Impact of alcohol consumption and body mass index on mortality from nonneoplastic liver diseases, upper aerodigestive tract cancers, and alcohol use disorders in Korean older middle-aged men: Prospective cohort study.
Alcohol use is a leading risk factor for the global disease burden including liver diseases. However, the combined effect of alcohol use and body mass index (BMI) on alcohol-related diseases has seldom been examined. We examined whether alcohol consumption and BMI could act together to increase mortality from nonneoplastic liver diseases, upper aero-digestive tract (UADT) cancers, and alcohol use disorders (AUD) in middle-aged Korean men.107,735 men (mean age, 58.8 years) participated in a postal survey in 2004 and were followed until 2010, by linkage to national death records. Hazard ratios (HRs) of cause-specific death were calculated after adjustment for confounders.Each 5-drink (approximately 45 g alcohol) higher weekly alcohol consumption was associated with increased mortality, by approximately 70% for nonneoplastic liver disease mortality (HR = 1.70, P < 0.001), approximately 60% for UADT cancer mortality (HR = 1.64, P < 0.001), and approximately 70% for AUD mortality (HR = 1.71, P < 0.001). Generally, BMI was inversely associated with these alcohol-related diseases (HR per each 5 kg/m higher BMI = 0.18-0.46, P < 0.001 for each cause), while, in participants with BMI ≥25 kg/m, each 5 kg/m higher BMI was also associated with an elevated mortality from nonneoplastic liver diseases of approximately 150% (HR = 2.52, P = 0.001). Men with BMI < 21 kg/m and weekly alcohol consumption ≥14 drinks showed markedly higher mortality from nonneoplastic liver diseases (HR = 5.7), alcoholic liver diseases (HR = 9.3), UADT cancers (HR = 10.5), and esophageal cancer (HR = 15.5), compared to men drinking less than 1 drink/wk with BMI ≥25 kg/m. The combined effect of low BMI and high weekly alcohol consumption was 2.25- to 3.29-fold greater than the additive effect of each factor for these alcohol-related diseases (P < 0.05 for each cause).Alcohol consumption and low BMI were related to deaths from nonneoplastic liver diseases, UADT cancers, and AUD, with evidence of a supra-additive combined effect of both factors. High BMI was also related to deaths from nonneoplastic liver diseases. Men with a low BMI (<23 kg/m) are suggested to be prone to the harmful effects of alcohol.
aDepartment of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine bInstitute for Clinical and Translational Research, Catholic Kwandong University, Gangneung cDepartment of Healthcare Management, Cheongju University College of Health Sciences, Cheongju dInstitute for Occupational and Environmental Health, Catholic Kwandong University, Gangneung eInstitute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul fDepartment of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Sang-Wook
SW
Yi
Jae-Seok
JS
Hong
Jee-Jeon
JJ
Yi
Heechoul
H
Ohrr
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D019973:Alcohol-Related Disorders / Q000209:etiology / Q000401:mortality*; D015992:Body Mass Index; D002423:Cause of Death; D004067:Digestive System Neoplasms / Q000209:etiology / Q000401:mortality*; D004938:Esophageal Neoplasms / Q000209:etiology / Q000401:mortality; D006801:Humans; D008107:Liver Diseases / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires
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