October 2008: Alcohol consumption by Aging Adults in the United States: Health benefits and Detriments

Introduction

The benefits versus the risks of alcohol consumption seem to strike a delicate balance. If you do not drink enough, you are at risk for heart disease. If you drink too much, you are at risk for heart disease. The current review article looks at alcohol consumption by aging adults in the US, and the accompanying health benefits and detriments.

While the specificities of the subject require further investigation, there is growing evidence that moderate alcohol intake (1-3 drinks per day) is associated with reduced morbidity and mortality among middle-aged and older adults (>45 years of age). The majority of US adults aged 60 and older in the United States are moderate drinkers based on the above definition. In the United States, one standard drink represents 15 g of ethanol, or a 12-ounce beer, 5 ounces of wine or 1.5 ounces of distilled alcohol. With age, heavy episodic drinking decreases according to a cross-sectional National Health Interview Survey Analysis.

Alcohol Pharmacokinetics

Gastric Alcohol Dehydrogenase (ADH), one of the enzymes responsible for ethanol metabolism, is greatly reduced in older adults. This decrease means potentially greater ethanol bioavailability, therefore greater amounts of ethanol diffusing across stomach and intestinal membranes into portal circulation. This in turn increases the amount of alcohol the hepatocytes must metabolize, activating the alternate microsomal ethanol-oxidizing system (MEOS). When MEOS is activated, drugs and nutrients may be co-metabolized, increasing the chances for drug- and nutrient- alcohol interactions. With this in mind, health care professionals should increase their awareness of such interactions when dealing with older adults. In addition, body composition is altered with age; by 65, body fat can increase by more than 50%, replacing body water. Since ethanol is easily solubulized in water, decreased body water leads to increased blood alcohol content (BAC) in an older individual compared to a young adult consuming the same alcoholic beverage.

Benefits of Moderate Alcohol Consumption

Data from more than 100 studies from geographically diverse countries report a U- or J – shaped association between alcohol consumption and coronary heart disease and mortality. Several studies suggest a positive influence of moderate alcohol intake on various cardiovascular risk factors and the incidence of conditions such as ischemic heart disease, elevated triglycerides, insulin insensitivity, inflammation and endothelial dysfunction. Alcohol may also protect older adults against cancer, diabetes, lower extremity arterial disease and inflammatory liver disease, when consumed in moderate amounts. Studies have failed to show reduced renal function with moderate alcohol intake, and there are reports of positive effects of alcohol/wine intake on bone density in older women. Early evidence suggests a reduced risk of vascular dementia and Alzheimer’s disease with moderate alcohol intake. Like so many other things, the key here seems to be moderation.

Psychosocial Benefits of Moderate Alcohol Consumption

Research looking at moderate alcohol intake among 3 US retirement communities found that alcohol was associated with improved social interactions and self-reported health status. A study of the same population found moderate alcohol consumption to be positively associated with longevity and health-related quality of life. To contrast, low and no alcohol intake were negatively associated with longevity and health-related quality of life.

Dietary Benefits of Moderate Alcohol Consumption

Research suggests some positive associations between moderate alcohol intake and health and energy intake. Overall, drinking heavily only occasionally was associated with decreased diet quality, whereas drinking small amounts of alcohol frequently was associated with improved diet quality. Most alcoholic beverages increase an individuals’ intake of protective photochemicals, thereby increasing diet quality.

Effect of Moderate Alcohol Consumption of Body Mass/Composition

Non-drinkers and those consuming a moderate level of alcohol had the lowest BMIs, compared to immoderate drinkers. Drinking small or moderate portions of alcohol regularly seems to prevent alcohol related weight gain. Interestingly, a significant positive correlation between habitual alcohol intake and physical activity was found in a study of subjects with a mean age of 61 ± 5 years.

Detriments of Immoderate Alcohol Consumption

In this study, immoderate alcohol consumption is defined as greater than 3 standard drinks per day. In the US, high levels of cancer, cardiovascular disease, liver disease and diabetes may be attributed to alcoholic oxidative stress. Oftentimes alcohol related symptoms are passed off as age related in the older population. Although alcoholism decreases in the older age groups, clinicians should be attentive to the potential misdiagnosis of patient symptoms, especially as the percentage of adults 65 and older continues to grow.

B vitamins, thiamin, niacin, riboflavin and pyridoxine are commonly deficient in alcoholic adults. Where moderate alcohol intake may stimulate the appetite and improve overall diet quality, immoderate intake can often times be detrimental to an individual’s health. Chronic immoderate consumption of alcohol can also elevate blood triglycerides and LDLs.

Supporting Article

This large-scale prospective study looked at 5,759 men and 7,574 women over the age of 64. The purpose was to assess the association between level of alcohol consumption and physical disability, cognition and mortality. The current study defines moderate alcohol consumption as 1-2 drinks per day. Results show no statistically significant increase in risks for physical disability, cognitive function measures and mortality. The non-drinker group was at higher risk for mortality and physical disability, compared to the moderate drinkers. Overall, the results indicate no clinically significant risk associated with moderate alcohol consumption to an elderly person’s health and cognative function.

Ferreira, M. P., & Weems, S. (2008). Alcohol consumption by Aging Adults in the United States: Health benefits and Detriments. Journal of the American Dietetic Association , 108 (10), 1668-1676.

Lang, I., Guralnik, J., Wallace, R., & Melzer, D. (2006). What Level of Alcohol consumption Is Hazardous for Older People? Functioning and Mrotality in U.S. and English National Cohorts. Journal of the American Geriatrics Society , 55 (1), 49-57.