Commentary on Di Castelnuovo et al: Implications of using low volume drinkers instead of never drinkers as the reference group

Naimi, Timothy S.; Chikritzhs, Tanya; Stockwell, Timothy

doi:10.1111/add.15692

Cited by 7 publications

(14 citation statements)

References 8 publications

(7 reference statements)

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“…We agree with Naimi et al . [1] on the need for very careful measurement of volume and pattern of alcohol consumption and believe that we were correct in this, but we disagree with their suggestion that in observational studies non‐drinkers should not be compared with low‐volume drinkers, given that these comparisons have public health importance, and data from clinical trials are presently lacking.…”

Section: Figurementioning

confidence: 79%

“…Naimi et al . [1] claim that we should have used low volume drinkers as the reference group (instead of no drinkers). Following their suggestion, we provide here in Figure 1 the dose–response relationship between level of alcohol intake and total mortality, using 5 g/day intake of alcohol as the reference value (the data set is the same as in Di Castelnuovo et al .…”

Section: Figurementioning

confidence: 99%

“…Thus, we agree with Naimi et al . [1] that the low‐volume drinking category may be an appropriate reference group to use when comparing different volumes among drinkers.…”

Section: Figurementioning

confidence: 99%

“…While we wait for data from clinical trials, the entire bulk of evidence from observational studies is robust enough to provisionally conclude that the J-shaped curve for alcohol and health does exist 1 We read with interest the commentaries [1,2] regarding our manuscript [3]. Naimi et al [1] claim that we should have used low volume drinkers as the reference group (instead of no drinkers). Following their suggestion, we provide here in Figure F1 1 the dose-response relationship between level of alcohol intake and total mortality, using 5 g/day intake of alcohol as the reference value (the data set is the same as in Di Castelnuovo et al [3]).…”

Section: Response To Commentaries: Alcohol Intake and Total Mortality...mentioning

confidence: 99%

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Response to commentaries: alcohol intake and total mortality, strengths and limitations of observational studies, waiting for clinical trials

et al. 2022

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Section: Figurementioning

confidence: 79%

Section: Figurementioning

confidence: 99%

“…Thus, we agree with Naimi et al . [1] that the low‐volume drinking category may be an appropriate reference group to use when comparing different volumes among drinkers.…”

Section: Figurementioning

confidence: 99%

Section: Response To Commentaries: Alcohol Intake and Total Mortality...mentioning

confidence: 99%

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Response to commentaries: alcohol intake and total mortality, strengths and limitations of observational studies, waiting for clinical trials

et al. 2022

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“…To compare directly associations with brain iron between alcohol intakes, weekly consumption was categorized into quintiles (and octiles for a sensitivity analysis). The lowest quintile of drinkers was used as the reference category to avoid under-estimating alcohol-related risks [23].…”

Section: Methodsmentioning

confidence: 99%

Impact of moderate alcohol consumption on brain iron and cognition: observational and genetic analyses

Topiwala

Wang

Ebmeier

et al. 2022

Preprint

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Brain iron deposition has been linked to several neurodegenerative conditions and reported in alcohol dependence. Whether iron accumulation occurs in moderate drinkers is unknown. Our objectives were to investigate causal relationships between alcohol consumption and brain iron levels and to examine whether higher brain iron represents a potential pathway to alcohol-related cognitive deficits. Multi-organ susceptibility-weighted magnetic resonance imaging was used to ascertain iron content of brain (quantitative susceptibility mapping (QSM) and T2*) and liver tissues (T2*), a marker of systemic iron. Observational associations between brain iron markers and self-reported alcohol consumption (n=22,254 UK Biobank participants) were compared with associations with genetically-predicted alcohol intake from two-sample Mendelian randomization (MR). Potential pathways to alcohol-related iron brain accumulation through elevated systemic iron stores (liver) were explored in causal mediation analysis. Cognition was assessed at the time of scan and in online follow-up. Alcohol consumption was associated with markers of higher iron in putamen (β=0.09 standard deviation (S.D.) [95% confidence interval 0.07 to 0.10]), caudate (β=0.06 [0.04 to 0.07]) and substantia nigra (β=0.04 [0.02 to 0.05]), and lower iron in the thalami (β= -0.05 [-0.06 to -0.03]). Quintile-based analyses found these effects in those consuming >7 units (56g) alcohol weekly. MR analyses provided some evidence these relationships are causal. A 1 S.D. higher genetically-predicted number of alcoholic drinks weekly associated with 0.25 [0.01 to 0.49] S.D. higher putamen susceptibility and 0.28 [0.05 to 0.50] S.D. higher hippocampus susceptibility. Genetically-predicted alcohol use disorder was causally related to higher putamen susceptibility (0.18 [0.001 to 0.35] S.D.), serum iron (0.12 [0.05 to 0.19] S.D.) and transferrin saturation (0.11[0.03 to 0.19] S.D.). Elevated liver iron was observed at just >11 units (88g) alcohol weekly (0.03 mg/g [0.01-0.05] higher c.f. <7 units (56g) weekly). Systemic iron levels partially mediated associations of alcohol intake with brain iron accumulation (proportion mediated: 32% [22 to 49]). Markers of higher basal ganglia iron were associated with accelerated age-related decline in executive function and fluid intelligence, and slower reaction times. This study represents the largest investigation of moderate alcohol consumption and iron homeostasis to date. Even low levels of alcohol consumption were associated with iron accumulation in the brain, suggesting a potential mechanism for alcohol-related cognitive decline.

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A comprehensive evaluation of the longitudinal association between alcohol consumption and a measure of inflammation: Multiverse and vibration of effects analyses

Visontay

Mewton

Sunderland

et al. 2023

Drug and Alcohol Dependence

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Commentary on Di Castelnuovo et al: Implications of using low volume drinkers instead of never drinkers as the reference group

Cited by 7 publications

References 8 publications

Response to commentaries: alcohol intake and total mortality, strengths and limitations of observational studies, waiting for clinical trials

Response to commentaries: alcohol intake and total mortality, strengths and limitations of observational studies, waiting for clinical trials

Impact of moderate alcohol consumption on brain iron and cognition: observational and genetic analyses

A comprehensive evaluation of the longitudinal association between alcohol consumption and a measure of inflammation: Multiverse and vibration of effects analyses

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