Contents

Search

alcoholic beverage

Ethanol content of various beverages: - beer 4% - wine 12-13% - distilled spirits 40% (80 proof) One drink = 13.6 grams (1/2 oz of ethanol) in: - 12 oz of beer - 5 oz of wine (5 drinks/750 mL bottle) - 1.5 oz of 80 proof spirits (11 drinks/pint) - 3 oz of sherry 1 unit in the U.K = 8 grams, thus 2 units/drink [6] * alcohol levels in these alcholic beverages are actually quite variable 1 United Kingdom unit = 8.1 grams of ethanol so that 3.5 UK units = 1 oz of ethanol [28] Benefit/risk: Benefits of moderate alcohol consumption: Defined as <= 2 drinks/day for men , <= 1 drink/day for women, <= 1 drink/day for elderly (men & women) > 65 years of age [6]* 1) diminished risk of congestive heart failure [2] 2) no benefit in taking up drinking in middle age, regardless of coronary artery disease status [3] 3) diminished risk of cardiovascular disease [18,35,40] a) 1-2 drinks per day - heavy drinking associated with increased risk [35] b) beer, wine, spirits with similar benefit [18] 4) diminished risk of coronary artery disease a) RR = 0.53 with > 14 drinks/week (elderly) [12] b) RR = 0.85 with 1-13 drinks/week (elderly) [12] 5) diminished risk of ischemic stroke in question [41] - heavy alcohol use associated with increased risk [11] - RR = 1.4 with > 30 g or 2 drinks/day [3] - only red wine associated with diminished risk - RR = 0.5 for > 10 g/day of red wine - RR closer to 1 when adjusted for hypertension - moderate alcohol consumption does not protect against stroke in men [41] 6) +/- diminished risk of dementia a) RR = 0.58, RR = 0.29 for vascular dementia [4] b) 1 drink/day may diminish risk of dementia in women [5] c) for patients in 70s & 80s without baseline minimal cognitive impairment, no lovel of alcohol consumption associated with risk of dementia [42] d) for patients in 70s & 80s with baseline minimal cognitive impairment, > 14 drinks weekly (vs < 1) associated with risk of dementia (RR=1.7) [42] e) dementia risk with any alcohol consumption not associated with apoE4 allele f) maintaining mild-moderate alcohol consumption or initiation of mild alcohol consumption is associated with decreased risk of dementia [49] g) heavy alcohol consumption is associated with an increased risk of dementia [49] 7) diminished risk of chronic kidney disease [29] - 1-4 drinks monthly (RR=0.85), 2-7 drinks weekly (RR=0.82), 1-3 drinks daily (RR=0.71), >3 drinks daily (RR=0.60) [29] 8) infrequent alcohol (< 1 drink monthly) associated with 1/2 risk of mild cognitive impairment as non-drinkers or more frequent drinkers [10] - risk of dementia increased with increasing alcohol consumption only in individuals carrying the apoE4 allele 9) may benefit essential tremor 10) overall mortality may be favorably affected [18] - low-moderate alcohol consumption is not associated with diminished all-cause mortality [50] 11) diminished all-cause mortality & cardiovascular mortality in hypertensive men [9] 12) cardioprotection from moderate drinking is limited to people with unhealthy behaviors [13] 13) less weight gain in middle-age women 14) regular alcohol consumption associated with less cardiovascular risk than binge drinking for the same amount of alcohol consumed [17] 15) occasional drinking may be associated with increased cardiovascular risk [35] 16) may diminish biochemical markers of bone turnover & increase bone density in postmenopausal women [19] 17) diminished risk of type 2 diabetes (RR=0.7) [31] 18) benefits of alcohol limited to men 50-64 years of age & women > 65 years of age [28] for both men & women, <= 100 grams of alcohol/week (~7 drinks) associated with lowest all-cause mortality [39] National Institute on Alcohol Abuse & Alcoholism (NIAAA) recommends