Alcohol: No safe dose

By Ana Espino | Published on January 14, 2026 | 3 min read


Alcohol use is a major risk factor for morbidity and mortality worldwide, contributing to more than 60 diseases, including cardiovascular diseases, cancers, liver cirrhosis, and neuropsychiatric disorders. Despite this well-documented burden, international recommendations regarding “moderate” levels of alcohol consumption remain controversial, sometimes conveying contradictory messages about potential protective effects of low doses. This ambiguity undermines the definition of safe consumption thresholds.  

One of the major challenges lies in the comparative assessment of the alcohol-attributable burden according to sex, age, world regions, and levels of consumption. The objective of this study, published in The Lancet, was to analyze alcohol consumption and its health impact in 195 countries between 1990 and 2016, using data from the Global Burden of Disease (GBD) study, in order to better inform public health policies.    

Zero drinks, zero risk?  

This comparative modeling study is based on data from the Global Burden of Disease Study 2016. It integrates 694 data sources on alcohol consumption, 592 studies on risk relationships, and models effects on 23 alcohol-attributable conditions. The analysis relies on a comparative risk assessment approach, combining levels of consumption, relative risks, prevalence estimates, and mortality data.  

The results show that alcohol is responsible for 2.8 million deaths per year (i.e., 1 in 10 deaths among individuals aged 15–49 years). Among young adults, alcohol is the leading cause of premature mortality, largely driven by injuries, violence, suicides, and tuberculosis. Contrary to widespread beliefs, no level of alcohol consumption is risk-free for overall health. Even low levels of consumption are associated with a net increase in risk, particularly for cancers. The level of consumption associated with the lowest risk is… zero. Eastern Europe and Latin America record the highest levels of consumption, while North Africa, the Middle East, and South Asia show the lowest levels.    

Changing the rules of the game?  

Alcohol is a major, avoidable risk factor, associated with high morbidity and mortality, particularly among young adults. The main challenge is to reconcile public health messaging with epidemiological evidence in a context where alcohol consumption is culturally valued. This study aimed to quantify the global impact of alcohol on health using the most recent and comprehensive data available.  

It robustly demonstrates that the level of consumption associated with minimal risk is zero, contradicting the notion of a protective effect of the “glass of wine per day.” However, some limitations remain: exposure data are heterogeneous across regions; potential cardiovascular benefits have not been completely excluded in individuals over 50 years of age; and individual differences (genetics, comorbidities) are not fully accounted for.

Future perspectives include more coherent public health campaigns, policies to reduce access, clear labeling, better consideration of cumulative risk in guidelines, and further research on differential effects by age, sex, and high-risk populations.   

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