Wednesday, March 29, 2023

Moderate Beer Consumption Is Associated with Good Physical and Mental Health Status and Increased Social Support

Moderate Beer Consumption Is Associated with Good Physical and Mental Health Status and Increased Social Support. Antonio Moreno-Llamas, Ernesto de la Cruz-Sánchez. Nutrients 2023, 15(6), 1519; March 21 2023.

Abstract: There is little large-scale evidence on the effect of alcoholic beer consumption on physical, mental and, above all, socio-emotional health. Here, we conducted a secondary data analysis of the 2012 and 2017 National Health Surveys with 33,185 individuals aged 18 years and older to assess beer consumption in relation to self-perceived health, functional limitations, mental health, and social support. Logistic regression models assessed the association of alcohol consumption (abstainers, ex-drinkers, occasional drinkers, moderate beer drinkers, and heavy beer drinkers) with self-perceived health (poor or good), limitations of type (none, physical, mental, or both) and intensity (none, mild, or severe), mental health (poor, average, or good) and social support (poor, average, or good). Analyses were adjusted for sex, age, occupational social class, educational level, place of residence, survey, part-time physical activity, dietary information, smoking, and body mass index. Compared to abstainers, occasional and moderate beer drinkers were associated with better mental and self-perceived health and social support, and were less likely to report mild or severe physical limitations. In contrast, former drinkers were associated with worse indicators of self-perceived health, physical health, mental health, and social support than abstainers. Alcoholic beer consumption showed a J-shaped relationship with self-perceived, physical, mental, and social-emotional health, with better values at moderate levels.

Keywords: alcohol; beer; mental health; social support; daily functioning; public health

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4. Discussion

4.1. Main Findings

Our results showed that moderate beer consumption may imply associations with better self-perceived, physical, mental and socio-affective health. Furthermore, our study replicated the J-shaped relationship between health and beer consumption in which moderate beer drinkers (women: 1 standard unit of drink per day; men: 2 standard units of drink per day) described the healthiest state even after controlling for health-related lifestyle behaviors (smoking, diet, and physical activity), BMI, socioeconomic status, and demographic factors. Compared to abstainers, drinkers who reported occasional alcohol consumption or moderate beer consumption were more likely to report higher self-perceived health, mental health, and social support, while they were also less likely to report mild and severe limitations and physical and/or mental limitations. Conversely, former drinkers were more likely to describe worse indicators of self-perceived health, daily limitations of type and intensity, mental health, and social support. The J-shaped relationship between beer and health was observed in both women and men, although women showed associations with better health status at lower doses than men. This health improvement with moderate doses of beer was observed mostly in drinkers aged 40 years and older, while little or no association was found among those under 40 years of age. Sensitivity analyses without those reporting severe acute drinking episodes showed the same results.

4.2. Comparisons with Other Studies and Potential Hypothetical Explanations

Previous empirical evidence is consistent with our findings. Regarding the relationship of health with alcohol consumption, in our case beer, several meta-analyses have investigated and re-analyzed the effects of alcohol consumption and drinking patterns on, primarily, physical health in terms of mortality and morbidity [2,4,6,11,40]. In summary, although there is a large body of research, the evidence remains uncertain. The use of reference groups such as abstainers alongside ex-drinkers and occasional alongside moderate drinkers has generated controversy in contributing to the famous J-shaped (or U-shaped) alcohol–health relationship, as other medium and large-scale studies with more robust and comprehensive methodological designs have found only detrimental health consequences [11,12,13]. However, the updated Global Burden of Disease review added that there may be benefits without gender differences for people over 40 years of age who consume between 0.114 and 1.870 standard units of drink daily, i.e., a moderate drinking habit [7]. In our study, we observed an improvement in health status with moderate doses of beer in drinkers aged 40 years and older and little or no association among those under 40 years. In addition, a randomized Mendelian study from the UK Biobank found that alcohol consumption of up to 17 standard drinking units per week (i.e., 2.43 standard drinking units per day) does not lead to premature ageing or death from telomere shortening [41]. From a physiological perspective, experimental research has suggested that low doses of alcohol can improve cardiovascular health, lipid profiles, redox status, and the immune system [9,17,18,19,20,21]. In our work, occasional and moderate beer drinkers (women: 1 standard unit of drink per day; men: 2 standard units of drink per day) were more likely to describe better physical health in terms of reduced functional limitations in type and intensity, but also in other relevant components of health that have received less attention, such as perceived health, mental health and socio-emotional domains.
Certainly, these aspects of health may involve biases, but on the other hand, they may also represent the physical, mental, and socio-emotional health of individuals and how they interact with their daily living conditions as a reflection of their quality of life. Our study is the first to encompass all these factors, as beer consumption shows better indicators of physical, self-perceived, mental, and socio-emotional health in moderate beer drinkers than in abstainers and ex-drinkers. Previous studies in Spain had found that high alcohol consumption was associated with poorer self-perceived health and no differences in socio-affective health [42]. On the other hand, other studies in small samples of populations aged 55 and over showed that moderate consumption of wine, a fermented beverage like beer, was associated with better self-perceived health, mental health and vitality, similar to our results for those aged 40 and over [43]. In Spain, a region with a pattern of alcohol consumption rooted in social gatherings and consumption with other foods compared to northern European countries, could partially and hypothetically explain these differences in mental and socio-affective health between abstainers and ex-drinkers compared to occasional and moderate drinkers. It is noteworthy that these data were also replicated in some Nordic countries, both under and over 40 years of age, which makes the internationalization of the results possible [32,44]. Danish researchers observed in 693 participants aged 29–34 years that simple wine drinking was associated with positive social, cognitive and personality development, while beer consumption reflected some negative outcomes [32]. Furthermore, in Finland, a longitudinal cohort of 2468 people aged 40–55 years indicated that wine consumption reduced cardiovascular mortality and increased quality of life and mental health, but no effect was observed for beer consumption [44]. A sociological study by Sayette et al. in 2012 suggested that, in spontaneous meetings, alcohol consumption, compared to placebo and non-drinking, facilitated the formation and creation of new small groups with casual and strangers meeting each other [45]. They also reported greater positive expressiveness, satisfaction and happiness in creating these new social bonds in the alcohol setting [45].
Loneliness and social isolation (stress caused by the discrepancy between actual and desired social relationships) have recently been characterized as a health risk factor, associated with premature mortality and poorer cardiovascular, metabolic, neurological, and mental prognosis [25]. However, we should also mention the possible hidden risks of moderate drinking. Moderate drinking in conjunction with these social meetings could mask and skew consumption towards higher levels of intake. We found that heavy beer drinkers were more likely to report higher self-perceived and mental health, and fewer mild and severe daily limitations. However, habitual and high alcohol consumption could be a health-damaging behavior [16,17,19]. In this respect, the interdependence of different health-related lifestyles should also be taken into account, as health-damaging behaviors can often occur together. In our study, heavy beer drinkers also reported a higher prevalence of tobacco use and a poorer diet, while the groups with the best diet and the lowest tobacco use were abstainers and ex-drinkers. However, the latter two groups also reported the highest prevalence of sedentary behavior. These results alert, on the one hand, to the need for further research on alcohol consumption and, on the other hand, to the interconnectedness and clustering of these behaviors, in which high beer consumption may be a double-edged habit and a health risk factor.

