Light-to-moderate drinking and dementia risk: The former drinkers problem re-visited

Roizen, Ron; Fillmore, Kaye Middleton; Chikritzhs, Tanya; Stockwell, Tim

doi:10.3109/16066359.2012.706343

Cited by 12 publications

(8 citation statements)

References 33 publications

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“…The impact of former drinking on the relationship between alcohol and dementia is an important methodological question within this field [ 21 ]. In the present study, the HUNT2 (1995–1997) material was only used to check the stability of reported alcohol consumption from HUNT1 to HUNT2.…”

Section: Methodsmentioning

confidence: 99%

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway

et al. 2015

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The relationship between alcohol consumption and dementia risk is unclear. This investigation estimates the association between alcohol consumption reported in a population-based study in the mid-1980s and the risk for dementia up to 27 years later. The entire adult population in one Norwegian county was invited to the Nord-Trøndelag Health Study during 1984–1986 (HUNT1): 88 % participated. The sample used in this study includes HUNT1 participants born between 1905 and 1946 who completed the questionnaire assessing alcohol consumption. A total of 40,435 individuals, of whom 1084 have developed dementia, are included in the analysis adjusted for age, sex, years of education, hypertension, obesity, smoking, and symptoms of depression. When adjusting for age and sex, and compared to reporting consumption of alcohol 1–4 times during the last 14 days (drinking infrequently), both abstaining from alcohol and reporting consumption of alcohol five or more times (drinking frequently) were statistically significantly associated with increased dementia risk with hazard ratios of 1.30 (95 % CI 1.05–1.61) and 1.45 (1.11–1.90), respectively. In the fully adjusted analysis, drinking alcohol frequently was still significantly associated with increased dementia risk with a hazard ratio of 1.40 (1.07–1.84). However, the association between dementia and abstaining from alcohol was no longer significant (1.15, 0.92–1.43). Equivalent results for Alzheimer’s disease and vascular dementia indicated the same patterns of associations. When adjusting for other factors associated with dementia, frequent alcohol drinking, but not abstaining from alcohol, is associated with increased dementia risk compared to drinking alcohol infrequently.

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Section: Methodsmentioning

confidence: 99%

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway

et al. 2015

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“…However, it is possible that this association partly reflects selection bias. Specifically, abstainers may include former heavy drinkers, with resultant poor cognitive and general health, and heavy drinkers are less likely to persist in longitudinal studies (38) . There is some evidence that n-3 fatty acids (39) and Vitamin B may be beneficial for those in the early stages of decline although a recent meta-analysis of 11 trials found no cognitive benefits associated with Vitamin B supplementation (40).…”

Section: The Role Of Biomarkers: Indicators Of Mechanismsmentioning

confidence: 99%

Bridging the Translation Gap: From Dementia Risk Assessment to Advice on Risk Reduction

Anstey¹,

Eramudugolla²,

Hosking³

et al. 2015

J Prev Alz Dis

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Dementia risk reduction is a global health and fiscal priority given the current lack of effective treatments and the projected increased number of dementia cases due to population ageing. There are often gaps among academic research, clinical practice, and public policy. We present information on the evidence for dementia risk reduction and evaluate the progress required to formulate this evidence into clinical practice guidelines. This narrative review provides capsule summaries of current evidence for 25 risk and protective factors associated with AD and dementia according to domains including biomarkers, demographic, lifestyle, medical, and environment. We identify the factors for which evidence is strong and thereby especially useful for risk assessment with the goal of personalising recommendations for risk reduction. We also note gaps in knowledge, and discuss how the field may progress towards clinical practice guidelines for dementia risk reduction.

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“…Consequently, some physicians actively advise their patients that "moderate" use of alcohol is beneficial for heart health (Mukamal et al, 2010). Recent evidence suggests that apparent protective effects of low-to moderate-level alcohol use on CHD, dementia, and allcause mortality may be over stated due to the presence of methodological biases (including drinker misclassification bias) in the majority of applicable studies (Chikritzhs et al, 2009;Fillmore et al, 2006Fillmore et al, , 2007Roizen et al, 2013;Stockwell et al, 2012b). Similarly, a study on cardiovascular disease (CVD) suggests that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding by other lifestyle factors (Naimi et al, 2005).…”

Section: Drinker Misclassification Errormentioning

confidence: 99%

“…These errors occur when former and/or occasional drinkers are included in the "abstainer" reference group, or when occasional drinkers are included in a lowlevel drinking group. Recent research has shown that including former and/or occasional drinkers with abstainers creates bias that can exaggerate protection against heart disease from low-risk drinking (Chikritzhs et al, 2009;Fillmore et al, 2006Fillmore et al, , 2007Roizen et al, 2013;Stockwell et al, 2012b). It is conceivable that such biases are operating in a similar manner in relation to other disease outcomes associated with alcohol consumption.…”

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confidence: 99%

Methodological Biases in Estimating the Relationship Between Alcohol Consumption and Breast Cancer: The Role of Drinker Misclassification Errors in Meta‐Analytic Results

Zeisser

Stockwell

Chikritzhs

2014

Alcoholism Clin & Exp Res

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Background While alcohol consumption has been linked to breast cancer in women, few studies have controlled for possible biases created by including former or occasional drinkers in the abstainer reference group. We explored the potential for such misclassification errors as sources of bias in estimates of the alcohol-breast cancer relationship. Methods Meta-analyses of population case-control, hospital case-control, and cohort studies to examine relationships between level of alcohol use and breast cancer morbidity and/or mortality in groups of studies with and without different misclassification errors. Results Of 60 studies identified, only 6 were free of all misclassification errors. The abstainer reference group was biased by the inclusion of former drinkers in 49 studies, occasional drinkers (<10g ethanol per week) in 22 and by both these groups in 18. Occasional drinkers were also mixed with light or hazardous level drinkers in 21 studies. Unbiased estimates of the OR for breast cancer were 1.011 (95% CI: 0.891-1.148) among former drinkers (n = 11) and 1.034 (95% CI: 1.003-1.064) among occasional drinkers (n=17). Hazardous level drinking (>20g<41g ethanol/day) was not significantly associated with breast cancer in studies with occasional drinker bias. However, in studies free from occasional drinker bias, the OR for breast cancer was 1.085 (95% CI: 1.015-1.160) for low level (<21g/day) drinkers (n=17), 1.374 (95% CI: 1.319-1.431) for hazardous level drinkers (n=26) and 1.336 (95% CI: 1.228-1.454) for harmful level (>40g/day) drinkers (n=9). Conclusions While the great majority of studies of the alcohol-breast cancer link include misclassification errors, only misclassification of occasional drinkers was found to bias risk estimates significantly. Estimates based on error free studies confirmed that low, hazardous and harmful levels of alcohol use each significantly increase the risk of breast cancer.

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Light-to-moderate drinking and dementia risk: The former drinkers problem re-visited

Cited by 12 publications

References 33 publications

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway

Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway

Bridging the Translation Gap: From Dementia Risk Assessment to Advice on Risk Reduction

Methodological Biases in Estimating the Relationship Between Alcohol Consumption and Breast Cancer: The Role of Drinker Misclassification Errors in Meta‐Analytic Results

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