6.Evidence quality grades of D and possibly C suggest that the evidence for those statements may be so unreliable that it would be better to make no evidence statement at all for those conditions.
7.We note that only health benefits and risks were considered. Alcohol is a complex subject and this review misses commentary on social benefits and risks.
8.Some of the evidence statements are too simplistic. They ignore the fact that some benefits or risks of alcohol may only become relevant at high alcohol use levels, that there is a balance between risk and benefit that for any condition has to be considered in the context of any individuals non alcohol based risk factors, and that in some conditions the benefit or risk is very small in absolute terms. Indeed, throughout the text there is no clear delineation between the effects of light-to-moderate and heavy alcohol consumption, especially regarding increased risks of adverse health effects the text refers throughout to "alcohol use or alcohol consumption", where amount and pattern are not considered.
9.A dual relationship exists between alcohol consumption and diabetes mellitus. Light to moderate drinking may be beneficial while heavy drinking is detrimental. (Baliunas et al., 2009 and cited in the World Health Organisation Global Status report on Alcohol and Health 2011). The grade of D for the evidence statement about alcohol and diabetes assigned in this review appears incorrect in light of these references and may reflect the fact that predominantly the review does not cover literature reported after 2009.
10.The authors appear to have assumed any cardioprotective effect of the alcohol component was due only to the reduction in the concentration of HDL cholesterol observed following
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Boston University Medical Center