The impact of alcohol consumption on health is considerable. According to the World Health Organization (WHO), 2.6 million deaths are attributable to alcohol consumption every year, representing 4.7 % of total global mortality. Some 400 million people – around 7 % of the world’s population aged over 15 – suffer from alcohol use disorders, and of those, 209 million live with alcohol dependence.
Alcohol consumption is associated with the development of liver, gastrointestinal and pancreatic diseases, cardiovascular and neurological disorders, and various types of cancer, including breast, liver, oesophageal and oral cavity cancers. Added to this is its role in road traffic accidents, injuries, violence, and social and work-related problems. In Spain, alcohol is the second leading preventable cause of mortality, responsible for around 4 % of annual deaths, and has a particularly high impact on the young population, due to both road traffic accidents and to violence and injuries.
However, various studies have also pointed out possible benefits of moderate alcohol consumption for health overall, which has contributed to a complex scientific and social debate. Numerous observational studies have described how individuals with low or moderate levels of consumption present a lower cardiovascular risk and lower mortality than heavy drinkers and, in some analyses, even lower than those who abstain entirely. These results have been observed more consistently when consumption occurs within the context of a Mediterranean dietary pattern, involving small amounts of wine, preferably red, consumed with meals, spread throughout the week and without episodes of heavy drinking. It is within this specific context that the findings observed in studies such as PREDIMED and the SUN cohort should be understood.
How should these findings be interpreted? Are we looking at a beneficial effect attributable to alcohol, or rather with a reflection of overall healthier lifestyles? To what extent do biases come into play, such as the difficulty of measuring actual consumption, the heterogeneity within the group of non-drinkers, or the social and cultural factors associated with the Mediterranean pattern? Most importantly, how should potential cardiovascular benefits be weighed against risks, such as the increased risk of cancer, which appears even with low levels of consumption and more markedly in women?
This scenario poses a challenge for public health and for healthcare professionals. Should a simple message of total abstinence be conveyed, or is it better to introduce nuance according to age, sex, pattern of consumption and dietary context? Although, at population level, it seems reasonable to insist that “the less alcohol, the better”, the message of “zero alcohol” as a universal recommendation often clashes with social reality and can lose force and credibility if perceived as unrealistic. The challenge lies in designing policies capable of shifting the entire population’s consumption curve to the left – reducing overall consumption – while at the same time developing a genuine “precision surgery” approach that makes it possible to identify and intervene more intensively in those individuals whose consumption pattern or biological profile places them in a critical risk zone.
To discuss these issues, we will be joined by two leading experts, professors Raúl Andrade Bellido and Miguel Ángel Martínez-González, whose careers offer complementary perspectives: one grounded in direct clinical experience in the management of digestive and liver diseases, and the other in research into nutrition, public health and preventive medicine, with extensive experience in large population studies and clinical trials.
Despite the vast number of studies available, there is still a lack of robust experimental evidence that would make it possible to answer clearly a key public health question: what is the true long-term impact of moderate alcohol consumption? The UNATI trial, funded by the European Research Council, was launched to address this gap. It is a large-scale randomised clinical trial whose aim is to determine, on the basis of robust scientific evidence, whether moderate alcohol consumption can be a safe alternative to total abstinence. The study, carried out with the involvement of more than 500 doctors across the country and led by Miguel Ángel Martínez-González and his team, is expected to enrol 10,000 participants across Spain. Over four years, participants receive recommendations focused either on abstinence or moderation, without any compulsory changes being imposed. The study will analyse the impact of both strategies on mortality, cardiovascular health and cancer risk, as well as on other health problems such as cirrhosis, type 2 diabetes, depression, dementia, severe infections, and injuries requiring hospital admission. The ultimate goal is to establish a stronger evidence base to guide both clinical recommendations and public health policies.
Speakers:
-
Miguel Ángel Martínez-González, professor of Preventive Medicine and Public Health at the University of Navarra (UNAV), nutrition researcher, and visiting professor of nutrition at the Harvard T. H. Chan School of Public Health. He leads the UNATI study.
-
Raúl Andrade Bellido, professor of Medicine at the University of Málaga (UMA), head of the Gastroenterology Department at the Virgen de la Victoria University Hospital (HUVV), and deputy scientific director of the Málaga Biomedical Research Institute and Nanomedicine Platform (IBIMA Plataforma BIONAND).
Moderator:
-
Beatriz Pérez, health editor at El Periódico de Catalunya.
This debate is being held within the framework of the reflection series Prevention and health promotion: from evidence to action, organised by the ”la Caixa” Foundation.
