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Alcohol consumption and brain health

BMJ 2017; 357 doi: (Published 06 June 2017) Cite this as: BMJ 2017;357:j2645
  1. Killian A Welch, consultant neuropsychiatrist and honorary senior lecturer
  1. Robert Fergusson Unit, Royal Edinburgh Hospital, EH10 5HF, UK
  1. Killian.Welch{at}

Even moderate drinking is linked to pathological changes in the brain

Epidemiological studies often report better heath in moderate drinkers compared with abstainers. Observed first in studies of incidence of myocardial infarction,1 the “J shaped curve” (describing the graphical appearance of health measures plotted against consumption) reappears in studies of diabetes, stroke, and even chronic widespread pain.2 As methods of investigating the association between alcohol and health are refined, however, the size of the apparent benefits reduces substantially.3 Studies using “Mendelian randomisation,” purportedly impervious to confounding or reverse causality, do not support the original claim that moderate drinking improves cardiovascular health.4

Regarded as a further example of the J shaped curve, a protective effect of moderate alcohol consumption against “all cause” dementia has been reported.5 This has not been underpinned by a convincing neural correlate, however, and it is here that the linked study by Topiwala and colleagues (doi:10.1136/bmj.j2353) is particularly ambitious.6 In their prospective cohort of 550 civil servants, none of whom were alcohol dependent, the authors repeatedly assessed alcohol consumption and …

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