Title: Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies
CONTENT
TITLE / PAGESearching Strategy / 2
Supplementary table1- Excluding studies and reasons / 3 to 4
Supplementary table 2- Quality assessment of included cohort studies / 5 to 6
Supplementary table 3- The dose-response relationship between alcohol intake (grams per day) and other outcomes other than dementia / 7 to 8
Searching Strategy
【PubMed】
(((((((((((alcohol) OR ethanol) OR alcohol consumption) OR alcohol drinking) OR drink) OR alcoholic beverages) OR drinking behaviour) OR liquor) OR beer) OR wine)) AND (((((cohort) OR prospective) OR nested case-control)) AND (((dementia) OR alzheimer) OR vascular))
【Embase】
#1 dementia OR Alzheimer OR vascular
#2 alcohol OR ethanol OR drink OR beverage OR liquor OR beer OR wine
#3 cohort OR prospective
#1 AND #2 AND #3
【Ovid-Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present】
Same with Embase
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Supplementary table 1- Excluded studies and reasons
N / Title / Excluded reason1 / Alcohol consumption in the elderly and risk of dementia related death - A Norwegian prospective study with a 17-year follow-up / This study explored the association between alcohol intake and risk of dementia related death.
2 / Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area / Full-text not available
3 / Incidence and predictors of cognitive impairment and dementia in Aboriginal Australians: A follow-up study of 5 years / This study used binary variable of alcohol and a special local population.
4 / Rates and risk factors for progression to incident dementia vary by age in a population cohort / This study used binary variable of alcohol (current alcohol use)
5 / Lifestyle behavior pattern is associated with different levels of risk for incident dementia and Alzheimer's disease: the Cache County study / This study used binary variable of alcohol (drank alcoholic beverages 2+ times/week)
6 / Lifestyle and the risk of dementia in Japanese-american men / This study did not independently explore the effect of alcohol but the diet score including alcohol.
7 / Risk factors for incident dementia and alzheimer disease in the nedices cohort / This study used binary variable of alcohol (current ethanol consumption)
8 / Incidence of and risk factors for dementia in the Ibadan study of aging / This study used binary variable of alcohol (ever ethanol consumption)
9 / Alcohol consumption, mild cognitive impairment, and progression to dementia / This study explored the association with progression to MCI of cognitively normal population or progression to dementia of MCI population
10 / Midlife risk factors for subtypes of dementia: a nested case-control study in Taiwan / This study explored the duration of alcohol use but not the frequency.
11 / Risk factors for incident dementia in England and Wales: The Medical Research Council Cognitive Function and Ageing Study. A population-based nested case-control study / This study used binary variable of alcohol (ever vs never)
12 / Lifestyle factors and risk of dementia: Dubbo Study of the elderly / This study used binary variable of alcohol (any vs nil)
13 / Risk factors for incident Alzheimer's disease in African Americans and Yoruba / This study used binary variable of alcohol (yes vs no of regular alcohol consumption)
14 / Incidence and risks of dementia in Japanese women: The adult health study / This study did not explore the association between alcohol and dementia.
15 / Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study / This study did not explore the association between alcohol and dementia.
16 / Alcohol consumption and incidence of dementia in a community sample aged 75 years and older / Excessive drinkers were excluded from multivariate analyses because there were too few subjects in this category
17 / Does an interaction between smoking and drinking influence the risk of Alzheimer's disease? Results from three Canadian data sets / This study was a retrospective case-control study
18 / Relation of smoking and alcohol consumption to incident Alzheimer's disease / The result was not adjusted for any confounders.
19 / Heavy drinking as a risk factor for depression and dementia in elderly men. Findings from the Liverpool longitudinal community study / This study used binary variable of alcohol (current vs past consumption)
20 / Healthy lifestyles reduce the incidence of chronic diseases and dementia: evidence from the Caerphilly cohort study / This study used binary variable of alcohol (yes vs no of three or fewer units per day)
21 / Sociodemographic and lifestyle risk factors for incident dementia and cognitive decline in the HYVET / This study used binary variable of alcohol (yes vs no of alcohol consumer)
22 / Mitochondrial aldehyde dehydrogenase polymorphism is not associated with incidence of Alzheimer's disease / This study did not explore the association between alcohol and dementia.
