Risk of Early Death Is Higher in Underweight People Who Drink to Excess

A study found that people who are underweight and drink to excess have a much higher chance of dying of heart disease, cancer, and other causes than people at a healthy weight who drink more moderately.

The risk of early death from excessive drinking is also higher for underweight people than for individuals with obesity who consume high amounts of alcohol, according to the research, which was published in the January edition of the journal Drug and Alcohol Dependence.

"We expected to see a link between obesity and mortality related to alcoholism, and we were surprised to see that the link was especially pronounced for people with underweight who drink excessively," said Muntasir Masum, PhD, a postdoctoral scholar at the Edna Bennett Pierce Prevention Research Center at Penn State in University Park, Pennsylvania, in a press release.

Excessive Alcohol Use in the United States

In 2019, more than half of all men and women in the United States older than 18 reported drinking in the prior month, with 8.3 percent of men and 4.5 percent of women engaging in heavy alcohol use, according to the according to National Institute on Alcohol Abuse and Alcoholism.

Heavy drinking is defined as 8 or more drinks per week for women and 15 or more drinks per week for men. Excessive drinking doesn’t mean you are abusing alcohol. Most people who drink excessively are not alcoholics or alcohol dependent, per the Centers for Disease Control and Prevention (CDC).

Excessive alcohol use is the third most common cause of preventable death in the United States and is estimated to cause 1 in 10 deaths among working-age adults, according to the Journal of the American Medical Association.

The 2020–2025 Dietary Guidelines for Americans recommends that adult men limit intake to 2 drinks or less in a day and that women have 1 drink or less a day.

Researchers Used National Data to Look at How Alcohol and Weight May Impact Early Death

To examine the combined effects of alcohol and weight status on mortality, investigators used data from the National Health Interview Survey (NHIS), a nationally representative sample of 209,317 U.S. adults ages 35 to 85, interviewed between January 1, 2001, and December 31, 2011.

"The NHIS is like a 'selfie' for the United States, because it is a snapshot of health behaviors of people from every type of background," explained Dr. Masum.

Participants were categorized according to their self-reported alcohol use. People could be never drinkers, former drinkers, light or moderate drinkers (fewer than 7 drinks a week for women and fewer than 14 drinks a week for men) or heavy drinkers (more than 7 drinks per week for women or more than 14 drinks per week for men on average over the previous year).

The researchers analyzed data on mortality risk among drinkers and nondrinkers using the CDC's BMI categories to define "underweight," "normal weight," "overweight," and "obesity."

Body mass index (BMI) is a person’s weight in kilograms divided by the square of height in meters. According to the CDC definitions, BMI status is defined as follows:

  • 5 or below, underweight
  • 5–24.9, healthy weight
  • 25–29.9, overweight
  • 30 and above, obese

For a person who is 5 feet 6 inches tall, a healthy weight is between 115 and 154 pounds. If that person weighs less than 115 pounds, they are considered underweight; if they weigh 155 to 194 pounds, they are in the overweight category, and if they weigh 195 pounds or more, they're in the obese category.

Although the measurement is a simple and inexpensive way to group people in research, critics of the tool point out that it doesn’t account for how much fat or muscle a person has. Additionally, BMI was developed and validated mostly in white men, and women and people of other races or ethnicities may have a different typical body composition.

Underweight People and People With Obesity Who Drink Heavily Have a Higher Risk of Death

Researchers found that individuals who were underweight according to their BMI had a 148 percent higher risk of death from any cause than people with a healthy BMI status and light or moderate alcohol intake. Underweight people also had a higher risk of dying of heart disease or cancer than light to moderate drinkers with a healthy BMI.

Heavy drinkers with obesity had a 16 percent higher chance of dying from any cause than did light to moderate drinkers with a normal BMI status.

Previous data has established that people who are underweight or who have obesity have a greater risk of early death, and this study factors the effects of alcohol on top of that, says Michael Fingerhood, MD, the director of the addiction medicine division and an associate professor of medicine at John Hopkins Medicine in Baltimore.

RELATED: How to Receive Treatment for Alcohol Addiction Online

“There are several known health risks [associated with] drinking too much alcohol,” says Dr. Fingerhood. According to the CDC, the long-term health risks of excessive drinking can include high blood pressure, heart disease, liver disease, digestive problems, certain types of cancer, dementia, and a weakening of the immune system.

Too Many Calories From Alcohol May Contribute to Malnutrition

“There’s also a strong likelihood that someone who is underweight may not be getting all the nutrition they need, says Dr. Fingerhood.

“A BMI of under 18.5 is really thin. If someone is underweight, they should be focusing on using their daily calories to get the most nutrition they can, and alcohol isn’t going to provide any nutritional benefits,” he says.

Fingerhood gives an example of someone with severe alcohol use disorder. “Say that person drinks a case of beer a day. That’s 24 cans of beer, and each of those cans has at least 100 calories — probably more. That means that person is consuming 2,400 or more calories a day that have no nutritional benefit at all,” he says.

It’s not surprising that people of any weight status who drink that heavily would have nutritional abnormalities, says Fingerhood. “In this instance, if your BMI is that low, it’s likely that you’re taking in a very low number of calories, and if a lot of those calories are from alcohol, you’re likely to develop vitamin deficiencies that could increase your risk of mortality,” he says.

Additionally, if people who are underweight drink at the same rate as people who are normal weight, their blood alcohol content will rise more quickly, which can also have a negative effect on health, says Fingerhood.

“Interestingly, people who have had bariatric surgery have an increased risk of developing new-onset alcohol use disorder. It’s thought to be because post-surgery, drinking raises their blood alcohol levels more quickly and as a result they’re more likely to develop problems,” he says.

These findings are another reason why people should be mindful of how much they drink, and make sure they aren’t drinking excessively, says Fingerhood. “For anybody who drinks alcohol in a concerning way, they may not be getting enough nutrition from their daily calorie intake.”

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