There is growing interest in the potential health-related effects of moderate alcohol consumption and, specifically, of beer. This entry provides an assessment of beer-associated effects on cardiovascular and metabolic risk factors to identify a consumption level that can be considered “moderate”.
It introduced all prospective clinical studies and systematic reviews that evaluated the health effects of beer published between January 2007 and April 2020. Five of six selected studies found a protective effect of moderate alcohol drinking on cardiovascular disease (beer up to 385 g/week) vs. abstainers or occasional drinkers. Four out of five papers showed an association between moderate alcohol consumption (beer intake of 84 g alcohol/week) and decreased mortality risk. We concluded that moderate beer consumption of up to 16 g alcohol/day (1 drink/day) for women and 28 g/day (1–2 drinks/day) for men is associated with decreased incidence of cardiovascular disease and overall mortality, among other metabolic health benefits.
Guidelines | 1 SDU = g Pure Alcohol | Term | Daily a,b (g Alcohol) | Weekly a,b (g Alcohol) |
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Spain. 2016 Socidrogalcohol consensus on alcohol in Primary Care [2] |
1 SDU = 10 g Wine: 1 glass Beer: 1 beer (≈200 mL) Spirits: 25 g |
Risky consumption (starting at) | Women: 20 g Men: 40–60 g |
Women: 140 g Men: 280 g |
Spain. 2019 Update Dietary Guidelines for the Spanish population [3] |
1 SDU = 10 g | Moderate consumption (upper limit) | Women: <20 g Men: <40 g |
- - |
UK. 2016 UK Chief Medical Officers’ Low Risk Drinking Guidelines [4] |
1 SDU = 8 g Wine: 1 glass (125 mL) (11% ABV) |
Low-risk drinking (upper limit) | - - |
Women: 112 g Men: 112 g |
USA. 2015 Dietary guidelines [5] |
1 SDU = 14 g Wine: 5 fl oz or 147.9 mL (12% ABV) Beer: 12 fl oz or 354.9 mL (5% ABV) Spirits: 1.5 fl oz or 44.4 mL (40% ABV) |
Moderate drinking (upper limit) | Women: 14 g Men: 28 g |
- - |
Canada. 2018 Canada low-risk alcohol drinking guidelines [6] |
1 SDU c ≈ 13 g Wine: 142 mL (12% ABV) Beer: 341 mL (5% ABV) Spirits: 43 mL (40% ABV) |
Recommended limit | - - |
Women: 130 g Men: 210 g |
37 countries. 2016 [1] | 1 SDU = 8–20 g | Low-risk drinking (upper limits range) | Women: 10–42 g Men: 10–56 g |
Women: 98–140 g Men: 150–280 g |
Study Funding/COI a |
Design (Mean/Median Years of Follow-Up) | n (Women) | Categories of Alcohol Consumption/Type of Drink | Variable/s | Reference Group (HR = 1) | Outcomes/Conclusions b |
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de Gaetano et al., 2016 [34] Assobirra, the Italian Association of the Beer and Malt Industries/ Some authors were consultants for the Web Newsletter of Assobirra, or were on the board/received lecture fees from Fundación Cerveza y Salud, FIVIN, the Beer and Health Foundation, ERAB, or Cerveceros de España. |
Systematic review | Wine, beer, and spirits | All-cause mortality | Evidence suggests a J-shaped relationship between alcohol consumption and total mortality, with lower risk for moderate alcohol consumers than for abstainers or heavy drinkers. Specific data on beer are not conclusive, although some results indicate a positive role of drinking beer in moderation (1 drink/day, about 12 g of ethanol) against mortality for any cause |
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1 meta-analysis of 34 prospective studies [65] | Over 1 million adults | Low to moderate Women: 1 drink/day. Men: 2 drinks/day / Wine, beer, and spirits |
All-cause mortality | Low to moderate consumption of alcohol significantly reduces total mortality, while higher doses increase it | ||
1 Prospective cohort [66] (12–18 y) |
36,250 men | Wine and beer | CV death All-cause mortality |
Non-drinkers | Moderate wine or beer drinking reduced the risk of CV death. Only moderate wine drinking was associated with lower all-cause mortality: RR: 0.67 (0.58 to 0.77; p < 0.001) |
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1 Prospective cohort [67] (16.8 y) |
7735 British men 40–59 y old | 1 SDU: Half pint beer (8–10 g alcohol). Frequency: Non-drinkers; Occasional (1–2 SDU/month); Weekend drinkers; Daily or on most days. Quantity: 1–2, 3–6, >6 / Wine, beer, and spirits |
