{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:00:37Z","timestamp":1792166437125,"version":"4.4.0"},"reference-count":47,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T00:00:00Z","timestamp":1703376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health, Italy","award":["ICS 160.2\/RF 2003, 2004\/2006"],"award-info":[{"award-number":["ICS 160.2\/RF 2003, 2004\/2006"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Alcohol is a psychoactive substance with deleterious effects on human health and mortality. This study aims to investigate the joint associations between the Mediterranean Diet (MedDiet), alcohol- consumption patterns and mortality from the following: all causes, cardiovascular, neoplastic, the digestive system, and other causes. Methods: A sample of 3411 alcohol consumers aged \u226518\u2009years was selected from two prospective cohort studies: the MICOL and NUTRIHEP Study. Cohorts were enrolled in 2005\u20132006, and followed up until December 2022, capturing data on alcohol consumption, diet, and mortality. Adherence to the MedDiet was measured by the relative Mediterranean score (rMED), and alcohol consumption by the Mediterranean Alcohol-drinking Pattern index (MADP). Statistical analyses included flexible parametric survival models and subdistribution hazard ratios, to consider different causes of death. Results: a significant increase in digestive-system (SHR 2.77, 95% CI 1.16; 63) and cancer mortality risk (SHR 2.25, 95% CI 1.08; 4.70) was observed among individuals with low adherence to the MADP. Low adherence to the Mediterranean pattern of alcohol consumption, combined with low adherence to the MedDiet, was associated with higher overall mortality (HR 2.29, 95% CI 1.04, 5.04), and, in particular, with higher mortality from digestive system diseases (SHR 4.38, 95% CI 1.22, 15.8). Conclusions: This study suggests that deleterious effects of alcohol on mortality vary, depending on alcohol consumption patterns and dietary context. Higher adherence to the MedDiet appears to mitigate the adverse effects of moderate alcohol consumption, particularly for wine drinkers.<\/jats:p>","DOI":"10.3390\/nu16010059","type":"journal-article","created":{"date-parts":[[2023,12,24]],"date-time":"2023-12-24T20:48:37Z","timestamp":1703450917000},"page":"59","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["High Adherence to a Mediterranean Alcohol-Drinking Pattern and Mediterranean Diet Can Mitigate the Harmful Effect of Alcohol on Mortality Risk"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5044-4625","authenticated-orcid":false,"given":"Angelo","family":"Campanella","sequence":"first","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8650-348X","authenticated-orcid":false,"given":"Caterina","family":"Bonfiglio","sequence":"additional","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7012-2885","authenticated-orcid":false,"given":"Francesco","family":"Cuccaro","sequence":"additional","affiliation":[{"name":"Local Health Unit\u2014Barletta-Andria-Trani, 76121 Barletta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9140-673X","authenticated-orcid":false,"given":"Rossella","family":"Donghia","sequence":"additional","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7891-6057","authenticated-orcid":false,"given":"Rossella","family":"Tatoli","sequence":"additional","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5140-8060","authenticated-orcid":false,"given":"Gianluigi","family":"Giannelli","sequence":"additional","affiliation":[{"name":"National Institute of Gastroenterology\u2014IRCCS \u201cSaverio de Bellis\u201d, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ding, C., O\u2019Neill, D., Bell, S., Stamatakis, E., and Britton, A. (2021). 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., 19.","DOI":"10.1186\/s12916-021-02040-2"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(18)30134-X","article-title":"Risk Thresholds for Alcohol Consumption: Combined Analysis of Individual-Participant Data for 599 912 Current Drinkers in 83 Prospective Studies","volume":"391","author":"Wood","year":"2018","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.jacc.2017.06.054","article-title":"Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer-Related Mortality in U.S. Adults","volume":"70","author":"Xi","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Murphy, N., Ferrari, P., and Soerjomataram, I. (2021). Alcohol and Cancer: Epidemiology and Biological Mechanisms. Nutrients, 13.","DOI":"10.3390\/nu13093173"},{"key":"ref_5","unstructured":"IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2010). Alcohol Consumption and Ethyl Carbamate, IARC Press."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1161\/CIRCULATIONAHA.115.019743","article-title":"Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis","volume":"133","author":"Mostofsky","year":"2016","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1056\/NEJMra2207599","article-title":"Alcohol-Associated Hepatitis","volume":"387","author":"Bataller","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_8","first-page":"1650","article-title":"Development of pediatric neuropathology in the USSR","volume":"67","author":"Tsuker","year":"1967","journal-title":"Zhurnal Nevropatol. I Psikhiatrii Im. SS Korsakova"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1161\/CIR.0000000000001168","article-title":"2023 AHA\/ACC\/ACCP\/ASPC\/NLA\/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"148","author":"Virani","year":"2023","journal-title":"Circulation"},{"key":"ref_10","unstructured":"(2022). GBD 2020 Alcohol Collaborators Population-Level Risks of Alcohol Consumption by Amount, Geography, Age, Sex, and Year: A Systematic Analysis for the Global Burden of Disease Study 2020. Lancet, 400, 185\u2013235."