适度饮酒会增加健康风险，但好处却很少
【中美创新时报2025 年 1 月 15 日编译讯】（记者温友平编译）根据周二发布的一份联邦分析报告，无论男女，每天只喝一杯酒精饮料都会增加患肝硬化、食道癌、口腔癌和各种损伤的风险。《纽约时报》记者Roni Caryn Rabin对此作了下述报道。
即使在这种适度饮酒水平下，女性患肝癌的风险也更高。每天喝两杯酒——是美国膳食指南对女性建议的两倍，但目前对男性的允许量——会增加男性和女性因酒精死亡的几率。
该报告由卫生和公众服务部主持的科学审查小组编写，是今年将用于制定有影响力的美国膳食指南的两项相互对立的评估之一。
多年来，一些科学家一直担心，适度饮酒的危害被低估了，尤其是癌症风险，根据美国癌症协会的数据，癌症是 85 岁以下美国人死亡的主要原因。
12 月，非政府组织美国国家科学、工程和医学院的一项审查得出了与最新报告不同的结论，称与不饮酒相比，适度饮酒与心脏病发作和中风死亡人数减少以及总体死亡人数减少有关。
美国国家科学院的分析承认，女性适度饮酒与乳腺癌发病率略有增加有关，但证据不足，无法将酒精与其他癌症联系起来。
然而，本月，美国卫生局局长援引越来越多的科学证据，呼吁在酒精上贴上类似于香烟上的癌症警告标签。 周二发布的政府报告发现，无论饮酒量多少，癌症风险都会增加，并且会随着饮酒量的增加而增加。
“很多人以前认为的‘适度’饮酒实际上具有中等风险，”新报告的作者之一、加拿大物质使用研究所所长蒂莫西·纳伊米 (Timothy Naimi) 表示。
适度饮酒的一些保护作用得到了认可。每天喝一杯酒的女性患糖尿病的风险较低。但报告发现，每天喝两杯酒，对中风的保护作用就会消失。
尽管多年来支持适度饮酒的主要论点之一是它可以预防心血管疾病，但无论饮酒量多少，都无法防止出血性中风和缺血性心脏病。
新的分析没有对人们应该喝多少酒提出具体建议；这将留给最终饮食指南的作者。但报告指出，酒精对健康的危害始于非常低的消费水平，并且随着消费量的增加而增加。
“对我来说，如果我是在劝告我所爱的人，低水平饮酒的潜在危害大于潜在益处，”哥伦比亚大学梅尔曼公共卫生学院流行病学教授、科学审查小组成员凯瑟琳·M·凯斯 (Katherine M. Keyes) 表示。
“任何认为低水平或中等水平的饮酒通常无害或有益的说法——数据都无法证明这一点，”她补充道。
其他研究表明，自疫情爆发以来，有害的饮酒习惯变得越来越普遍。
报告的另一位作者、加拿大成瘾和心理健康中心心理健康政策研究所的高级科学家尤尔根·雷姆博士 (Dr. Jurgen Rehm) 表示，应该将分析解读为，任何水平的饮酒都是没有风险的。
“人类接受他们的活动的风险，他们会进行山地自行车和其他危险活动，”雷姆说。“如果你取通常的高风险阈值，那就相当于每天喝不到一杯酒。”
但是，他说，尽管科学家在一个多世纪前就首次注意到酒精和癌症之间的联系，但许多美国人仍然没有意识到这一点。
酒精制造商抨击了这份新报告，指责作者存在偏见和利益冲突。
“我们致力于科学而非偏见，”代表 23 家啤酒、葡萄酒和烈酒制造商、小麦、大麦和啤酒花种植者以及餐馆和调酒师组织的联盟在一份声明中表示。
“这份报告加深了我们的担忧，即美国人关于饮酒的饮食指南建议不会以大量可靠的科学证据为基础。”
“许多生活方式的选择都存在潜在风险，饮酒也不例外，”声明继续说道。“我们鼓励所有选择饮酒的成年人遵守饮食指南并咨询他们的医疗保健提供者。”
2020 年，即饮食指南最后一次接受审查时，科学顾问建议将建议降低到男性和女性每天一杯。但最终指南并没有改变男性两杯、女性一杯的建议。
新报告称，饮酒与七种癌症的死亡风险增加有关，包括乳腺癌、结直肠癌和肝癌以及口腔癌、咽喉癌和食道癌。
报告称，男性和女性都容易受到这些健康危害，但女性患上与饮酒有关的癌症的可能性要大得多。
这份报告由美国卫生与公众服务部预防未成年人饮酒机构间协调委员会主持编写，还强调了青少年时期开始饮酒的人面临死于车祸和受伤的风险。
报告称，对于 15 岁开始饮酒的女孩和男孩来说，随着他们饮酒次数从每周一杯增加到每天三杯，因饮酒而死亡的几率将增加十倍以上，年轻男性的风险更高。
新报告评估了以前的评论和观察性研究的证据，这些证据无法证明酒精会导致疾病。它不包括可以证明因果关系的随机对照试验数据，因为这些数据非常有限。
与美国国家科学院将适度饮酒与不饮酒进行比较的报告不同，新的分析评估了不同程度的低酒精消费与因饮酒有因果关系的健康状况和事故而导致的总体死亡风险之间的关系。
这些结论适用于所有类型的酒精，包括葡萄酒、啤酒和烈酒。
从周三开始，公众将有机会对国家科学院和政府间委员会发布的两份报告发表评论，直至 2 月 14 日。
本文最初发表于《纽约时报》。
题图：多年来，一些科学家一直担心适度饮酒的危害被低估了。Tony Cenicola/NYT
附原英文报道：
Moderate drinking raises health risks while offering few benefits
By Roni Caryn Rabin New York Times,Updated January 15, 2025
For years now, there have been fears among some scientists that the harms of moderate drinking have been underestimated.Tony Cenicola/NYT
Among both men and women, drinking just one alcoholic beverage a day increases the risk of liver cirrhosis, esophageal cancer, oral cancer and injuries of various kinds, according to a federal analysis issued Tuesday.
