Moderate wine consumption has historically been associated with a J-shaped relationship between dose and total mortality, driven primarily by cardiovascular protection, enhanced endothelial function, improved glucose metabolism, and anti-inflammatory and antioxidant effects attributable to both ethanol and grape-derived phenolic constituents. Yet in recent years, international alcohol guidelines have shifted markedly towards the assertion that ‘no safe level’ of alcohol exists. This transition has occurred despite the continued consistency of mechanistic, clinical, and epidemiological evidence demonstrating hormetic (biphasic) responses to wine and its constituents and despite methodological controversies over the mathematical models used in several recent national guideline revisions. This narrative review synthesises mechanistic evidence on hormesis and wine-specific biological effects—including polyphenols, resveratrol, nitric oxide signalling, platelet modulation, and endothelial benefits—with epidemiological data on J-shaped associations with cardiovascular disease, diabetes, and total mortality. It further examines key methodological changes in recent guidelines, particularly the adoption of the ‘Sheffield model’ and the exclusion of or reduced emphasis on cardioprotective outcomes. The review argues that these methodological decisions, rather than new scientific evidence, largely explain the departure from earlier guideline thresholds that allowed moderate wine consumption. Understanding wine’s biological specificity, the differential health implications of drinking patterns and contexts, and the limitations of model-driven policy changes is essential to develop coherent, evidence-informed public health recommendations.

Polyphenols are a group of phytochemicals with potential health-promoting effects. They are classified as flavonoid (flavonols, flavanols, flavones, flavanones, isoflavones, and anthocyanins) and non-flavonoid molecules (phenolic acids, hydroxycinnamic acids, lignans, stilbenes, and tannins). Although an increasing number of trials have shown a correlation among polyphenol consumption and a reduction in risk factors for chronic diseases, discrepancies in explaining their positive effects have been found in terms of the bioavailability. In fact, polyphenols show a low bioavailability due to several factors: interaction with the food matrix, the metabolic processes mediated by the liver (phase I and II metabolism), intestine and microbiota. On the other hand, the biological activities of phenol compounds may be mediated by their metabolites, which are produced in vivo, and recent studies have confirmed that these molecules may have antioxidant and anti-phlogistic properties. This review discusses the studies performed in vivo, which consider the polyphenol bioavailability and their different food sources. Factors influencing the biological effects of the main classes of polyphenols are also considered.

Since 1988, alcohol has been classified as a Group 1 carcinogen, the highest level of risk, by the International Agency for Research on Cancer (IARC). In fact, alcohol consumption is the third leading risk factor for disease and mortality in Europe. It accounts for 4.65 % of the global burden of both injury and disease, making it one of the most preventable causes of injury and death. Tissues in closest contact with alcohol when it is ingested, such as those of the oral cavity, pharynx, esophagus and larynx, have at greater risk of becoming cancerous than other body tissues. The consumption of alcohol is also associated with an increased risk of stomach, colon, rectum, liver, female breast and ovarian cancers. Conversely, recent studies suggest that red wine components inhibit colony formation of human breast cancer and esophageal carcinoma cells, suggesting that wine-derived phenolic compounds may be inhibitory, in contrast to the alcohol component of wine. Because of a lack of systematic studies dealing with the different types of cancer and alcoholic beverages and wine in particular, in this narrative review we summarize the general risk of cancer linked to the consumption of alcoholic beverages, including wine, according to type of cancer, with 140 extracted relevant references from 1966 to 2020. Mostly epidemiological studies concerning large cohorts have been selected. For the cancers of the upper aerodigestive tract, liver, colorectum, breast cancer, pancreatic, prostate, an excessive consumption and/or misuse of alcoholic beverages is correlated with increased risk. Conversely a probable decreased risk has been found for renal/kidney cancers, as well as for Non-Hodgkin lymphomas, such as thyroid lymphomas, associated with the moderate consumption of alcoholic beverages. There is no evidence of ovarian, gastric, head and neck, and lung cancer being linked to the moderate consumption of alcoholic beverages. Cancer is a multifactorial disease, and many factors contribute to effects on health status, usually being both genetic and environmental. Habits (smoking, dietary/lifestyle pattern/habits, physical activity), should also be taken into account when defining appropriate consumption frequencies for different types of alcoholic drink (wine, beer, spirits). Further research is needed related to wine consumption in the context of a healthy dietary and lifestyle pattern given health-promoting constituents of wine and its effects on cancer incidence.