All-cause mortality | Occasional drinkers | Regular beer drinking [HR: 0.84 (0.71 to 1.01)] showed no significant difference vs. occasional drinking | |
1 Prospective cohort [68] Copenhagen City Heart Study (25 y) |
14,223 adults | 1 SDU: 1 bottle beer (12 g alcohol). Never, Hardly ever, Monthly, Weekly Daily: 1–2 SDUs Daily: >2 SDUs / Wine, beer, and spirits |
All-cause mortality | Never beer drinkers | In men, monthly beer intake (RR: 0.86 (0.77 to 0.97)) was associated with lower mortality, and daily intake >2 beers (RR: 1.14 (1.02 to 1.27)) to increased risk. In women the associations were not statistically significant: Monthly beer intake (RR: 0.98 (0.88 to 1.08)), and daily intake >2 beers (RR: 1.31 (0.92 to 1.88)) At a medium education level, monthly beer intake was associated with lower risk (RR: 0.87 (0.77 to 0.97)), and at low [RR:1.20 (1.07 to 1.34) and medium education level (RR:1.18 (1.02 to 1.37)), >2 beers daily was associated with increased risk. |
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1 Prospective cohort [69] (12.6 y) |
380,395 adults (247,795 women) | For beer: Never. Light: 0.1–2.9 g/day, 3–9.9 g/day, 10–19.9 g/day, 20–39.9 g/day (only for men). ≥20 g/day (extreme for women) ≥40 g/day (extreme for men) / Wine and beer |
All-cause mortality | Light consumers (0.1–2.9 g/day) | In women: Compared to low-level consumers, lifetime non-drinkers (HR: 1.06; 1.02 to 1.12), and consumers of beer at amounts ≥3 g/day displayed significantly higher overall mortality risk. In men: Lifetime non-drinkers (HR: 1.07; 0.98 to 1.16) and consumers of 3–9.9 g/day (HR: 1.04; 0.98 to 1.10) showed no significant differences compared to light consumers. Consumers of beer amounts ≥10 g/day displayed a significantly higher overall mortality risk. |
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Stockwell et al., 2016 [53] None declared |
Systematic review/meta-analysis of 87 studies (13.4 y) |
3998,626 adults | Abstainer. Former drinker. Occasional: <1.30 g/day. Low: 1.30 to <25 g /day. Medium: 25 to <45 g/day High: 45 to <65 g/day. Higher: ≥65 g/day / Alcohol in general |
All-cause mortality | Abstainer OR occasional drinker | Standard adjustment: Significant protective effect for low-volume (RR: 0.86 (0.83 to 0.90); p < 0.0001) and occasional drinkers (RR: 0.84 (0.79 to 0.89); p < 0.0001) as compared with abstainers. Abstainers were at significantly higher risk (RR: 1.19 (1.12 to 1.27); p < 0.0001) as compared to occasional drinkers. Full adjustment: No significant protection was estimated for occasional (RR: 0.95 (0.85 to 1.05)), low-volume (RR: 0.97 (0.88 to 1.07)), or medium-volume drinkers (RR: 1.07 (0.97 to 1.18)) as compared with abstainers. |
Xi et al., 2017 [51] None declared |
Population survey data linked to mortality data (8.2 y) |
333,247 adults | 1 SDU: 14 g alcohol. Lifetime abstainers. Lifetime infrequent drinkers. Former drinkers. Current light drinkers. Moderate: >3 to ≤14 drinks/w for men or >3 to ≤7 drinks/w for women. Heavy drinkers. Binge drinking / Alcohol in general |
All-cause, cancer, or CVD mortality. | Lifetime abstainers | All cause-mortality: Decreased for Light (HR 0.79 (0.76 to 0.82)) and Moderate (HR 0.78 (0.74 to 0.82)) drinkers. Increased in Heavy: HR: 1.11 (1.04 to 1.19) and binge (HR: 1.13 (1.04 to 1.23)) drinkers. CVD-specific mortality: Light: HR 0.74 (0.69 to 0.80); Moderate: HR 0.71 (0.64 to 0.78) |
Bell et al., 2017 [49] National Institute for Health Research, Welcome Trust, the Medical Research Council prognosis research strategy Partnership and other government health-related agencies. |
Prospective cohort (6 y) |
1937,360 (51% women) | 1 SDU c: 8 g Non-drinkers. Former drinkers Occasional drinkers: drinks rarely or occasionally. Moderate: Men: 21 SDU/w or 3 SDU/day. Women: 14 SDU/w or 2 SDU/day Heavy drinkers / Alcohol in general |
CV death and all-cause mortality | Moderate drinkers | Non-drinkers (former and occasional drinkers removed) had an increased risk of CV death (HR: 1.32 (1.27 to 1.38)) and all-cause mortality (HR: 1.24 (1.20 to 1.28)). |
