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This review aimed to update current knowledge on causality and risk relationships to inform global and national comparative risk assessments for alcohol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fully alcohol\u2010attributable conditions were identified using International Classification of Diseases (ICD) 10th and 11th revision codes. We conducted a scoping review of meta\u2010analyses of cohort studies on average consumption and health outcomes (56 reviews), a systematic review of Mendelian randomisation (MR) studies on alcohol and ischaemic heart disease (IHD; 20 studies), and narrative syntheses on injuries, biological pathways, and reversibility of effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ICD\u201011 provides more detailed categories, defining 62 fully alcohol\u2010attributable conditions compared with 48 in ICD\u201010. Meta\u2010analyses support monotonic increasing dose\u2013response relationships between average consumption and most attributable health outcomes within infectious diseases, cardiovascular diseases, cancers, and digestive diseases. Relationships are J\u2010shaped for IHD, ischaemic stroke, and type 2 diabetes, with lower risk at low\u2010to\u2010moderate consumption (generally only without heavy episodic drinking). For dementia, heavy drinking is harmful and, among non\u2010heavy drinkers, relationships are age\u2010specific. MR evidence for IHD largely suggested null or harmful relationships, but only three studies tested non\u2010linear effects. In our view, the overall synthesis indicates that current MR evidence is insufficient to refute a J\u2010shaped relationship for IHD. Injury risk is driven primarily by acute intoxication and includes substantial harm to others. Acute risks are reversible with reductions in drinking or abstention, whereas many chronic disease processes are only partly reversible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Epidemiological evidence to inform comparative risk assessments for alcohol is comprehensive, but prone to major limitations. Triangulation, alongside biological plausibility, can strengthen synthesis across cohort and Mendelian randomisation studies, and the target trial framework can help future studies avoid design\u2010induced biases. Comparative risk assessments with ischaemic heart disease should, at this point, prioritise evidence from cohort studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70435","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:01:53Z","timestamp":1778731313000},"page":"1998-2018","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A review of the relationship between dimensions of alcohol consumption and the burden of disease: 2026 update including Mendelian randomisation studies"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0421-3145","authenticated-orcid":false,"given":"Sinclair","family":"Carr","sequence":"first","affiliation":[{"name":"Department of Epidemiology Harvard T.H. 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Chan School of Public Health  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9403-9405","authenticated-orcid":false,"suffix":"Sr.","given":"Gerhard E.","family":"Gmel","sequence":"additional","affiliation":[{"name":"Institute for Mental Health Policy Research, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Addiction Medicine, Lausanne University Hospital and University of Lausanne  Lausanne Switzerland"},{"name":"Faculty of Health and Social Sciences University of the West of England  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8878-5567","authenticated-orcid":false,"given":"Ahmed S.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Institute for Mental Health Policy Research, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1871-8849","authenticated-orcid":false,"given":"Kevin D.","family":"Shield","sequence":"additional","affiliation":[{"name":"Institute for Mental Health Policy Research, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Canada"},{"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"World Health Organization\/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Departments of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry Western University  London Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5665-0385","authenticated-orcid":false,"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[{"name":"Institute for Mental Health Policy Research, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Canada"},{"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"World Health Organization\/Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Department of Psychiatry University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"World Health Organization.Global status report on alcohol and health and treatment of substance use disorders. 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