The abuse of alcoholic beverages has been associated with an increased risk of chronic-degenerative diseases, including diabetes mellitus, so that there is a general diffidence towards the low/moderate consumption of wine by individuals with type-2 diabetes (T2D) or at risk of developing it. This narrative review investigates by critical revision of the scientific literature whether wine/grape derivatives must be excluded or if their low/moderate consumption could be part of the daily diet of T2D individuals. Although further intervention studies on the consumption of alcoholic beverages and the development or control of T2D are needed, the burden of evidence suggests that low/moderate wine consumption could have beneficial effects.

With an increase in life expectancy, the incidence of chronic degenerative pathologies such as dementia has progressively risen. Cognitive impairment leads to the gradual loss of skills, which results in substantial personal and financial cost at the individual and societal levels. Grapes and wines are rich in healthy compounds, which may help to maintain homeostasis and reduce the risk of several chronic illnesses, including dementia. This review analyzed papers that were systematically searched in PubMed, MEDLINE, Embase, and CAB-, using the association between grapes (or their derivatives) and their effects on cognitive functions in humans. Analysis was restricted to epidemiological and randomized-controlled studies. Consumption of grape juice (200-500 mL/day) and/or light-to-moderate wine (one to four glasses/day) was generally associated with improved cognitive performance, while the results for other alcoholic beverages were controversial and inconclusive. Bioactive molecules contained in grapes and wine were also considered, with particular attention paid to resveratrol. Due to the relatively high doses required (150-1000 mg/day) for bioactivity coupled with its low bioavailability, resveratrol is only one of the possible grape-derived compounds that may partly underpin the beneficial effects of grapes on the central nervous system.

Moderate wine consumption may be associated with specific health benefits and a healthy lifestyle. However, increased amounts of ethanol are cytotoxic and associated with adverse health outcomes. Alcohol reduction in wine might be an avenue to reduce alcohol related harm without forcing consumers to compromise on lifestyle and benefit from positive aspects of moderate consumption. The aim of this review is to give an overview of viticultural and pre and post fermentation methods to produce low-alcohol wine, and to summarize the current evidence on the consumer acceptance and behaviour related to low-alcohol wine. Strategies for the labelling and marketing of wines with reduced alcohol content are discussed.

Resveratrol, (3, 5, 4 '-trihydroxystilbene) is a non-flavonoid polyphenol stilbene synthesized by plants when damaged by infectious diseases or ionizing radiation. Although present in more than seventy plant species, grapes and wine are the major dietary contributors of resveratrol, responsible for 98% of the daily intake. In 1992, Renaud and De Lorgeril first linked wine polyphenols, including resveratrol, to the potential health benefits ascribed to regular and moderate wine consumption (the so called "French Paradox"). Since then, resveratrol has received increasing scientific interest, leading to research on its biological actions, and to a large number of published papers, which have been collected and discussed in this review. The relatively low amounts of resveratrol measured in wine following moderate consumption, however, may be insufficient to mitigate biological damage, such as that due to oxidative stress. On this basis, the authors also highlight the importance of viticulture and the winemaking process to enhance resveratrol concentrations in wine in order to bolster potential health benefits.