23 / Nutritional factors and risk of incident dementia in the PAQUID longitudinal cohort / Full-text not available
24 / Incidence and risk factors of dementia in a defined elderly Japanese population: the Hisayama study / Data was ambiguous
25 / Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study / This study used binary variable of alcohol (yes vs no of alcohol consumer)
26 / The effects of wine and tobacco consumption on cognitive performance in the elderly: a longitudinal study of relative risk / This study used binary variable of alcohol (yes vs no of alcohol consumer)
27 / Health habits and risk of cognitive impairment and dementia in old age: a prospective study on the effects of exercise, smoking and alcohol consumption / This study used binary variable of alcohol (yes vs no of alcohol consumer)
28 / Incidence and risk factors of vascular dementia and Alzheimer's disease in a defined elderly Japanese population: the Hisayama Study / This study used binary variable of alcohol (yes vs no of alcohol consumer)
29 / Effects of a history of heavy alcohol consumption on Alzheimer's disease / This study did not give 95%CI.
30 / Fruit and vegetable juices and Alzheimer's disease: the Kame Project / The case number of the high alcohol exposure group is too small.
31 / Vascular dementia : incidence and risk factors in the Canadian study of health and aging / binary variable of alcohol type and the outcome is vascular dementia
32 / Apolipoprotein E epsilon4 magnifies lifestyle risks for dementia: a population-based study / The case number is too small.
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Supplementary table 2- Quality assessment of included cohort studies (Newcastle Ottawa Scale)Study / Selection / Comparability / Outcome / Quality score
Representativeness of the exposed cohort (adult mixed gender or male or female) / Selection of the non-exposed cohort / Ascertainment of exposure / Demonstration that outcome of interest was not present at start of study / Comparability of cohorts on the basis of the design or analysis # / Assessment of outcome / Was follow-up long enough for outcomes to occur (mean follow-up) / Adequacy of follow up of
cohorts §
Paganini-Hill；2016 / ★ / ★ / ★(Questionnaire) / ★ / ★- / ★ / ★(3) / ★(96%) / 8
Langballe; 2015 / ★ / ★ / ★(Questionnaire) / - / ★★ / ★ / ★(9.96) / ★(98%) / 8
Handing; 2015 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(max=43) / - (74%) / 8
Zhou; 2014 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(7) / ★(93%) / 9
Weyerer; 2011 / ★ / ★ / ★(Structured interview) / ★ / ★★ / ★ / ★(3) / ★(96%) / 9
Mehlig; 2008 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(34) / ★(96.4%) / 9
Deng; 2006 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / - (2) / ★(92.3%) / 8
Jarvenpaa; 2005 / ★ / ★ / ★(Structured interview) / ★(*) / ★★ / ★ / ★(25) / - (72%) / 8
Luchsinger; 2004 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(4) / - (69%) / 8
Anttila; 2004 / ★ / ★ / ★(Questionnaire) / ★(*) / ★★ / ★ / ★(23) / - (70%) / 8
Mukamal; 2003 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(6) / - (NA) / 8
Truelsen; 2002 / ★ / ★ / ★(Questionnaire) / ★(¶) / ★★ / ★ / ★(3) / - (NA) / 8
Ruitenberg; 2002 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(6) / ★(99.7%) / 9
Lindsay; 2002 / ★ / ★ / ★(Questionnaire) / ★ / ★- / ★ / ★(5) / - (72%) / 7
Kivipelto; 2008 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(21) / - (88.6) / 8
Espeland; 2005 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / ★ / ★(4.2) / - (NA) / 8
Lemeshow; 1998 / ★ / ★ / ★(Questionnaire) / ★ / ★★ / - / ★(3) / - (NA) / 7
# We herein selected “age, sex, and education” as the most important adjusting factors.
A mean follow-up duration of at least 3 years was predefined as long enough for outcome (AD) to occur in our study.
§ It was regarded as adequate when the follow-up rate was at least 90%.;
* One point was rated since the age of population at baseline is young (49.4±5.9 for Jarvenpaa; 2005 and 48.3±4.8 for Anttila; 2004), so that there is basically no concern that demented person was present at the start of the study.
¶One point was rated sincefew if any demented subjects at the first study examinationwould have survived the time to the thirdstudy examination,as depicted in the paper
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Supplementary table 3 The dose-response relationship between alcohol intake (grams per day) and other outcomes other than dementia.