Suadicani, 2008 [61] The King Christian X’s Foundation, The Danish Medical Research Council, The Danish Heart Foundation, and The Else & Mogens Wedell Wedellsborg Foundation. |
Prospective cohort (16 y) |
3022 Caucasian males 53–74 y old |
1 SDU: 10–12 g ethanol / Wine, beer, and spirits |
All-cause and IHD-related death within the different blood phenotypes | Alcohol abstainers (comparison only for wine drinkers) | For beer, the median (P20, P80) number of drinks/week among those with the non-O phenotype was significantly higher in those who died (overall mortality): 10.5 (0, 15.5) vs 7.5 (0, 10.5); p ≤ 0.001. The effect of wine intake on all-cause mortality among middle-aged and elderly men may depend on ABO phenotypes. Among non-O phenotype, drinking 1–8 drinks/w: HR: 0.8 (0.7 to 1.8) and drinking >8 drinks/w: HR: 0.7 (0.6 to 0.98) |
Study Funding/COI a |
Design (Mean/Median Years of Follow-Up) | n (Women) | Categories of Alcohol Consumption/Type of Drink | Variable/s | Reference Group (HR = 1) |
Outcomes/Conclusions b |
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Fresan et al., 2016 [52] The Spanish Ministry of Health, the Navarra Regional Government, and the University of Navarra. |
Prospective cohort (4 y) |
15,765 adults | Beverages groups: Water, low/non-caloric beverages (diet soda beverages, coffee without sugar), milk, juice, and sugared coffee (dairy products, juices, coffee with sugar). Occasional consumption (SSSBs and spirits). Wine, beer |
Change in BW and new-onset obesity | No substitution | Substitution of one beer with one serving of water per day at baseline was related to a lower incidence of obesity (OR 0.81, 95%CI 0.69 to 0.94 and OR 0.84, 95%CI 0.71 to 0.98, when further adjusted for the consumption of other beverage groups) and to higher weight loss (−328 g, 95%CI −566 to −89). |
Bendsen et al., 2013 [55] The Dutch Beer Institute (funded by the Dutch Brewers)/ Three of the authors are employed by or are board members of the Dutch Beer Institute. |
Systematic review of 35 observational studies and 12 experimental studies Meta-analyses: 14 observational studies (11 cross-sectional and 3 prospective) included in dose-response graphs. 10 intervention studies (6 beer vs non-alcoholic beer and 4 beer vs control) included in quantitative synthesis |
1 SDU beer = 330 mL, 4.6% alcohol = 12 g/drink. / Beer |
BW increase, BMI, and abdominal obesity (WC and WHR) | Control: Non-drinkers or in the absence of non-drinkers, the group with the lowest beer intake Low or non-alcoholic beer |
Dose-response graphs: High beer intake (>4 L/w) was associated with a higher degree of abdominal obesity in men. Quantitative synthesis: High beer consumption (about 1000 mL/day; 5% alcohol) did not result in increased BW compared with control groups but did result in increased BW compared with low- or non-alcoholic beer groups (mean difference 0.73 kg, 95% CI: 0.53 to 0.92; z = 7.39, p < 0.0001, I2 = 0%) |
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Schütze et al., 2009 [59] The German Cancer Aid, the German Federal Ministry of Education and Research and the European Union. |
Prospective cohort (8.5 y) |
20,625 (12,749 women) | WOMEN: No beer. Very light: >0 to <125 mL/day. Light: ≥125 to <250 mL/day. Moderate: ≥250 mL/d MEN: No beer. Very light: >0 to <250 mL/day. Light: ≥250 to <500 mL/day. Moderate: ≥500 to <1000 mL/day Heavy: ≥1000 mL/day / Beer |
WC change BW change |
Very light | MEN: Moderate beer consumption showed significant lower relative odds for WC loss (OR 0.44, 95%CI 0.24 to 0.80) WOMEN: Although beer-abstaining women showed significantly lower relative odds (OR.0.88; CI 0.81, 0.96) for WC gain compared with their very-low-level-drinking counterparts, significance was lost once the model was adjusted by HC change; however, the new OR was on the border of significance (OR.0.91; CI 0.83, 1.00) |
Padro et al., 2018 [46] Fundacion Cerveza y Salud, Madrid, Spain; The European Foundation for Alcohol Research; Spanish Ministry of Economy and Competitiveness of Science; Institute of Health Carlos III. |