Following an ever-increasing tendency to underline the detrimental effects of alcoholic beverages on human health, wine consumption has also recorded a steady decrease. This is despite multiple beneficial effects on health demonstrated by research. This review presents the latest information regarding the effects of wine on human health. While the potential detrimental effect of alcohol is not disregarded, but acknowledged where science clearly demonstrated a negative impact, potential beneficial effects are also presented and discussed. Aside from alcohol, wine contains other compounds which have been shown to serve as antioxidants and anti-blood clotting agents or metabolic signaling molecules, with anti-proliferative, chemoprotective, immunomodulating actions. Accordingly, light to moderate but not heavy wine consumption can complement other dietary effects on human health. Recent research suggests that wine-derived compounds belonging to the phenolic compound classes are important to human health and some of their putative actions are presented in this review.

Accumulating evidence suggests that regular moderate consumption of wine can positively influence risk factors associated with cardiovascular health. These effects are often attributed to grape and wine-derived phenolic compounds and their effects on risk factors such as atherosclerosis, for which mechanisms have been clearly identified, such as a decrease in the oxidation of LDL-cholesterol and reduction of oxidative stress, and an increase in nitric oxide and related restoration of endothelial function. In addition, the ethanol component of wine increases HDL-cholesterol, inhibits platelet aggregation, promotes fibrinolysis and reduces systemic inflammation. Scientific research needs to be conducted, however, before we can begin to provide science-based dietary recommendations, although there is sufficient evidence to generally recommend consuming food sources rich in bioactive compounds such as wine in moderation. This narrative review examines published evidence on the cardioprotective effects associated with wine-derived compounds, with a primary focus on the development and progression of atherosclerosis and thrombosis.

Low- and reduced-alcohol beverages become increasingly popular in many countries with different factors driving a change in the beverage market. The aim of the current narrative review is (a) to provide an introduction on low-alcohol wine, and (b) to provide an overview of the literature on research that investigated perception and behaviour related to low-alcohol wine consumption. Wines with reduced alcohol content can be an interesting product for a variety of stakeholders and may offer benefits for consumers while having the potential to reduce alcohol consumption and therefore contribute to the reduction of alcohol-related harm. Additional research and marketing efforts are needed to further increase awareness of the availability and quality of these products.

Several epidemiological studies associated the consumption of wine with the reduction of the risk factors for cardiovascular disease and certain cancers, as well as for diabetes. These conditions are characterized by inflammatory mechanisms in addition to other biological mechanisms. Acute and chronic inflammation is mediated by a plethora of biomarkers production and pathway activation. Since the health promoting properties of wine in different pathological conditions may include the reduction of inflammation, the aim of this paper was to collect and review the in vitro, in vivo, and human studies performed to evaluate the effects of wine on different models of inflammation. Although great variability in wine intake, period of consumption, and content of phenolic compounds was observed, data from both human and animal studies showed a positive modulation of inflammatory biomarkers (cytokines, coagulation parameters) and oxidative stress (mainly malondialdehyde) involved in cardiovascular function. In addition, some convincing evidence was obtained in different models suggesting a positive modulation of risk factors for gastric and intestinal inflammation. Contradictory results were obtained for metabolic syndrome and type 2 diabetes. To date, no significant paper has been published in the area of immune function. Integrating in vivo data and in vitro studies, the NF-κB pathway has been identified as a critical target for the protective properties of a moderate wine consumption.

Changes in wine consumption are influenced most by health: results from a population survey of South Australians in 2013 Creina S Stockley,1 Anne W Taylor,2 Alicia Montgomerie,2 Eleonora Dal Grande2 1The Australian Wine Research Institute, 2Population Research & Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia Aims: Individuals change their wine consumption over their life course, and mean volume typically declines with increasing age. Research on the reasons individuals change their consumption has primarily focused on youth/the young, but not on older adults. This study's aim was to ascertain changes in wine consumption over a 12-month period in Australians at different ages and what influenced these changes.Methods: As part of the Spring 2013 South Australian Health Omnibus Survey, persons (n=2,908) aged 15 years and over who had most recently had a birthday in the selected household were interviewed in their home by trained interviewers. Of these, 48.9% were males and their mean age was 46.3 (standard deviation 18.9) years.Results: Regular, light–moderate wine consumers were generally stable in the amount of wine they drank over a 12 month period, particularly those aged 55 years and older. They generally cited health (48.0%) as a reason for decreasing their wine consumption. Those who usually consumed three to four standard drinks on days they drank wine were also more likely to give health (54.3%) as a reason for decreasing their consumption, as were heavy wine consumers (57.7%). The 25- to 34-year age-group was more likely to have decreased (36% vs 26%) their wine consumption in the last 12 months. The 15- to 24-year age-group was most likely to have increased (28% vs 10%) their wine consumption in the last 12 months. Health was most cited as the reason for decreasing this consumption, while family and friends were most cited as the reason for increasing this consumption.Conclusion: In this representative population of South Australians, the wine consumption of previously identified at-risk groups for both short- and long-term harms, ie, youth and older adults, as well as excessive and heavy drinkers, was most influenced by health, family and friends, and employment. Keywords: alcohol, wine, consumption, changes