Outcome / Linear or non-linear relationship (p for non-linearity) / Risky (↑) or protective (↓) or non-significant dose / Cutoff for the protective effect / ReferenceCoronary artery disease / Non-linear (<0.00) / ↓ / >45 g/day / [Yang, 2016] 1
Pancreatic cancer / Non-linear (0.0874) / ↓ / ≈10 g/day / [Wang, 2016] 2
Myocardial infarction, 1 day / Non-linear (<0.001) / ↓ / 50-60 g/day / [Mostofsky, 2016] 3
Ischemic stroke, 1 day/1 week / Non-linear (0.52/0.02) / Non-significant / 0 g/day
Hemorrhage stroke, 1 day / Non-linear (0.005) / ↓ / 50-60 g/day
Hemorrhage stroke, 1 week / Non-linear (0.42) / ↑ / 0 g/day
Type 2 diabetes for all sample / Non-linear (<0.001) / ↓ / >60 g/day / [Li, 2016] 4
Type 2 diabetes for women / Non-linear (<0.001) / ↓
Type 2 diabetes for men / Non-linear (<0.001) / ↓
Heart failure / Non-linear (0.001) / ↓ / ≈10 g/day / [Larsson, 2015] 5
Type 2 diabetes for all sample / Non-linear (<0.001) / ↓ / ≈60 g/day / [Knott, 2015] 6
Type 2 diabetes for women / Non-linear (Not accessible) / ↓ / ≈70 g/day
Type 2 diabetes for men / Non-linear (Not accessible) / Non-significant / 0 g/day
Cancer / Non-linear (Not accessible) / ↑ / 0 g/day / [Bagnardi, 2015] 7
Total stroke / Non-linear (<0.001) / ↓ / 20-30 g/day / [Zhang, 2014] 8
Ischemic stroke / Non-linear (<0.001) / ↓ / 20-30 g/day
Hemorrhage stroke / Non-linear (<0.008) / Non-significant / 0 g/day
Stroke mortality / Non-linear (<0.001) / ↓ / 20-30 g/day
Rheumatoid arthritis / Non-linear (<0.001) / ↓ / 10-15 g/day / [Jin, 2014] 9
Colorectal cancer / Non-linear (Not accessible) / ↑ / 0 g/day / [Fedirko, 2011] 10
Hypertension for men / linear / ↑ / 0 g/day / [Taylor, 2009] 11
Hypertension for men / linear / Non-significant / 0-10 g/day
Reference
1.Yang Y, Liu DC, Wang QM, et al. Alcohol consumption and risk of coronary artery disease: A dose-response meta-analysis of prospective studies. Nutrition 2016;32:637-44.
2.Wang YT, Gou YW, Jin WW, Xiao M, Fang HY. Association between alcohol intake and the risk of pancreatic cancer: a dose-response meta-analysis of cohort studies. BMC Cancer 2016;16:212.
3.Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA. Alcohol and Immediate Risk of Cardiovascular Events: A Systematic Review and Dose-Response Meta-Analysis. Circulation 2016;133:979-87.
4.Li XH, Yu FF, Zhou YH, He J. Association between alcohol consumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis. Am J Clin Nutr 2016;103:818-29.
5.Larsson SC, Orsini N, Wolk A. Alcohol consumption and risk of heart failure: a dose-response meta-analysis of prospective studies. Eur J Heart Fail 2015;17:367-73.
6.Knott C, Bell S, Britton A. Alcohol Consumption and the Risk of Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of More Than 1.9 Million Individuals From 38 Observational Studies. Diabetes Care 2015;38:1804-12.
7.Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer 2015;112:580-93.
8.Zhang C, Qin YY, Chen Q, et al. Alcohol intake and risk of stroke: a dose-response meta-analysis of prospective studies. Int J Cardiol 2014;174:669-77.
9.Jin Z, Xiang C, Cai Q, Wei X, He J. Alcohol consumption as a preventive factor for developing rheumatoid arthritis: a dose-response meta-analysis of prospective studies. Annals of the rheumatic diseases 2014;73:1962-7.
10.Fedirko V, Tramacere I, Bagnardi V, et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Ann Oncol 2011;22:1958-72.
11.Taylor B, Irving HM, Baliunas D, et al. Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction (Abingdon, England) 2009;104:1981-90.
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