Open-label, prospective randomized, two-arm, longitudinal cross-over | 36 (15 women) | WOMEN: 330 mL/day normal or non-alcoholic beer (15 g/day or 0 g/day alcohol) MEN: 660 mL/day normal or non-alcoholic beer (30 g/day or 0 g/day alcohol) / Beer |
BMI T2D Lipid Profile |
Moderate beer consumption (traditional or alcohol-free) does not increase body weight in obese healthy individuals or have negative effects on the vascular system. Moderate consumption was associated with reduced risk of dyslipidemia, increased anti-oxidative properties of high-density lipoprotein, and increased efflux of cholesterol. | |
Polsky et al., 2017 [50] None declared |
Systematic Review of 96 studies | 18 studies included more than 10,000 subjects each. | Alcohol in general | Moderate alcohol consumption generally reduces diabetes risk. | ||
Cullman et al. 2012 [43] The Swedish Research Council; the Swedish Diabetes Association; the Swedish Council of Working Life and Social research; and Novo Nordisk Scandinavia. |
Prospective cohort (8–10 y) |
5128 adults (3058 women) with normal glucose tolerance and 111 (41 women) with pre-diabetes. 35–56 y old |
Abstainers Total alcohol Occasional: 0.01–1.49 g/day in women, 0.01–6.79 g/day in men. Low: 1.50–4.71 g/day in women, 6.80–13.01 g/day in men. Medium: 4.72–8.75 g/day in women, 13.02–22.13 g/day in men. High: ≥8.76 g/day in women, ≥22.14 g/day in men Wine Occasional: ≤0.32 g/day in women, ≤0.99 g/day in men. Medium: 0.33–1.65 g/day in women, 1–4.99 g/day in men. High: ≥1.66 g/day in women, ≥5 g/day in men Beer (only in men) Occasional: ≤0.99 g/day. Medium: 1–4.99 g/day. High: ≥5 g/day / Wine, beer and spirits |
PreD T2D PreD + T2D |
Occasional drinkers | Normal glucose tolerance at baseline MEN: High alcohol: Higher risk of preD + T2D (OR 1.42, 95% CI 1.00–2.03). High beer: Higher risk of preD + T2D (OR 1.63, 95% CI 1.07–2.48) and higher risk of preD (OR 1.84, 95% CI 1.13–3.01) Abstainers vs occasional wine or beer drinkers: Higher risk of preD + T2D (OR 2.01, 95%CI 1.01–3.98 and OR 2.13, 95%CI 1.03–4.39, respectively). WOMEN: High wine: lower risk of preD (OR 0.66, 95% CI 0.43–0.99) Normal glucose tolerance or preD at baseline WOMEN: Low alcohol: Lower risk of T2D (OR 0.41, 95% 0.22–0.79). Medium wine: Lower risk of T2D (OR 0.46, 95%CI 0.24–0.88) |
Yin et al., 2011 [58] National Health and Medical Research Council of Australia, Tasmanian Government and Royal Hobart Hospital Acute Care Programme. |
Prospective cohort (2 y) |
862 (49% women) Mean age 63 y, range 51–81 |
1SDU: 10 g alcohol Frequency: Never, <once a month, 1–3 days/month, 1/2/3/4/5/6 days /wk, every day. Amount 30mL spirits: 1 glass. 1 can beer: 2 glasses. 1 bottle wine (750 mL): 6 glasses. 1 bottle sherry (750 mL): 12 glasses. g/day / Wine, beer, and spirits |
BMD change | Total alcohol intake in men positively predicted change in BMD at the lumbar spine and hip (beta = 0.008% and 0.006% per year per gram of alcohol intake, p < 0.05). The frequency of drinking red wine was positively associated with percentage change in BMD at the lumbar spine in men (beta= 0.08% per year per class, p= 0.048). At baseline, lumbar spine BMD was positively associated with frequency of low-alcohol beer drinking in women (beta = 0.034 g/cm(2) per category, p = 0.002). |
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Mukamal et al., 2007 [62] The National Heart, Lung, and Blood Institute. The National Institute on Ageing. |
Prospective population-based cohort study (12 y If no hip fracture 7.5 y If hip fracture) |
5865 ≥60 y |
1 SDU: 12-ounce can or bottle of beer, 6-ounce glass of wine, and 1 shot of liquor. 1 SDUc = 14 g Categories Long-term abstainers, former drinkers, <1 drink/w, 1–6 drinks/w, 7–13 drinks/w, ≥14 drinks/w / Wine, beer, and spirits |
Hip fracture BMD |
Long-term abstainers | Strong, graded, positive relationship between greater alcohol consumption and greater BMD up to 13 drinks/week. U-shaped relationship between alcohol intake and risk for hip fracture (quadratic trend: p = 0.02), with lower HRs in intermediate drinking categories. Drinking <1 beer/w showed a significantly lower risk of hip fracture (HR 0.66, 95%CI 0.44–0.99). |
This entry is adapted from the peer-reviewed paper 10.3390/nu13030879