In both the NHIS dataset, an epidemiologic sample, and VA dataset, a clinical sample, the nadir of all-cause mortality is drinking 1–2 drinks approximately 3 times weekly, and drinking 1–2 drinks more frequently increases the risk of all-cause mortality. In our analyses of the NHIS and VA data, drinking daily does not show increased risk of all-cause mortality relative to non-drinkers, which is consistent with previously published studies, and is the reason for the J or U-shaped curve often discussed in the literature (Costanzo, Di Castelnuovo, Donati et al. 2010). However, the reference category with the lowest risk level of alcohol consumption is essential for making recommendations regarding alcohol use. For example, the current U.S. dietary guidelines recommend that non-drinkers remain abstinent from alcohol (Division of Population Health; U.S. Department of Health and Human Services and U.S. Department of Agriculture 2015; National Institute on Alcohol Abuse and Alcoholism 2016), and it is appropriate to guide current drinkers based on the minimum all-cause mortality seen based on drinking patterns among those who drink.
