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Alcohol consumption, smoking and development of visible age-related signs: a prospective cohort study
  1. Anne L Schou1,
  2. Marie-Louise Mølbak1,
  3. Peter Schnor2,
  4. Morten Grønbæk1,
  5. Janne S Tolstrup1
  1. 1 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  2. 2 Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Janne S Tolstrup, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK-1353 Copenhagen, Denmark; jst{at}


Background Visible age-related signs indicate biological age, as individuals that appear old for their age are more likely to be at poor health, compared with people that appear their actual age. The aim of this study was to investigate whether alcohol and smoking are associated with four visible age-related signs (arcus corneae, xanthelasmata, earlobe crease and male pattern baldness).

Methods We used information from 11 613 individuals in the Copenhagen City Heart Study (1976–2003). Alcohol intake, smoking habits and other lifestyle factors were assessed prospectively and visible age-related signs were inspected during subsequent examinations.

Results The risk of developing arcus corneae, earlobe crease and xanthelasmata increased stepwise with increased smoking as measured by pack-years. For alcohol consumption, a high intake was associated with the risk of developing arcus corneae and earlobe crease, but not xanthelasmata.

Conclusions High alcohol consumption and smoking predict development of visible age-related signs. This is the first prospective study to show that heavy alcohol use and smoking are associated with generally looking older than one’s actual age.

  • ageing
  • alcohol
  • epidemiology of ageing
  • epidemiology
  • smoking

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  • Contributors This manuscript was written by ALS, M-LM, PS, MG and JST. JST as the corresponding author planned and designed the work. JST approved the final version for publication. ALS and JST conducted the analysis and wrote the manuscript. M-LM contributed to writing of the manuscript. PS and MG revised the manuscript critically and persisted with knowledge to the included dataset.

  • Competing interests None declared.

  • Ethics approval The ethics committee for Copenhagen and Frederiksberg.

  • Provenance and peer review Not commissioned; externally peer reviewed.