Objective:We conducted a meta-analysis to systematically quantify the association between occupational exposure to aluminum and risk of Alzheimer disease (AD). Methods: Electronic database searches were conducted up to March 2015 for controlled studies. Study quality was assessed using the Newcastle-Ottawa Scale. Results: Three retrospective case-control studies, involving 1056 participants, met the criteria for inclusion. All studies used surrogate informants to ascertain exposure. Occupational aluminum exposure was not associated with AD (odds ratio, 1.00; 95% confidence interval, 0.59 to 1.68), even in sensitivity analysis excluding studies with low-quality assessment scores (odds ratio, 1.06; 95% confidence interval, 0.36 to 3.10).
Conclusions:The findings of the present meta-analysis do not support a causative role of aluminum in the pathogenesis of AD. Nevertheless, in the absence of prospective studies with more precise ascertainment of exposure, a role for aluminum cannot be definitively excluded.A lzheimer disease (AD) accounts for 60% to 80% of dementia cases. 1 The worldwide prevalence of AD is projected to exceed 100 million by 2050, by which time 1 in 85 persons is expected to be living with this debilitating disease. 1 As current treatments for AD are unable to significantly modify disease progression, there has been growing interest in the identification of risk factors that may enable implementation of preventative strategies.Pathologically, AD is characterized by the aggregation of β-amyloid peptide in the form of neuritic plaques and the accumulation of hyperphosphorylated tau proteins as neurofibrillary tangles. 2 Nevertheless, a complete understanding of the mechanisms and factors underlying these changes remains elusive. Although AD is known to have a genetic component, epidemiological studies show more than two thirds of identical twins are discordant, indicating a significant etiological role for environmental factors. 3 Occupational exposures have garnered particular interest as the long prodromal phase of AD suggests the gradual effect or accumulation of a neurotoxin over many years. Previous meta-analyses have demonstrated an increased risk of AD with occupational exposure to low-frequency electromagnetic fields, 4 but no association with lead or industrial solvents. 5 Nevertheless, to date, the relationship between occupational exposure to aluminum and the risk of AD has not been systematically quantified.Aluminum is the most abundant metal in the Earth's crust, but the daily human intake in most countries is only in the order of a few milligrams. 6 Nevertheless, in individuals working in aluminumrelated industries, absorption from the nasal cavity may represent a significant additional source of aluminum exposure. 6 Olfactory neuron terminals within the nasal mucosa represents the only site where the central nervous system is directly exposed to the environment and inhalation of aluminum has been shown to markedly increase brain aluminum levels. 7 The present meta-analysis was thus con...