Alcohol and Health Outcomes: An Umbrella Review of Meta-Analyses Base on Prospective Cohort Studies

Abstract

An umbrella review of meta-analyses was performed to summarize the evidence of associations between alcohol consumption and health outcomes and to assess its credibility. Meta-analyses of prospective cohort studies reporting the associations of alcohol consumption with health outcomes were identified. We recalculated the random-effects summary effect size and 95% confidence interval, heterogeneity, and small-study effect for each meta-analysis and graded the evidence. Fifty-nine publications reporting 224 meta-analyses of prospective cohort studies with 140 unique health outcomes were included, in which there were 49 beneficial associations and 25 harmful associations with nominally statistically significant summary results. But quality of evidence was rated high only for seven beneficial associations (renal cell carcinoma risk, dementia risk, colorectal cancer mortality, and all-cause mortality in patients with hypertension for low alcohol consumption; renal cell carcinoma risk, cardiovascular disease (CVD) risk in patients with hypertension and all-cause mortality in patients with hypertension for moderate consumption) and four harmful associations (cutaneous basal cell carcinoma risk for low alcohol consumption; cutaneous basal cell carcinoma risk and cutaneous squamous cell carcinoma risk for moderate alcohol consumption; hemorrhagic stroke risk for high alcohol consumption). In this umbrella review, only 11 health outcomes (5 in low alcohol consumption, 5 in moderate alcohol consumption and 1 in high alcohol consumption) with statistically significant showed high quality of epidemiologic evidence. More robust and larger prospective studies are needed to verify our results.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…Although the evidence is largely limited to observational studies and their meta-analyses, all lifestyle interventions seem to have heart-healthy benefits that may go beyond the benefits associated with their effect on BP. The most important and well established effective lifestyle interventions that have been shown to reduce premature CV morbidity and mortality are losing weight [349], the DASH diet [350,351], salt reduction [352], augmentation of potassium intake [353][354][355], engaging in regular physical activity and structured exercise [356][357][358][359] and a moderation of alcohol consumption [360][361][362] The Achilles' heel of treatment strategies based on or inclusive of nonpharmacological interventions is the low persistence of the prescribed measures. This is in part the result of the difficulty of permanently adhering to lifestyles that may interfere with working or home habits and needs.…”

Alcohol consumption and hepatocellular carcinoma: novel insights from a prospective cohort study and nonlinear Mendelian randomization analysis

“…Compared to the two largest cohort studies, our study yielded a similar finding and provided a more detailed dissection of the association between alcohol use and HCC. A recent umbrella review of meta-analyses also showed that low alcohol consumption was associated with a 27% (95% CI 2-46%) decreased risk of liver cancer [9]. In contrast, some studies reported no association or a proportionally increasing correlation between alcohol use and the risk of liver cancer [10,[24][25][26].…”

“…For example, in a cohort study of nearly 0.2 million Chinese men, there was a positive dose-response relationship between the amount of alcohol intake and the risk of liver cancer [7]. However, several studies reported that low-to-moderate alcohol drinking was inversely associated or not significantly associated with the risk of liver cancer (or HCC) [8][9][10]. For example, a meta-analysis of prospective studies reported a suggestive but not statistically significant decreased risk of liver cancer in individuals with moderate drinking (< 3 drinks per day) compared with abstainers [10].…”

Alcohol and its associated liver carcinogenesis

“…There may also be an inverse relationship between low‐level alcohol consumption and HCC risk as demonstrated in a nonlinear Mendelian randomization analysis on UK biobank data 12 . Furthermore, an umbrella meta‐analysis demonstrated a 27% reduction in HCC risk associated with low alcohol consumption (relative risk 0.73, 95% CI 0.54–0.98) 13 . Cessation of alcohol consumption also reduces the risk of HCC development by 6–7% annually and should therefore be encouraged in ALD patients 14 …”

“…12 Furthermore, an umbrella meta-analysis demonstrated a 27% reduction in HCC risk associated with low alcohol consumption (relative risk 0.73, 95% CI 0.54-0.98). 13 Cessation of alcohol consumption also reduces the risk of HCC development by 6-7% annually and should therefore be encouraged in ALD patients. 14 Sex.…”