesis. Eur J Clin Nutr 2007; 61:
147–59.
33. Calabrese EJ, Mattson MP. How does hormesis impact biol-
ogy, toxicology, and medicine? NPJ Aging Mech Dis 2017; 3:
13.
34. Blow FC, Barry KL. Alcohol and substance misuse in older
adults. Curr Psychiatry Rep 2012; 14: 310–9.
Received 21 June 2019; editorial decision 04 November
2019
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Background: Previous studies have revealed inconsistent findings regarding the association of light to moderate alcohol consumption with cardiovascular disease (CVD) and cancer mortality. Objectives: The aim of this study was to examine the association between alcohol consumption and risk of mortality from all causes, cancer, and CVD in U.S. adults. Methods: Data were obtained by linking 13 waves of the National Health Interview Surveys (1997 to 2009) to the National Death Index records through December 31, 2011. A total of 333,247 participants ≥18 years of age were included. Self-reported alcohol consumption patterns were categorized into 6 groups: lifetime abstainers; lifetime infrequent drinkers; former drinkers; and current light, moderate, or heavy drinkers. Secondary exposure included participants' binge-drinking status. The main outcome was all-cause, cancer, or CVD mortality. Results: After a median follow-up of 8.2 years (2.7 million person-years), 34,754 participants died of all causes (including 8,947 CVD deaths and 8,427 cancer deaths). Compared with lifetime abstainers, those who were light or moderate alcohol consumers were at a reduced risk of mortality for all causes (light-hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.76 to 0.82; moderate-HR: 0.78; 95% CI: 0.74 to 0.82) and CVD (light-HR: 0.74; 95% CI: 0.69 to 0.80; moderate-HR: 0.71; 95% CI: 0.64 to 0.78), respectively. In contrast, there was a significantly increased risk of mortality for all causes (HR: 1.11; 95% CI: 1.04 to 1.19) and cancer (HR: 1.27; 95% CI: 1.13 to 1.42) in adults with heavy alcohol consumption. Binge drinking ≥1 d/week was also associated with an increased risk of mortality for all causes (HR: 1.13; 95% CI: 1.04 to 1.23) and cancer (HR: 1.22; 95% CI: 1.05 to 1.41). Conclusions: Light and moderate alcohol intake might have a protective effect on all-cause and CVD-specific mortality in U.S. adults. Heavy or binge drinking was associated with increased risk of all-cause and cancer-specific mortality.
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Introduction The rising number of obese and/or physically inactive individuals might negatively impact human lifespan. This study assessed the association between height, body mass index (BMI) and non-occupational physical activity and the likelihood of reaching 90 years of age, in both sexes separately. Methods Analyses were conducted using data from the Netherlands Cohort Study. Participants born in 1916–1917 (n=7807) completed a questionnaire in 1986 (at age 68–70 years) and were followed up for vital status information until the age of 90 years (2006–2007). Cox regression analyses were based on 5479 participants with complete data to calculate risk ratios (RRs) of reaching longevity (age 90 years). Results In women, we observed significant associations between reaching longevity and height (RR: 1.05 per 5 cm increment; 95% CI 1.00 to 1.09), BMI at baseline (≥30vs18.5–<25 kg/m ² ; RR: 0.68; 95% CI 0.54 to 0.86) and BMI change since age 20 years (≥8vs0–<4 kg/m ² ; RR: 0.81; 95% CI 0.66 to 0.98). In men, height and BMI were not associated with reaching longevity. In women, non-occupational physical activity showed an inverse U-shaped association with reaching longevity, with the highest RR around 60 min of physical activity per day. In men, a positive linear association was observed between physical activity and reaching longevity. Conclusion This study indicates that body size and physical activity are related to the likelihood of reaching 90 years of age and that these associations differ by sex.
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Alcohol use disorders (AUD) are complex traits, meaning that variations in many genes contribute to the risk, as does the environment. Although the total genetic contribution to risk is substantial, most individual variations make only very small contributions. By far the strongest contributors are functional variations in two genes involved in alcohol (ethanol) metabolism. A functional variant in alcohol dehydrogenase 1B (ADH1B) is protective in people of European and Asian descent, and a different functional variant in the same gene is protective in those of African descent. A strongly protective variant in aldehyde dehydrogenase 2 (ALDH2) is essentially only found in Asians. This highlights the need to study a wide range of populations. The likely mechanism of protection against heavy drinking and AUD in both cases is alteration in the rate of metabolism of ethanol that at least transiently elevates acetaldehyde. Other ADH and ALDH variants, including functional variations in ADH1C, have also been implicated in affecting drinking behavior and risk for alcoholism. The pattern of linkage disequilibrium in the ADH region, and the differences among populations, complicate analyses, particularly of regulatory variants. This critical review focuses upon the ADH and ALDH genes as they affect AUDs. This article is protected by copyright. All rights reserved.