adults >= 65 years not drink > 3 drinks/day & not drink > 7 drinks/week [49] * RR = relative risk Pharmacokinetics: - alcohol is metabolized in the liver leading to an accumulation of NADH - high concentrations of NADH inhibit gluconeogenesis by preventing oxidation of lactate to pyruvate, thus increasing risk of lactic acidosis & hypoglycemia Drug interactions: - in combination with acetaminophen, increases risk of hepatotoxicity - increases risk of opioid overdose - increases risk of benzodiazepine overdose Complications: 1) alcoholism - using alcohol as a sleep aid may signal hazardous behavior [16] 2) increased risk of gout [7] - spirits & beer confer greater risk than wine 3) increased risk of cancer-related death* a) increased risk of gastrointestinal cancers - even moderate drinking associated with oral cancer, esophageal cancer, laryngeal cancer, & colorectal cancer [37] - increased risk of colorectal cancer with consumption of > 45 g of alcohol/day (~ 3 drinks), relative risk 1.5 [8] - increased risk of early onset colorectal cancer (< 50 years) with > 0.7 drinks/day (RR=1.1) [52] - with >= 2.1 drinks/day for men, >= 1.4 drinks/day for women (RR=1.2) - frequent drinking may be a more important risk factor for incident GI cancers than the amount of alcohol consumed per occasion [47] b) although not carcinogenic, associated with risk of cancer in the upper respiratory tract as well as hepatocellular carcinoma in the setting of cirrhosis c) even moderate drinking associated with breast cancer [37] - increased risk of breast cancer begining with intake of 1-2 drinks/day [6,25] - risk may be attenuated by folic acid [6,25] d) in male smokers & women, even light-to-moderate drinking is associated with increased risk for alcohol-related cancers* [3] e) responsible for about 3.5% of all cancer deaths in the U.S. in 2009 [21] f) any alcohol consumption may increase risk of cancer [40] 4) increased risk of atrial fibrillation [26] - relative risks (RR) compared with no alcohol intake - 1 drink/day: RR = 1.08 - 2 drinks/day: RR = 1.17 - 3 drinks/day: RR = 1.26 - 4 drinks/day: RR = 1.36 - 5 drinks/day: RR = 1.47 - 1 drink doubles risk of atrial fibrillation within 4 hours [44] 5) moderate alcohol consumption (>= 7-14 drinks/week) associated with - structural brain changes [36] - reduced gray matter volume [43] & density - hippocampal atrophy - reduced white matter microstructural integrity - reduced lexical fluency [36] 6) exceeding 100 grams of alcohol/week (~7 drinks) associated with shorter life expectancy at age 40 (2.7 years for men & 1.3 years for women) [39] 7) no amount of alcohol is safe [48] * alcohol-related cancers include: colorectal cancer, breast cancer, oral cancer, pharyngeal cancer, laryngeal cancer, liver cancer, & esophageal cancer Management: - brief intervention or counseling by primary care providers can lead to a reduction of alcohol consumption by patients consuming > 2 drinks/day for men (> 1 drink/day if > 65 years (> 14 drinks/week or 4 drinks/occasion), > 1 drink/day for women (> 7 drinks/ week or 3 drinks/occasion), i.e. at risk drinking [6,14] - reduce alcohol intake to accetable limits for patients with atrial fibrillation - no recommendation for discontinuing alcohol [6] Notes: - acute or short term alcohol intake enhances neuronal inhibition through facilitation of GABA-A receptors - chronic alcohol comsumption may inhibit GABA-A receptors [20] - prices & taxes on alcohol should be increased [37] - alcohol companies should not engage in pink-washing (use of pink ribbons or the color pink to raise breast cancer awareness) [37] - new report suggests lowering limit for legal intoxication to 0.05%, & increasing state & federal taxes on alcohol [38]