Women face a higher risk of developing liver cancer even at this modest level of drinking. Drinking two drinks a day — double the U.S. Dietary Guidelines’ recommendation for women but the current amount condoned for men — increases the odds of a death caused by alcohol for both men and women.
The report, prepared by a scientific review panel under the auspices of the Department of Health and Human Services, is one of two dueling assessments that will be used to shape the influential U.S. Dietary Guidelines this year.
For years now, there have been fears among some scientists that the harms of moderate drinking have been underestimated, particularly the risk of cancer, the leading cause of death of Americans under 85, according to the American Cancer Society.
In December, a review by the National Academies of Sciences, Engineering and Medicine, a nongovernmental body, came to conclusions that differ from this latest report, saying that moderate drinking was linked to fewer heart attack and stroke deaths, and fewer deaths overall, compared with no drinking.
The National Academies’ analysis acknowledged that moderate drinking in women was linked to a small but significant increase in breast cancer but said there was insufficient evidence to tie alcohol to other cancers.
This month, however, the U.S. surgeon general, citing mounting scientific evidence, called for labeling alcohol with cancer warnings similar to those that appear on cigarettes. And the governmental report issued Tuesday found that the increased cancer risk comes with any amount of alcohol consumption and rises as consumption rises.
“What a lot of folks may have previously considered ‘moderate’ drinking is actually moderately risky,” said Timothy Naimi, one of the authors of the new report and director of the Canadian Institute for Substance Use Research.
Some protective effects of moderate drinking were acknowledged. Women who have one drink a day may have a lower risk of diabetes. But the protection against strokes is wiped out at two drinks a day, the report found.
No protection against hemorrhagic strokes and ischemic heart disease was seen at any level of alcohol consumption, even though one of the prime arguments made for years in favor of moderate drinking was that it might prevent cardiovascular disease.
The new analysis did not make specific suggestions about how much people should be drinking; that will be left to the authors of the final dietary guidelines. But the report indicates that the health harms of alcohol start at very low levels of consumption and increase in proportion to the amount consumed.
“For me, if I were advising my loved ones, the potential harms outweigh the potential benefits at low levels of drinking,” said Katherine M. Keyes, a professor of epidemiology at the Columbia University Mailman School of Public Health and a member of the scientific review panel.
“Any suggestion that low or moderate levels of consumption are generally harmless or beneficial — the data just don’t bear that out,” she added.
Since the pandemic, harmful drinking habits have become more common, other research has shown.
The analysis should be read to mean that no level of alcohol consumption is risk-free, said Dr. Jurgen Rehm, another author of the report and a senior scientist at the Institute for Mental Health Policy Research at Canada’s Centre for Addiction and Mental Health.
“Humans accept risk for their activities, and they do things like mountain biking and other dangerous activities,” Rehm said. “If you take the usual threshold for higher risk, that would be equivalent to a little less than one drink a day.”
But, he said, even though the link between alcohol and cancer was first noted by scientists over a century ago, many Americans are still unaware of it.
Alcohol manufacturers attacked the new report, accusing the authors of bias and conflicts of interest.
“We are committed to science over bias,” said a statement by a coalition representing 23 beer, wine and spirits manufacturers; wheat, barley and hops growers; and restaurant and bartenders’ organizations.
“This report heightens our concerns that the dietary guidelines for Americans’ recommendations with respect to alcohol will not be based on a preponderance of sound scientific evidence.”
“Many lifestyle choices carry potential risks, and the consumption of alcohol is no exception,” the statement continued. “We encourage all adults who choose to drink to adhere to the Dietary Guidelines and consult with their health care providers.”
In 2020, the last time the dietary guidelines came up for review, scientific advisers suggested lowering the recommendation to one drink daily for both men and women. But the final guidelines made no change in the recommendation of two drinks for men and one for women.
Drinking is linked to a higher risk of death for seven types of cancer, including breast cancer, colorectal cancer and liver cancer as well as cancers of the oral cavity, the pharynx and larynx, and the esophagus, the new report said.
Men and women are both vulnerable to these health harms, it said, but women are much more likely to develop a cancer linked to drinking.
The report, prepared under the auspices of the Health and Human Services Department’s Interagency Coordinating Committee on the Prevention of Underage Drinking, also emphasized the risk of dying from car accidents and injuries that faces those who start drinking as teenagers.
For girls and boys who start drinking at 15, the odds of a death attributed to alcohol increases more than tenfold as the number of drinks they consume increases from one per week to three per day, with higher risks for young men, the report said.
The new report evaluated evidence from previous reviews and observational studies, which cannot prove that alcohol caused an illness. It did not include data from randomized controlled trials, which could prove cause and effect, because they are very limited.
Unlike the National Academies’ report, which compared moderate drinking to not drinking, the new analysis assessed relationships between different levels of low alcohol consumption and the risk of dying overall from health conditions and accidents that are causally related to alcohol consumption in the United States.
The conclusions apply to all types of alcohol, including wine, beer and spirits.
The public will have an opportunity to comment on the two reports issued by the National Academies and the intergovernmental committee starting Wednesday and continuing until Feb. 14.
This article originally appeared in The New York Times.
