27 March 2020 In General Health

OBJECTIVE: We assessed the influence of sex on the effects of smoking and alcohol consumption on the risk of Parkinson's disease (PD).

METHODS: This population-based cohort study examined data of 6,795,816 Koreans aged >/=40 years from the Korean National Health Insurance Service database who completed a national program for general health check-up at 2009. For a maximum 9 years' observation period, incident PD was tracked, and hazard ratios and 95% confidence intervals (CIs) were computed using the Cox proportional hazard models, adjusted for potential confounding factors for each sex group. We tested interactions on the addictive scale by estimating the relative excess risk due to interaction (RERI).

RESULTS: 3,400,538 men and 3,395,278 women generated 24,365,694 and 24,754,154 person-years, respectively. A total of 13,223 men (0.39%) and 14,818 women (0.44%) developed PD during follow-up. Current smoking and alcohol independently reduced the risk of PD in both sexes. Current male smokers tended to have a lower risk of PD than current female smokers at equal smoking intensity (P < 0.0001 for interaction) and duration (P < 0.0001 for interaction). In contrast, at equal alcohol intakes, PD risk tended to be lower in female drinkers than in male drinkers (P < 0.0001 for interaction). A superadditive interaction between smoking and alcohol was found in current male smokers (RERI, 0.19; 95% CI, 0.04 to 0.34; P = 0.015) and female ex-smokers (RERI, 0.42; 95% CI, 0.09 to 0.76; P = 0.014).

CONCLUSION: Our data suggest sex-related differences in individual and joint impacts of smoking and alcohol intake on the risk of PD.

27 March 2020 In Dementia

BACKGROUND: Understanding the long-term health effects of low to moderate alcohol consumption is important for establishing thresholds for minimising the lifetime risk of harm. Recent research has elucidated the dose-response relationship between alcohol and cardiovascular outcomes, showing an increased risk of harm at levels of intake previously thought to be protective. The primary objective of this review was to examine (1) whether there is a dose-response relationship between levels of alcohol consumption and long-term cognitive effects, and (2) what the effects are of different levels of consumption.

METHODS: The review was conducted according to a pre-specified protocol. Eligible studies were those published 2007 onwards that compared cognitive function among people with different levels of alcohol consumption (measured >/= 6 months prior to first follow-up of cognition). Major cognitive impairment was excluded. Searches were limited to MEDLINE, Embase and PsycINFO (January 2007 to April 2018). Screening, data extraction, and risk of bias assessment (ROBINS-I) were piloted by three authors, then completed by a single author and checked by a second. Analyses were undertaken to identify and characterise dose-response relationships between levels of alcohol consumption and cognition. Certainty of evidence was assessed using GRADE.

RESULTS: We included 27 cohort studies (from 4786 citations). Eighteen studies examined the effects of alcohol consumption at different levels (risk of bias 16 serious, 2 critical). Ten studies provided data for dose-response analysis. The pooled dose-response relationship showed a maximum standardised mean difference (SMD) indicating slightly better cognition among women with moderate alcohol consumption compared to current non-drinkers (SMD 0.18, 95%CI 0.02 to 0.34, at 14.4 grams/day; 5 studies, very low certainty evidence), and a trivial difference for men (SMD 0.05, 95% CI 0.00 to 0.10, at 19.4 grams/day; 6 studies, very low certainty evidence).

CONCLUSIONS: Major limitations in the design and reporting of included studies made it impossible to discern if the effects of 'lower' levels of alcohol intake are due to bias. Further review of the evidence is unlikely to resolve this issue without meta-analysis of individual patient data from cohort studies that address biases in the selection of participants and classification of alcohol consumption.

27 March 2020 In Cardiovascular System

BACKGROUND: Light-to-moderate alcohol drinking reduces the risk of ischemic heart disease, and this effect of alcohol is mainly explained by alcohol-induced elevation of HDL cholesterol. Hypo-HDL cholesterolemia is a potent risk factor for cardiovascular disease. The aim of this study was to clarify how alcohol relates to cardiovascular risk factors in men with hypo-HDL-cholesterolemia.

METHODS: The subjects were middle-aged men with hypo-HDL cholesterolemia (< 40mg/dl), and they were divided into four groups by daily alcohol consumption (non-; light, < 22g ethanol/day; moderate, >/=22g ethanol and /=44g ethanol/day). Each risk factor was compared among the groups after adjustment for age and histories of smoking and regular exercise.

RESULTS: Systolic and diastolic blood pressure levels, log-transformed lipid accumulation product and log-transformed cardio-metabolic index were significantly higher in moderate and heavy drinkers than in nondrinkers. Log-transformed triglycerides and triglycerides-to-HDL cholesterol ratio were significantly higher in light, moderate and heavy drinkers than in nondrinkers and tended to be higher with an increase of alcohol intake. LDL cholesterol and LDL cholesterol-to-HDL cholesterol ratio were significantly lower in light, moderate and heavy drinkers than in nondrinkers and tended to be lower with an increase of alcohol intake. The above trends for the relationships of alcohol drinking with the cardiovascular risk factors were also found in multivariate logistic regression analysis.

CONCLUSIONS: In men with hypo-HDL cholesterolemia, alcohol drinking shows positive associations with blood pressure and triglycerides and an inverse association with LDL cholesterol.

27 March 2020 In Cancer

Alcohol intake is associated with the risk of breast cancer. Different patterns of alcohol-drinking may have different effects on breast cancer even when keeping constant the total amount of alcohol consumed. We aimed to assess the association between binge drinking and breast cancer risk. The SUN Project is a Spanish dynamic prospective cohort of university graduates initiated in 1999. In the 556-item lifestyle baseline questionnaire a validated food-frequency questionnaire was embedded. Participants completed biennial follow-up questionnaires. Cox regression models were used to estimate the hazard ratio (HR) for breast cancer associated with the exposure to binge drinking. A stratified analysis was performed according to menopausal status. We included 9577 women (mean age = 34 years, SD = 10 years), with a median follow-up of 11.8 years. Among 104,932 women-years of follow-up, we confirmed 88 incident cases of breast cancer. Women in the binge drinking group showed a higher risk of breast cancer (HR = 1.76; 95% CI: 1.03-2.99) compared to women in the non-binge drinking category. In the stratified analysis, a 2-fold higher risk for premenopausal breast cancer was associated with binge drinking habit (HR = 2.06; 95% CI: 1.11-3.82). This study adds new evidence on the association of binge drinking with breast cancer risk.

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