Interactions

drug interactions

Related

alcohol consumption in the elderly alcohol during pregnancy alcoholism (includes binge drinking) at-risk drinking ethanol; ethyl alcohol medication interactions with alcohol screening for alcohol abuse teenage use of alcohol veisalgia

Specific

beer wine

General

beverage

References

  1. Alison Moore, UCLA Multicampus Program in Geriatrics & Gerontology, 2002
  2. Journal Watch 22(5):36, 2002 Walsh CR et al Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med 136:181, 2002 PMID: 11827493 - Nicolas JM et al The effect of controlled drinking in alcoholic cardiomyopathy. Ann Intern Med 136:192, 2002 PMID: 11827495
  3. Journal Watch 22(5):37, 2002 Wannamethhee SG & Shaper AG Taking up regular drinking in middle age: effect on major coronary heart disease events and mortality. Heart 87:32, 2002 PMID: 11751661
  4. Journal Watch 22(5):37, 2002 Ruitenberg A, van Swieten JC, Witteman JC, Mehta KM, van Duijn CM, Hofman A, Breteler MM. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet. 2002 Jan 26;359(9303):281-6. PMID: 11830193
  5. Journal Watch 25(5):40, 2005 Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. N Engl J Med. 2005 Jan 20;352(3):245-53. PMID: 15659724
  6. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; - Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  7. Journal Watch 24(11):90, 2004 Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004 Apr 17;363(9417):1277-81. PMID: 15094272 Zeng QY. Drinking alcohol and gout. Lancet. 2004 Apr 17;363(9417):1251-2. No abstract available. PMID: 15094267
  8. Journal Watch 24(11):87, 2004 Cho E, Smith-Warner SA, Ritz J, van den Brandt PA, Colditz GA, Folsom AR, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Holmberg L, Kim DH, Malila N, Miller AB, Pietinen P, Rohan TE, Sellers TA, Speizer FE, Willett WC, Wolk A, Hunter DJ. Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. Ann Intern Med. 2004 Apr 20;140(8):603-13. PMID: 15096331
  9. Journal Watch 24(11):88, 2004 Malinski MK, Sesso HD, Lopez-Jimenez F, Buring JE, Gaziano JM. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Arch Intern Med. 2004 Mar 22;164(6):623-8. PMID: 15037490
  10. Journal Watch 24(20):150, 2004 Anttila T, Helkala EL, Viitanen M, Kareholt I, Fratiglioni L, Winblad B, Soininen H, Tuomilehto J, Nissinen A, Kivipelto M. Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study. BMJ. 2004 Sep 4;329(7465):539. Epub 2004 Aug 10. PMID: 15304383 http://bmj.bmjjournals.com/cgi/content/full/329/7465/539
  11. Journal Watch 25(3):24, 2005 Mukamal KJ, Ascherio A, Mittleman MA, Conigrave KM, Camargo CA Jr, Kawachi I, Stampfer MJ, Willett WC, Rimm EB. Alcohol and risk for ischemic stroke in men: the role of drinking patterns and usual beverage. Ann Intern Med. 2005 Jan 4;142(1):11-9. Summary for patients in: Ann Intern Med. 2005 Jan 4;142(1):I24. PMID: 15630105
  12. Mukamal KJ, Chung H, Jenny NS, Kuller LH, Longstreth WT Jr, Mittleman MA, Burke GL, Cushman M, Psaty BM, Siscovick DS. Alcohol consumption and risk of coronary heart disease in older adults: the cardiovascular health study. J Am Geriatr Soc. 2006 Jan;54(1):30-7. PMID: 16420195
  13. Britton A, Marmot MG, Shipley M. Who benefits most from the cardioprotective properties of alcohol consumption-health freaks or couch potatoes? J Epidemiol Community Health. 2008 Oct;62(10):905-8. PMID: 18791048
  14. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
  15. Wang L et al Alcohol Consumption, Weight Gain, and Risk of Becoming Overweight in Middle-aged and Older Women Arch Intern Med. 2010;170(5):453-461 PMID: 20212182 http://archinte.ama-assn.org/cgi/content/short/170/5/453?home
  16. Vinson DC et al Alcohol and Sleep Problems in Primary Care Patients: A Report from the AAFP National Research Network Annals of Family Medicine 8:484-492 (2010) PMID: 21060117 http://www.annfammed.org/cgi/content/full/8/6/484
  17. Ruidavets JB et al Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME) BMJ 2010; 341:c6077 PMID: 21098615 http://www.bmj.com/content/341/bmj.c6077.full
  18. Ronksley PE et al. Association of alcohol consumption with selected cardiovascular disease outcomes: A systematic review and meta-analysis. BMJ 2011 Feb 22; 342:d671. PMID: 21343207 - Brien SE et al. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies. BMJ 2011 Feb 22; 342:d636 PMID: 21343206
