From the, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
J Intern Med. 2020 Nov;288(5):550-559. doi: 10.1111/joim.13129. Epub 2020 Jun 29.
Alcohol has been produced by humans for nearly ten millennia, but gold-standard evidence by which to judge the health effects of limited alcohol consumption remains elusive, introducing serious difficulty in considering the safety of alcohol consumption. To do so, physicians and policymakers must consider the population, dose and context of alcohol consumption and the end-point, preferably a holistic composite, of interest. The limitations of new research trends, such as mega-cohorts, genetic instrumental variable analysis and modelling studies, must also be viewed against the much larger backdrop of existing evidence. Some existing guidelines, such as the 2015-2020 Dietary Guidelines for Americans, succeed remarkably in this task. Nonetheless, large-scale randomized trials are urgently needed if future generations are to enjoy any greater insight into the health effects of population-wide alcohol consumption than the current one has.
人类酿酒的历史已近一万年，但判断有限量饮酒健康影响的黄金标准证据仍难以捉摸，这给评估饮酒安全性带来了严重困难。因此，医生和政策制定者必须考虑饮酒的人群、剂量和背景，以及终点，最好是一个整体的综合终点。还必须从现有证据的更大背景来看待新研究趋势（如大型队列研究、遗传工具变量分析和模型研究）的局限性。一些现有的指南，如 2015-2020 年美国人饮食指南，在这方面非常成功。尽管如此，如果要让后代对人群饮酒的健康影响有比当前更深入的了解，仍迫切需要进行大规模的随机临床试验。
