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Brain & Heart Wine intake and 45-year mortality in rural men

1. Introduction For the purpose of the analysis, several other personal
characteristics were considered, including: (i) age, in years,
Research into the relationship between alcohol consumption approximated to the nearest birthday, (ii) body mass index,
and health has a long-standing history. Epidemiological expressed as kg/m , calculated following the procedure
2
findings consistently suggest a J-shaped relationship outlined in the World Health Organization (WHO)
between alcohol consumption and cardiovascular disease Cardiovascular Survey Methods Manual, (iii) cigarette
29
(CVD) and all-cause mortality, highlighting beneficial smoking, quantified as the number of cigarettes smoked
effects among moderate drinkers compared to abstainers per day, derived from a questionnaire, (iv) working physical
and heavy drinkers. 1-17 Recent contributions have activity, classified as sedentary, moderate, or vigorous based
specifically focused on wine rather than overall alcohol on a questionnaire matched with reported occupation. These
intake. 18-25 Therefore, an in-depth discussion comparing categories were validated using ergonometric procedures
these findings to our own investigation is warranted. in a subgroup of subjects and calorie intake derived from
Our study aimed to assess long-term CVD and all- the Dietary History, 31,32 and (v) dietary score, termed the
cause mortality in a cohort of middle-aged men, nearly Mediterranean Adequacy Index (MAI), derived from the
all of whom were habitual wine drinkers with very high population sample used for the SCS feasibility study. High
alcohol consumption levels. 26,27 Notably, over two-thirds of MAI levels indicate a diet rich in vegetable-based food
subjects also engaged in heavy physical labor related to the groups, olive oil, and fish, while low levels indicate a diet
rural environment approximately 60 years ago. This raises dominated by animal-based food groups, hard fats, and
the question of whether high levels of physical activity sugars. In previous analyses, the MAI was inversely related
33
and alcohol consumption might compensate for each to all-cause mortality and coronary heart disease (CHD)
34
other, potentially mitigating their individual impacts on mortality. For this analysis, the MAI was recomputed,
35
survival, though the duration of this effect remains unclear. excluding wine from the vegetable food group to avoid
Therefore, we also investigated whether alcohol intake had mathematical conflicts with alcohol intake. The MAI score
differing effects on survival and age at death during the was transformed into its natural logarithm (lnMAI). 34,35 In
first 20 years of follow-up. addition, a comorbidity index was established by adding the
number of major morbid conditions recorded during field
2. Methods examinations for each subject. These conditions included
2.1. Population and baseline-line risk factors CHD, heart failure, arrhythmia or block of undefined
origin, stroke, peripheral artery disease, chronic bronchitis,
The data analyzed in this study were derived from two diabetes, and cancer (scores: 1 – 8).
Italian cohorts enrolled in the Seven Countries Study
(SCS) of CVDs, started in 1958. This pioneering study 2.2. Endpoints
was the first to systematically and comparably investigate The follow-up period spanned 45 years, during which the
multiple population samples of middle-aged men across date and cause of death for all men were recorded and coded
various countries, focusing on lifestyle habits, risk factors according to the WHO ICD-8 classification. These codes
36
for CVDs, and mortality in a long-term follow-up in were assigned based on defined criteria and allocated by a
different countries. Further details on the study design and single reviewer. In the presence of multiple causes of death
methodology can be found elsewhere. 28
or uncertainties regarding the principal cause, a ranking
In 1965, the population samples of the Italian rural areas system was adopted, prioritizing causes such as violence,
of the SCS were re-examined on the fifth anniversary of their cancer, CHD, stroke, and others in that order.
29
enrollment. The cohort consisted of 1284 middle-aged men The primary end-points for analysis included
(aged 45 – 64). During this follow-up examination, alcohol mortality from all causes, major CVDs of atherosclerotic,
intake was assessed using a dietary history questionnaire hypertensive, and degenerative origin (CVD; ICD-8
30
administered by trained and supervised nutritionists. codes 410 – 404, 427, 430 – 438, 441 – 445), cancer
Alcohol consumption was reported in mL/day and (ICD-8 codes 140 – 239), and liver cirrhosis (ICD-8 code
converted to g/day based on the average alcohol content of 571). Moreover, age at death was expressed as the difference
local wine. The vast majority of participants consumed red between the date of death and the date of birth for those
wine, with an average alcohol content of 12%. Spirits with who died during the 45-year follow-up period.
higher alcohol content played a minor role, accounting for
only 3% of total alcohol intake. After 20 years of follow-up, Baseline data were collected before the Helsinki
an interim examination was conducted, during which Declaration era, with consent implied through participation
alcohol consumption was reassessed following the same in the examinations. Subsequently, verbal or written
procedure among the survivors. consent was obtained during follow-up data collection.

Volume 2 Issue 3 (2024) 2 doi: 10.36922/bh.3016