The potential health benefits of moderate alcohol consumption are not limited to a reduced risk of cardiovascular disease but are also observed for type 2 diabetes mellitus. The relationship appears to be J-shaped where moderate alcohol consumption reduces the risk of developing type 2 diabetes mellitus in both men and women, irrespective of age, and in those with a low and a high body mass index. The optimal amount of wine appears to be approximately two drinks per day, where a standard drink in Australia is considered to be 10 g alcohol. Given that the incidence of diabetes is projected to approximately double in the next 15 years, simple dietary supplementation to a healthy diet and lifestyle to reduce the risk will become increasingly important. This paper reviews the association between wine specifically and type 2 diabetes mellitus, and discusses biological mechanisms related to the association

The aim of this study was to determine the relationship of alcohol consumption (reported in four different ways) with other specific disease-related risk factors (that is, smoking, high body mass index, low physical activity and insufficient fruit and vegetables). Data were collected from 2003 to 2015 in South Australia using an on-going monthly chronic disease and risk factor telephone survey of randomly selected persons (18+ years). The proportion of alcohol drinkers and, for those who drank alcohol, the proportion drinking more than one day per week, the proportion drinking on six or more days per week, and the mean alcohol drinks per day were assessed. Logistic regression and linear regression modelling were used on age and sex adjusted data. In total, over 71,000 respondents aged 18 years and older were interviewed (48.8% male). Overall prevalence of alcohol consumption was 81.3%. Trends in the direction promoted by current policies and preventative authorities were apparent with appropriate changes for all four measures for overall and for those underweight, undertaking sufficient activity, consuming <2 serves of fruit per day, consuming <5 serves of vegetables per day and with 3+ total risk factors. This research has provided evidence on the trends in alcohol consumption in relation to a range of other specific modifiable disease-related risk factors. The trends analysis has shown different patterns for each risk factor, and highlights the interplay between the respective modifiable or preventive risk factors.

Conclusions of epidemiological studies examining the effects of alcoholic beverages on human health may be unclear and limited if they do not take into account drinking pattern parameters such as beverage type, regular moderate versus binge drinking and drinking with or without meals. This review considers different aspects of drinking patterns and effects on human health with special attention to wine. We particularly discuss the potential underlying mechanisms for epidemiological evidence that the beneficial effects of wine are more evident if consumed with food. In this context, we address the effects of food on blood alcohol concentration and acetaldehyde production in the gastrointestinal tract, the role of wine components and uric acid in counteracting the detrimental effects of postprandial oxidative stress, as well as wine's antimicrobial properties and its potential to act as a digestive aid. In addition to its biological correlates, drinking patterns with regard to different socio-cultural circumstances in different populations are also considered. In order to avoid confusion and misconceptions in the general population because of the hormetic associations of wine with human health, it is important that all medical and scientific information concerning the effect of wine consumption on human health are evidence-based and communicated in a competent, credible and unbiased manner. In conclusion, we propose several practical recommendations concerning wine consumption and consumer information to minimize the risks of alcohol-related harm and to encourage individual responsibility and a healthy lifestyle.