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1007\/s00394-020-02342-w","article-title":"Mediterranean Diet, Alcohol-Drinking Pattern and Their Combined Effect on All-Cause Mortality: The Seguimiento Universidad de Navarra (SUN) Cohort","volume":"60","author":"Morales","year":"2021","journal-title":"Eur. J. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.numecd.2019.03.007","article-title":"Mediterranean Alcohol-Drinking Pattern, Low to Moderate Alcohol Intake and Risk of Atrial Fibrillation in the PREDIMED Study","volume":"29","author":"Bazal","year":"2019","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1017\/S0007114513004376","article-title":"Mediterranean Alcohol-Drinking Pattern and Mortality in the SUN (Seguimiento Universidad de Navarra) Project: A Prospective Cohort Study","volume":"111","author":"Gea","year":"2014","journal-title":"Br. J. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/00042737-199606000-00017","article-title":"Epidemiology of Cholelithiasis in Southern Italy. Part II: Risk Factors","volume":"8","author":"Misciagna","year":"1996","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"The NUTRIHEP Collaborating Group, Cozzolongo, R., Osella, A.R., Elba, S., Petruzzi, J., Buongiorno, G., Giannuzzi, V., Leone, G., Bonfiglio, C., and Lanzilotta, E. (2009). Epidemiology of HCV Infection in the General Population: A Survey in a Southern Italian Town. Am. J. Gastroenterol., 104, 2740\u20132746.","DOI":"10.1038\/ajg.2009.428"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3317\/jraas.2006.011","article-title":"New Hypertension Guidelines from the National Institute for Health and Clinical Excellence and the British Hypertension Society","volume":"7","author":"Sever","year":"2006","journal-title":"J. Renin-Angiotensin-Aldosterone Syst."},{"key":"ref_17","unstructured":"(2023, November 14). UNESCO International Standard Classification of Education (ISCED-97) 2006. Available online: https:\/\/unesdoc.unesco.org\/ark:\/48223\/pf0000146967?posInSet=1&queryId=a8d996ff-eddd-4153-9468-5d7f9e8f7199."},{"key":"ref_18","unstructured":"(2023, November 14). International Standard Classification of Occupations, International Labour Office. Available online: https:\/\/www.ilo.org\/public\/english\/bureau\/stat\/isco\/docs\/resol08.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1093\/ije\/26.suppl_1.S15","article-title":"Validation and Calibration of Dietary Intake Measurements in the EPIC Project: Methodological Considerations. European Prospective Investigation into Cancer and Nutrition","volume":"26","author":"Kaaks","year":"1997","journal-title":"Int. J. Epidemiol."},{"key":"ref_20","unstructured":"(2010). WHO International Classification of Diseases, WHO. [10th ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1093\/aje\/kwp282","article-title":"Adherence to the Mediterranean Diet and Risk of Coronary Heart Disease in the Spanish EPIC Cohort Study","volume":"170","author":"Buckland","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_22","unstructured":"International Olive Council (IOC) (2023, November 20). EU Olive Oil Figures. 2019. Available online: https:\/\/www.internationaloliveoil.org\/wp-content\/uploads\/2022\/12\/IOC-Olive-Oil-Dashboard-2.html#production-1."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Barber\u00eda-Latasa, M., Bes-Rastrollo, M., P\u00e9rez-Araluce, R., Mart\u00ednez-Gonz\u00e1lez, M.\u00c1., and Gea, A. (2022). Mediterranean Alcohol-Drinking Patterns and All-Cause Mortality in Women More Than 55 Years Old and Men More Than 50 Years Old in the \u201cSeguimiento Universidad de Navarra\u201d (SUN) Cohort. Nutrients, 14.","DOI":"10.3390\/nu14245310"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A Proportional Hazards Model for the Subdistribution of a Competing Risk","volume":"94","author":"Fine","year":"1999","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/1536867X0400400201","article-title":"Cumulative Incidence Estimation in the Presence of Competing Risks","volume":"4","author":"Coviello","year":"2004","journal-title":"Stata J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e202219059","DOI":"10.1002\/anie.202219059","article-title":"Akaike\u2019s Information Criterion for Stoichiometry Inference of Supramolecular Complexes","volume":"62","author":"Ikemoto","year":"2023","journal-title":"Angew. Chem. Int. Ed."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Barto\u0161, F., Aust, F., and Haaf, J.M. (2022). Informed Bayesian Survival Analysis. BMC Med. Res. Methodol., 22.","DOI":"10.1186\/s12874-022-01676-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data from 6 Countries","volume":"173","author":"Quan","year":"2011","journal-title":"Am. J. