Tipos de bebidas alcohólicas y efectos diferenciados en la salud: una revisión paraguas de estudios observacionales

espanolFundamentos: Existe gran controversia sobre si el consumo de diversos tipos de bebidas alcoholicas tiene efectos diferenciados en la salud. El objetivo de este estudio fue realizar una revision paraguas de los estudios que describian la asociacion del consumo de diferentes tipos de bebidas alcoholicas con diversos indicadores de salud. Metodos: Se realizo una busqueda a traves de PubMed (entre enero de 2000 y febrero de 2019) de revisiones sistematicas y metaanalisis que reportaban resultados cuantitativos de la asociacion entre el consumo de diferentes tipos de bebidas alcoholicas y efectos en salud. Se identificaron 26 estudios: veintiuno estaban relacionados con cancer, tres con enfermedades cardiometabolicas, dos con neurodegenerativas y uno con mortalidad general. Resultados: Los resultados fueron heterogeneos. Las grandes diferencias metodologicas en la estimacion de la ingesta de alcohol, el control de las variables confusoras y el contraste de las estimaciones entre el tipo de bebidas hacian muy dificil concluir sobre si provocaban un efecto desigual en la salud. En la mortalidad general y las enfermedades cardiometabolicas, aunque parece que la cerveza y los licores tenian un mayor efecto negativo que el vino, las diferencias entre tipos de bebidas no eran estadisticamente significativas. Respecto al cancer, en aquellos tipos cuya evidencia causal era totalmente consistente (orofaringe, colorrectal y de mama [mujeres]), las revisiones no mostraban un efecto diferenciado segun los tipos de bebidas alcoholicas. Respecto a las enfermedades neurodegenerativas, la informacion disponible tampoco permitia establecer claras conclusiones. Conclusiones: La evidencia revisada no permite afirmar que el consumo de vino, cerveza o licores tenga un efecto diferencial en las enfermedades cardiometabolicas, las neurodegenerativas o el cancer. EnglishBackground: There is great controversy about whether the consumption of different types of alcoholic beverages has different effects on health. The objective was to carry out an umbrella review of the studies that described the association between the consumption of different types of alcoholic beverages and various health indicators. Methods: Search through PubMed (from January 2000 to February 2019) of systematic reviews and meta- analysis that reported quantitative results of the association between the consumption of different types of alcoholic beverages and health effects. 26 studies were identified: 21 related to cancer, three to cardiometabolic diseases, two to neurodegenerative diseases, and one to general mortality. Results: The results were heterogeneous. The great methodological differences in the estimation of alcohol intake, control of confounding variables, and the evaluation of statistical difference between types of beverages, made it very difficult to conclude whether they cause an unequal effect on health. In general mortality and cardiometabolic diseases, it was suggested that beer and spirits appear to have a greater negative effect than wine, but the differences were not statistically significant. Regarding cancer, in those types where the causal evidence is totally consistent: oropharynx, colorectal and breast (women), the reviews did not show a differentiated effect according to the type of alcoholic beverages. Regarding neurodegenerative diseases, the available information did not allow clear conclusions to be drawn. Conclusions: The reviewed evidence does not allow to conclude that the consumption of wine, beer or spirits, has a differential effect on cardiometabolic, cancer or neurodegenerative diseases.