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Background and aims Observational evidence that light‐to‐moderate alcohol consumption lowers mortality is questioned because of potential selection biases and residual confounding. We assess the association between alcohol intake and all‐cause death in older adults after accounting for those methodological issues. Methods Data came from 3045 individuals representative of the non‐institutionalized population aged ≥60 years in Spain. Participants were recruited in 2008‐2010, when they reported current and lifetime alcohol intake; drinkers were classified as occasional (<1.43g/day), light (1.43 to <20g/day for men and 1.43 to <10g/day for women), moderate (20 to <40g/day for men and 10 to <20g/day for women) or heavy (≥40g/day for men and ≥24g/day for women)/binge. Participants were followed‐up through 2017 to assess vital status. In analyses, ex‐drinkers were removed from the abstainer group and were classified according to their lifetime intake to address the “abstainer bias”. Moreover, analyses were replicated in individuals without functional limitations, and excluded deaths in the first year of follow‐up, to address reverse causation. Also, occasional drinkers were used as reference in some analyses to reduce the “healthy drinker/survivor” bias. Results were adjusted for many covariates to minimize residual confounding. Results Compared with never‐drinkers, the hazard ratio (95% confidence interval) of mortality for light drinkers was 1.05 (0.71‐1.56) and 1.20 (0.72‐2.02) in those without functional limitations. Corresponding values for moderate drinkers were 1.28 (0.81‐2.02) and 1.55 (0.87‐2.75), and for heavy/binge drinkers 1.85 (1.07‐3.23) and 2.15 (1.09‐4.22). Results were consistent when occasional drinkers were used as reference. Among drinkers without functional limitations, the hazard ratio (95% confidence interval) of mortality per 10g/day of alcohol was 1.12 (1.02‐1.23). Conclusion After accounting for potential biases, light‐to‐moderate drinking among people 60+ years of age appears to have no statistically significant benefit on mortality compared with abstention from alcohol. By contrast, heavy/binge drinking shows higher death risk compared with abstention from alcohol. Alcohol intake appears to have a positive dose‐response with mortality among drinkers.
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Introduction In developed countries, the rising number of obese- and/or physically inactive individuals might negatively impact human lifespan. The aim of this study was to quantity the association between body size and non-occupational physical activity, and the chance of reaching longevity (defined as 90 years of age), in men and women separately. Methods For this study, data from the oldest birth cohort (1916–17) of the Netherlands Cohort Study (NLCS) was used. Participants (n = 7807) completed a baseline questionnaire in 1986 (at age 68–70). Follow-up for vital status information until the age of 90 years (2006–07) was > 99.9% complete. Multivariable-adjusted Cox regression analyses were based on 5479 participants with complete exposure and co-variable data to calculate risk ratios (RR) of reaching longevity. Results In women, increasing height was positively associated with reaching longevity [RR: 1.05; 95% confidence interval (CI): 1.00–1.09 per 5 cm increment]. Significantly inverse associations were observed between reaching longevity and BMI at baseline (≥ 30 vs. 18.5–< 25 kg/m²; RR: 0.68; 95% CI: 0.54–0.86) and BMI change since the age of 20 years (BMI ≥ 8 vs. 0–< 4 kg/m²; RR: 0.81; 95% CI: 0.66–0.98). In men, no significant associations were found between body size and longevity. A positive linear relationship was found between non-occupational physical activity and reaching longevity in men (RR: 1.05; 95% CI, 1.02–1.09 per 30 min/day increment), while in women the association between physical activity and longevity showed an inverse U-shaped association, with an optimal level of physical activity between ≥ 30 and 60 min/day (RR: 1.21; 95% CI: 1.07–1.37) compared to 0–< 30 min/day. Conclusion Body size at the age of 68–70 years showed significant associations with the chance of reaching longevity in women, but not in men. Increasing levels of non-occupational physical activity were significantly associated with an increased chance of reaching longevity in both sexes, but evidence for a non-linear relationship was found in women.