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2932","DOI":"10.1038\/oby.2007.350","article-title":"Interaction between High-Fat Diet and Alcohol Dehydrogenase on Ethanol-Elicited Cardiac Depression in Murine Myocytes","volume":"15","author":"Ren","year":"2007","journal-title":"Obesity"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Moreira J\u00fanior, R.E., De Carvalho, L.M., Pedersen, A.S.B., Damasceno, S., Maioli, T.U., De Faria, A.M.C., and Godard, A.L.B. (2019). Interaction between High-Fat Diet and Ethanol Intake Leads to Changes on the Fecal Microbiome. J. Nutr. Biochem., 72.","DOI":"10.1016\/j.jnutbio.2019.07.006"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1001\/archinte.159.16.1865","article-title":"Wine, Beer, and Mortality in Middle-Aged Men From Eastern France","volume":"159","author":"Renaud","year":"1999","journal-title":"Arch. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1136\/jech.2008.082198","article-title":"Long-Term Wine Consumption Is Related to Cardiovascular Mortality and Life Expectancy Independently of Moderate Alcohol Intake: The Zutphen Study","volume":"63","author":"Streppel","year":"2009","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1093\/aje\/kwg184","article-title":"Wine, Liquor, Beer, and Mortality","volume":"158","author":"Klatsky","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"411","DOI":"10.7326\/0003-4819-133-6-200009190-00008","article-title":"Type of Alcohol Consumed and Mortality from All Causes, Coronary Heart Disease, and Cancer","volume":"133","year":"2000","journal-title":"Ann. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1093\/alcalc\/agl087","article-title":"Average volume of alcohol consumed, type of beverage, drinking pattern and the risk of death from all causes","volume":"41","author":"Baglietto","year":"2006","journal-title":"Alcohol Alcohol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/gerona\/62.2.213","article-title":"Alcoholic Beverage Preference, 29-Year Mortality, and Quality of Life in Men in Old Age","volume":"62","author":"Strandberg","year":"2007","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hrelia, S., Di Renzo, L., Bavaresco, L., Bernardi, E., Malaguti, M., and Giacosa, A. (2022). Moderate Wine Consumption and Health: A Narrative Review. Nutrients, 15.","DOI":"10.3390\/nu15010175"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1056\/NEJMoa022095","article-title":"Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men","volume":"348","author":"Mukamal","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0031-1278336","article-title":"Polyphenols Are Medicine: Is It Time to Prescribe Red Wine for Our Patients?","volume":"18","author":"Cordova","year":"2009","journal-title":"Int. J. Angiol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ditano-V\u00e1zquez, P., Torres-Pe\u00f1a, J.D., Galeano-Valle, F., P\u00e9rez-Caballero, A.I., Demelo-Rodr\u00edguez, P., Lopez-Miranda, J., Katsiki, N., Delgado-Lista, J., and Alvarez-Sala-Walther, L.A. (2019). The Fluid Aspect of the Mediterranean Diet in the Prevention and Management of Cardiovascular Disease and Diabetes: The Role of Polyphenol Content in Moderate Consumption of Wine and Olive Oil. Nutrients, 11.","DOI":"10.3390\/nu11112833"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00001648-200203000-00005","article-title":"Alcoholic Beverage Preference and Risk of Becoming a Heavy Drinker","volume":"13","author":"Jensen","year":"2002","journal-title":"Epidemiology"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Surial, B., Bertholet, N., Daeppen, J.-B., Darling, K., Calmy, A., G\u00fcnthard, H., St\u00f6ckle, M., Bernasconi, E., Schmid, P., and Rauch, A. (2021). The Impact of Binge Drinking on Mortality and Liver Disease in the Swiss HIV Cohort Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020295"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1080\/00365520802555991","article-title":"Alcohol Consumption Is Associated with Progression of Hepatic Fibrosis in Non-Alcoholic Fatty Liver Disease","volume":"44","author":"Ekstedt","year":"2009","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"a1344","DOI":"10.1136\/bmj.a1344","article-title":"Adherence to Mediterranean Diet and Health Status: Meta-Analysis","volume":"337","author":"Sofi","year":"2008","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1001\/jama.2022.0395","article-title":"Treatment of Tobacco Smoking: A Review","volume":"327","author":"Rigotti","year":"2022","journal-title":"JAMA"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1093\/aje\/kwp107","article-title":"Competing Risk Regression Models for Epidemiologic Data","volume":"170","author":"Lau","year":"2009","journal-title":"Am. J. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/S0140-6736(88)92890-5","article-title":"Alcohol and Mortality in British Men: Explaining the U-Shaped Curve","volume":"2","author":"Shaper","year":"1988","journal-title":"Lancet"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/1\/59\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:41:27Z","timestamp":1760132487000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/1\/59"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,24]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["nu16010059"],"URL":"https:\/\/doi.org\/10.3390\/nu16010059","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,24]]}}}