4.3. Study Limitations

Despite the potential implications of our findings, the results should be taken with caution due to the several limitations of the study. Firstly, although our study includes two waves of the National Health Survey, representative of the Spanish population, the cross-sectional nature of its data precludes establishing a cause–effect relationship between beer consumption and the subsequent development of a certain health value, as the same participants were not followed longitudinally over time. Secondly, the assessment of health status, alcoholic beer consumption, and some of the health-related lifestyle variables was done through self-reporting by individuals, which may imply under- or overestimation. This type of measurement also involves specific biases associated with memory and recall, mainly on quantitative variables, which are more pronounced in older people and those with very low alcohol consumption [30]. Some types of health-related lifestyle variables may also contain biases related to individual or family socio-economic status and place of residence. For example, behaviors that are socially perceived as harmful may be underestimated by social desirability and subject compliance [30,46]. However, the design of the SNHS, comprising a large sample size representative of the Spanish adult population, allows for a comprehensive assessment of alcohol consumption, such as frequency of alcohol consumption in the last twelve months, frequency of regular weekly drinking from Monday to Sunday in general and specific to different types of alcoholic beverages in number, and in grams of alcohol, in order to establish accurate cut-off points for drinking behaviors. However, in the SNHS, in those drinkers who reported drinking 2–3 times per month, 1 time per month or less than 1 time per month, the exact total alcohol consumption overall and between types of alcoholic beverages was not subsequently assessed. Similarly, beer drinkers were established when their total alcohol consumption came predominantly from beer (more than 50%). In this case, to ensure an adequate sample size for comparisons between groups, we proceeded as follows, defining the groups into non-consumers (abstainers), ex-drinkers (separate from abstainers), and moderate and heavy beer drinkers [30,31,32]. Furthermore, our study only focuses on Spain, so the cultural and social context might influence not only alcohol consumption, but also physical, mental, and social self-perception, which might be different in countries outside the Mediterranean context.

4.4. Future Research

Future research should encompass many complementary directions. Special efforts should be devoted to further elucidating the complex relationship of alcohol consumption with health through both physiological and epidemiological research. More evidence is needed not only on general health or mortality, but also with special attention to the mental, social, and emotional domains in relation to light and moderate alcohol consumption in general and beer consumption in particular. Along these lines, different socio-affective domains such as family, friends, partner, work, or leisure could be assessed separately, as well as implementing the measurement of the number and quality of social relationship networks, which in turn may also be closely associated with mental and self-perceived health. Longitudinal studies between alcohol and beer consumption and health outcomes (physical, mental, and socio-affective) would provide strong causal evidence, as would replication of the results in other regions with cultural differences in alcohol consumption, such as in Northern Europe. Therefore, future research should also include multi-country studies to compare possible variations according to country context in relation to beer consumption and subjective perceptions of physical, mental, and social health. In addition, the inclusion of non-alcoholic beer in population-based health surveys could reveal whether the association between moderate consumption and improved health is due to alcoholic or non-alcoholic compounds in beer, which could support non-alcoholic beer as a healthier and more consumer-friendly alternative through public health policies.