  19. Marrone JA et al. Moderate alcohol intake lowers biochemical markers of bone turnover in postmenopausal women. Menopause 2012 Sep; 19:974 PMID: 22922514
  20. Lithari C et al Alcohol Affects the Brain's Resting-State Network in Social Drinkers. PLoS ONE 7(10): e48641. PMID: 23119078 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0048641
  21. Nelson DE et al Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States American Journal of Public Health. Feb 2013 PMID: 23409916 http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301199
  22. Allen NE, Beral V, Casabonne D et al Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009 Mar 4;101(5):296-305. PMID: 19244173
  23. Costanzo S, Di Castelnuovo A, Donati MB et al Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2010 Mar 30;55(13):1339-47. PMID: 20338495 - Costanzo S, Di Castelnuovo A, Donati MB et al Cardiovascular and overall mortality risk in relation to alcohol consumption in patients with cardiovascular disease. Circulation. 2010 May 4;121(17):1951-9. PMID: 20439811
  24. Di Castelnuovo A, Costanzo S, Bagnardi V et al Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006 Dec 11-25;166(22):2437-45. PMID: 17159008
  25. Singletary KW, Gapstur SM. Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms. JAMA. 2001 Nov 7;286(17):2143-51. PMID: 11694156
  26. Larsson SC et al. Alcohol consumption and risk of atrial fibrillation: A prospective study and dose-response meta-analysis. J Am Coll Cardiol 2014 Jul 22; 64:281. PMID: 25034065 - Conen D and Albert CM. Alcohol consumption and risk of atrial fibrillation: How much is too much? J Am Coll Cardiol 2014 Jul 22; 64:290 PMID: 25034066
  27. Jones CM et al Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse-Related Emergency Department Visits and Drug- Related Deaths - United States, 2010 MMWR. October 10, 2014 / 63(40);881-885 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a1.htm
  28. Knott CS et al All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ 2015;350:h384 PMID: 2567062 http://www.bmj.com/content/350/bmj.h384 - Daube M Alcohol's evaporating health benefits BMJ. 2015 Feb 10;350:h407 PMID: 25670722
  29. Koning SH et al. Alcohol consumption is inversely associated with the risk of developing chronic kidney disease. Kidney Int 2015 May; 87:1009. PMID: 25587707
  30. Cao Y et al Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ 2015;351:h4238 PMID: 26286216 http://www.bmj.com/content/351/bmj.h4238 - Rehm J Light or moderate drinking is linked to alcohol related cancers, including breast cancer. BMJ 2015;351:h4400 PMID: 26286217 http://www.bmj.com/content/351/bmj.h4400
  31. Koppes LL, Dekker JM, Hendriks HF, Bouter LM, Heine RJ. Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies. Diabetes Care. 2005 Mar;28(3):719-25. Review. PMID: 15735217
  32. Leong DP, Smyth A, Teo KK et al Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study. Circulation. 2014 Jul 29;130(5):390-8. PMID: 24928682 Free Article
  33. Tolstrup J et al Prospective study of alcohol drinking patterns and coronary heart disease in women and men. BMJ. 2006 May 27;332(7552):1244-8. PMID: 16672312 Free PMC Article
  34. Roerecke M, Rehm J. The cardioprotective association of average alcohol consumption and ischaemic heart disease: a systematic review and meta-analysis. Addiction. 2012 Jul;107(7):1246-60. Review. PMID: 22229788 Free PMC Article
  35. Bell S, Daskalopoulou M, Rapsomaniki E et al Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ 2017;356:j909 PMID: 28331015 http://www.bmj.com/content/356/bmj.j909 - Mukamal K, Lazo M Alcohol and cardiovascular disease BMJ 2017;356:j1340 PMID: 28330843 http://www.bmj.com/content/356/bmj.j1340
  36. Topiwala A et al Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study. BMJ 2017;357:j2353 PMID: 28588063 Free full text http://www.bmj.com/content/357/bmj.j2353 - Welch KA Alcohol consumption and brain health BMJ 2017;357:j2645 PMID: 28588039 Free full text http://www.bmj.com/content/357/bmj.j2645
  37. LoConte NK, Brewster AM, Kaur JS et al Alcohol and Cancer: A Statement of the American Society of Clinical Oncology. J Clin Oncol. Nov 2017 PMID: 29112463 http://ascopubs.org/doi/abs/10.1200/JCO.2017.76.1155
  38. National Academy of Science, Engineering & Medicine New Report Calls for Lowering Blood Alcohol Concentration Levels for Driving, Increasing Federal and State Alcohol Taxes, Increasing Enforcement, Among Other Recommendations. News Release. Jan 17, 2018 http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24951
