Ken
Mukamal
Ken Mukamal
USA - Boston, Massachusetts
Biography
Dr. Mukamal serves as the Associate Chief for Research in General Medicine at Beth Israel Deaconess Medical Center, Associate Professor of Medicine at Harvard Medical School, and Department Associate in Nutrition at the Harvard Chan School of Public Health. Dr. Mukamal's primary research interests are in the roles of dietary and lifestyle factors – with particular focus on alcohol consumption – on the incidence and prognosis of neurocognitive and cardiovascular disorders. As a general internist and clinical investigator, his research has incorporated large-scale epidemiological studies, hospital-based clinical data, and focused interventional studies. Dr. Mukamal chaired the 2011 Expert Panel on Alcohol and Chronic Disease Epidemiology for the National Institute of Health. His most recent projects include epidemiological characterization of the role of free fatty acid species in chronic diseases and small trials focused on the effects of anthocyanins in older adults and alcohol among women taking aromatase inhibitors.
Affiliations
- Harvard Medical School
Areas of expertise
- Role of dietary and lifestyle factors on incidence and prognosis of neurocognitive and cardiovascular disorders.
Abstract
Alcohol and the Global Burden of Disease: An Update for Health Professionals
Alcohol and the Global Burden of Disease: An Update for Health Professionals
Alcohol consumption remains a topic of enormous interest, uncertainty, and controversy worldwide. National guidelines on alcohol consumption have progressively lowered the upper limit of acceptable consumption, driven in part by several scientific trends. Among the foremost of these trends is the synthetic estimation of disability-adjusted life-years (DALYs) lost, nationally and globally. This synthesis integrates meta-analytic summary relative risks related to overall volumes of consumption for individual conditions with the morbidity and mortality of those conditions and nation-specific reports of alcohol consumption. As expected, this approach identifies a major signal of harm related to excessive alcohol consumption, but yields inconsistent estimates of benefit or harm from limited consumption. Important limitations of this approach include its sensitivity to accurate quantification of dose-response relationships, differential cross-nation baseline rates and selective inclusion of alcohol-sensitive conditions, inaccuracies in ascribed rates of limited and excessive drinking, inability to quantify scientific (versus statistical) uncertainty, and failure to account for drinking patterns. Consequently, differences in DALYs ascribed to limited drinking should be viewed with caution. With those caveats, results from 2022 suggested limited alcohol consumption might yield similar DALYs to abstention anywhere from 0 to 1.75 drinks per day among individuals aged 15–39 years. Among individuals aged 40 years and older, the curve was consistently J-shaped, with safe levels that ranged from 0.2 to 7 drinks per day.[1] The substantial variability in these estimates suggests that better evidence on the true health effects of alcohol consumption, ideally from high-quality clinical trials, is needed, evidence that cannot be replaced by even the most sophisticated modeling.
Acknowledgements: Dr. Mukamal receives grant support from the US National Institutes of Health, American Heart Association, and US Highbush Blueberry Council, none of which had any role in this presentation.
Reference:
1) GBD 2020 Alcohol Collaborators. (2022) Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet: 400(10347):185-235. DOI: 10.1016/S0140-6736(22)00847-9.
Alcohol consumption remains a topic of enormous interest, uncertainty, and controversy worldwide. National guidelines on alcohol consumption have progressively lowered the upper limit of acceptable consumption, driven in part by several scientific trends. Among the foremost of these trends is the synthetic estimation of disability-adjusted life-years (DALYs) lost, nationally and globally. This synthesis integrates meta-analytic summary relative risks related to overall volumes of consumption for individual conditions with the morbidity and mortality of those conditions and nation-specific reports of alcohol consumption. As expected, this approach identifies a major signal of harm related to excessive alcohol consumption, but yields inconsistent estimates of benefit or harm from limited consumption. Important limitations of this approach include its sensitivity to accurate quantification of dose-response relationships, differential cross-nation baseline rates and selective inclusion of alcohol-sensitive conditions, inaccuracies in ascribed rates of limited and excessive drinking, inability to quantify scientific (versus statistical) uncertainty, and failure to account for drinking patterns. Consequently, differences in DALYs ascribed to limited drinking should be viewed with caution. With those caveats, results from 2022 suggested limited alcohol consumption might yield similar DALYs to abstention anywhere from 0 to 1.75 drinks per day among individuals aged 15–39 years. Among individuals aged 40 years and older, the curve was consistently J-shaped, with safe levels that ranged from 0.2 to 7 drinks per day.[1] The substantial variability in these estimates suggests that better evidence on the true health effects of alcohol consumption, ideally from high-quality clinical trials, is needed, evidence that cannot be replaced by even the most sophisticated modeling.
Acknowledgements: Dr. Mukamal receives grant support from the US National Institutes of Health, American Heart Association, and US Highbush Blueberry Council, none of which had any role in this presentation.
Reference:
1) GBD 2020 Alcohol Collaborators. (2022) Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet: 400(10347):185-235. DOI: 10.1016/S0140-6736(22)00847-9.