Why NASEM’s approach to assessing alcohol risks deserves a closer look
With updated US dietary guidelines being developed, a group of leading alcohol and public health researchers is urging caution about how we interpret data on drinking and health. In a recent commentary in The Lancet Regional Health – Americas, researchers argue that many of the studies and approaches used to inform drinking guidelines, including those cited and employed by the National Academies of Sciences, Engineering, and Medicine (NASEM), have serious limitations that could lead to misleading conclusions.
Much of the evidence cited comes from all-cause mortality studies, which look at how alcohol use is linked to the risk of death from any cause, not just alcohol-related illnesses or injuries. While common in health research, these studies are too broad and often prone to bias, such as not being able to control for disease-specific confounding which can lead to overestimating the protective effects of alcohol.
The researchers also emphasize that most all-cause mortality studies are based on cohort data studies, that is, observational studies that follow groups of people over time. While widely used in public health, these studies often rely on narrow samples, typically involving middle-aged, middle-income individuals from similar cultural backgrounds. As a result, the findings may not reflect broader population differences in drinking patterns, underlying health risks, or health outcomes. This selection bias can distort the evidence base and limit its usefulness in shaping inclusive, evidence-informed guidelines.
They further note that many of the studies cited in NASEM’s review are based on populations outside the US, making them less applicable to American public health contexts. Additionally, average alcohol use is often reported in ways that mask important differences between moderate drinkers and those who engage in heavy or episodic binge drinking, obscuring meaningful patterns of harmful alcohol use.
Using flawed research to inform the public about alcohol sends mixed messages about its risks. The best available science simply doesn’t support the idea that a nightly drink is good for you.
–Co-author and ARG Scientist Priscilla Martinez, PhD
The Problem with All-Cause Mortality Studies
All-cause mortality studies look at deaths from any cause, not just those directly linked to alcohol. This broad inclusion can make it seem like alcohol has protective effects when it doesn’t. Here’s why experts say these studies are misleading:
- They include causes of death unrelated to alcohol, obscuring its actual health risks.
- Some studies suggest alcohol reduces death risk from things like injury or infection, which is unlikely and likely due to other confounding factors.
- Drinkers are often compared to former drinkers, who may have quit for health reasons, making current drinkers appear healthier by contrast.
- Drinking patterns, like daily vs. binge drinking, are often not captured, leading to oversimplified conclusions.
- Most of these studies are derived from cohort studies that do not reflect the diversity of the US population.
Why This Matters
Millions of Americans drink alcohol, and many look to the Dietary Guidelines for reassurance about what’s safe. But if those guidelines are based on flawed or incomplete evidence, people may underestimate the real risks especially when it comes to less well-known harms from alcohol use such as cancer and heart disease.
The authors urge federal agencies to prioritize cause-specific studies that look directly at how alcohol affects the likelihood of dying from alcohol-specific health outcomes, such as liver disease, cancers, or injuries instead of relying on all-cause mortality alone.
Read the commentary: Shield, K., Keyes, K., Martinez, P., Milam, A.J., Rehm, J,. Naimi, T. S. (2025). Biases inherent in all-cause mortality studies: implications for shaping the 2025–2030 dietary guidelines for Americans on alcohol consumption: https://www.sciencedirect.com/science/article/pii/S2667193X25000936
Related Information
Even Small Amounts of Alcohol Increase Health Risk
The recently released Alcohol Intake and Health Study finds that even low levels of drinking raise the risk of cancer and death. Conducted by a scientific review panel under the Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), the study includes contributions from Priscilla Martinez, PhD, Deputy Scientific Director and Scientist at the Alcohol Research Group, a program of the Public Health Institute.
Report on Alcohol and Health Risk
The Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), a U.S. Department of Health and Human Services (HHS) committee, with contributions from leading researchers across multiple disciplines and institutions, including the World Health Organization, the Mayo Clinic, University of Victoria, the Center for Addiction and Mental Health, and Columbia University.
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