  39. Wood AM, Kaptoge S, Butterworth AS, et al Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599,912 current drinkers in 83 prospective studies. Lancet 391:1513-1523, 14 April 2018 PMID: 29676281 Free PMC Article http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext - MacReady N Even Modest Alcohol Intake May Up Mortality Risk Medscape - Apr 13, 2018. https://www.medscape.com/viewarticle/895170
  40. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease study 2016. Lancet 2018 Sep 22; 392:1015. ePub Aug 23, 2018 PMID: 30146330 Free PMC Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext
  41. Millwood IY, Walters RG, Mei XW et al Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500,000 men and women in China. Lancet. April 4, 2019 PMID: 30955975 Free Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31772-0/fulltext
  42. Koch M, Fitzpatrick AL, Rapp SR et al. Alcohol consumption and risk of dementia and cognitive decline among older adults with or without mild cognitive impairment. JAMA Netw Open 2019 Sep 27; 2:e1910319. PMID: 31560382 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752097
  43. Syrek R Trending Clinical Topic: Alcohol . Medscape - Jun 04, 2021. https://reference.medscape.com/viewarticle/952168
  44. Wendling P HOLIDAY Monitors: Even One Drink Doubles Risk for AF Within 4 Hours. Medscape - May 21, 2021 https://www.medscape.com/viewarticle/951623
  45. Medscape - Labos C The Sick-Quitter Effect: How Alcohol Can Seem Cardioprotective When It Isn't. Medscape. June 29, 2021 https://www.medscape.com/viewarticle/953696 - Stiles S New-AF Risk May Not Rise With Light Drinking, May Fall With Wine. Medscape. August 5, 2021 https://www.medscape.com/viewarticle/956211 - Stiles S Stroke Risk in New-Onset Atrial Fib Goes Up With Greater Alcohol Intake. Medscape. June 17, 2021 https://www.medscape.com/viewarticle/953317 - Brooks M Moderate Drinking Protective After MI, Stroke in 'Flawed' Study. Medscape. July 27, 2021 (flawed study is next ref [46] PMID: 34311738) https://www.medscape.com/viewarticle/955474 - Labos C Alcohol and Cardioprotection: Enduring Truth or Myth That Won't Die? Medscape. July 14, 2021 https://www.medscape.com/viewarticle/933238
  46. Ding C, O'Neill D, Bell S et al Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women. BMC Med 2021 19:167. July 27 PMID: 34311738 PMCID: PMC8314518 Free PMC article https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02040-2
  47. Yoo JE, Shin DW, Han K et al Association of the Frequency and Quantity of Alcohol Consumption With Gastrointestinal Cancer. JAMA Netw Open. 2021;4(8):e2120382 August 18 PMID: 34406403 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783180
  48. Brooks M No Amount of Alcohol Safe for the Heart: WHF. Medscape. Jan 24, 2022 https://www.medscape.com/viewarticle/967124 - World Heart Federation. THE IMPACT OF ALCOHOL CONSUMPTION ON CARDIOVASCULAR HEALTH: MYTHS AND MEASURES. https://world-heart-federation.org/wp-content/uploads/WHF-Policy-Brief-Alcohol.pdf
  49. Jeon KH, Han K, Jeong SM et al Changes in Alcohol Consumption and Risk of Dementia in a Nationwide Cohort in South Korea. JAMA Netw Open. 2023;6(2):e2254771 PMID: 36745453 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800994
  50. Zhao J, Stockwell T, Naimi T et al Association Between Daily Alcohol Intake and Risk of All-Cause Mortality. A Systematic Review and Meta-analyses. JAMA Netw Open. 2023;6(3):e236185. PMID: 37000449 PMCID: PMC10066463 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802963
  51. Rethinking Drinking. Alcohol and your health. What's a "standard" drink? http://rethinkingdrinking.niaaa.nih.gov/whatcountsdrink/whatsastandarddrink.asp - National Institute on Alcohol Abuse and Alcoholism What Is A Standard Drink? https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink - Older Adults National Institute on Alcohol Abuse and Alcoholism https://www.niaaa.nih.gov/alcohols-effects-health/special-populations-co-occurring-disorders/older-adults
  52. Jin EH, Han K, Shin CM et al Sex and Tumor-Site Differences in the Association of Alcohol Intake With the Risk of Early-Onset Colorectal Cancer. J Clin Oncol. 2023 Aug 1;41(22):3816-3825. PMID: 37315287 https://ascopubs.org/doi/full/10.1200/JCO.22.01895