Longitudinal Trajectories of Alcohol Consumption with All-Cause Mortality, Hypertension, and Blood Pressure Change: Results from CHNS Cohort, 1993–2015

Abstract

Background: Previous studies have demonstrated a J-shaped association of alcohol consumption with all-cause mortality and hypertension, but the majority of these studies focus on a single measurement of alcohol intake and were conducted in a Western population. Whether long-term trajectories of alcohol consumption are associated with all-cause mortality, hypertension, and a change in blood pressure remains to be elucidated. Methods: In the large, population-based China Health and Nutrition Survey cohort from between 1993 and 2015, group-based trajectory modeling was conducted to identify distinct alcohol-consumption trajectory classes. We investigated their association with all-cause mortality and hypertension using Cox regression and binary logistics regression models. A restricted cubic spline was performed to determine the nonlinear relationships of mean alcohol intake with mortality and hypertension. Multivariate-adjusted generalized linear mixed-effects models were conducted to assess the change in blood pressure among alcohol-consumption trajectory classes. Results: Among the 5298 participants, 48.4% were women and the mean age was 62.6 years. After 22 years of follow-up, 568 (10.7%) of the participants died and 1284 (24.2%) developed hypertension. Long-term light and moderate drinkers had a lower risk of death than the non-drinkers, and a restricted cubic spline showed a J-shaped relationship between mean alcohol intake and mortality. Although blood pressure increased slower in light and moderate drinkers, a reduced risk of hypertension was only observed in the former. The long-term heavy drinkers had the highest blood pressure and death rate. Conclusions: Light alcohol intake might be protective even in the long run, while heavy drinking reversed the beneficial effect. The causality of such a connection needs to be further investigated.

Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies

“…A recent cohort study conducted in China, which was not eligible for inclusion in the present meta-analysis because it lacked suitable data, provided no evidence for a smaller change of DBP in light or moderate drinkers, compared with nondrinkers, in a sex-adjusted multivariable model. 10 While we are not aware of systematic reviews or meta-analyses assessing the relationship between usual alcohol consumption at baseline and subsequent BP changes over time, 2 studies have investigated the association between alcohol intake and risk of hypertension, also focusing on possible sex-and region-specific effects. 27,28 The first review found a positive correlation between alcohol consumption and risk of hypertension in men, with no evidence of a threshold.…”

“…A recent cohort study conducted in China, which was not eligible for inclusion in the present meta-analysis because it lacked suitable data, provided no evidence for a smaller change of DBP in light or moderate drinkers, compared with nondrinkers, in a sex-adjusted multivariable model. 10 …”

“… 5 , 7 – 9 The body of evidence detailing the effects of changes in alcohol intake on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in persons who were initially consuming light to moderate amounts of alcohol is limited, with neither systematic reviews or meta-analyses being available on this topic. Longitudinal studies on the association between low intakes of alcohol and BP have been published recently, 10 , 11 and a new statistical meta-analytic technique that allows for a comprehensive exploration of dose-response relationships, the so-called 1-stage dose-response meta-analysis for aggregated data, has recently been reported. 12 This technique allows inclusion of studies in the dose-response analysis even when as few as 2 categories of exposure have been assessed, 13 , 14 preserving any study-specific structure of contrasts in the estimation of the dose-response relationship within a single model.…”

Alcohol Intake and Risk of Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Nonexperimental Cohort Studies

“…Alcohol intake was assessed by dietary intake using simple or standardized questionnaires, 24,27,28,[30][31][32][33]35,[37][38][39][40][41] interview-based questionnaire, 9,26,36 or interviews by trained and certified health professionals. 13,22,23 Four of the self-report studies used a food frequency questionnaire. 25,29,34,42 Details of the methods used for exposure assessment and calculation of alcohol dose are presented in the Table.…”

L-shaped association between dietary coenzyme Q10 intake and high-sensitivity C-reactive protein in Chinese adults: a national cross-sectional study

“…Urbanization index, daily total energy intake, and physical activity levels were calculated by the methods used in previous studies. 27,[41][42][43][44] The provinces were categorized into the northern regions (Liaoning, Heilongjiang, Shandong, and Henan) and southern regions (Jiangsu, Hubei, Hunan, Guangxi, and Guizhou) for further analysis, divided by the Qinling Mountain-Huaihe River Line. 45 The body mass index (BMI), a covariate added to the sensitivity analysis, was calculated by dividing weight (kg) by the square of height (m 2 ).…”