Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: a meta-analysis
Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: a meta-analysis
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DOI：
10.1046/j.1360-0443.1999.9410155111.x
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发表时间：
1999-10-01
期刊：
影响因子：
6
通讯作者：
Arico, S
中科院分区：
文献类型：
--
作者：
Corrao, G;Bagnardi, V;Arico, S
Objective.比较流行病学文献提供的关于饮酒与sh癌（口腔癌、食道癌、结直肠癌、肝癌、喉癌、乳腺癌）、高血压、脑血管疾病、胃溃疡和十二指肠溃疡、肝硬化和其他慢性肝病、胰腺炎、损伤和不良反应风险之间相关性的证据的强度。方法.从1966年至1998年的流行病学文献进行了检索几个书目数据库。考虑到固定和随机模型以及酒精摄入对每种疾病风险的线性和非线性影响，拟合了荟萃回归模型。研究的一些特征的影响，包括其质量指数被认为是估计异质性的推定来源。发表偏倚也通过漏斗图的不对称性进行了研究。结果在397项初步审查的研究中，选择了200项进行荟萃分析。由于研究的定性特征通常是异质性的重要来源，因此汇总剂量-反应斜率的估计值仅基于123项具有较高质量评分和/或报告相对风险调整估计值的研究。酒精含量较高的人有可能患上肝硬化、上呼吸道和消化道肿瘤、出血性中风、受伤和副作用。结直肠癌、肝癌和乳腺癌、原发性高血压和慢性胰腺炎的相关性较弱。对于所有这些情况，低摄入量，相当于每天饮用两杯饮料或两杯葡萄酒（25克/天），已显示出显著的风险。缺血性中风、胃溃疡和十二指肠溃疡似乎与酒精摄入无关。进行研究的区域、研究的设计和结果变量对斜率有不同的影响。结论.足够可靠的研究数量很少，它们之间的异质性的强烈迹象和出版偏倚的怀疑表明，非常需要在几个国家进行良好的流行病学研究，以检查酒精摄入量与几种酒精相关疾病风险之间的剂量反应关系，以及饮酒模式在确定风险中的作用。
Objective. To compare the strength of the evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of sh cancers (oral cavity, oesophagus, colorectum, liver, larynx, breast), hypertension, cerebrovascular diseases, gastric and duodenal ulcer, liver cirrhosis and other chronic liver diseases, pancreatitis and injures and adverse effects. Methods. A search of the epidemiological literature from 1966 to 1998 was performed by several bibliographic databases. Meta-regression models were fitted considering fixed and random models and linear and non-linear effects of alcohol intake on the risk of each condition. The effects of some characteristics of the studies including an index of their quality were considered as putative sources of heterogeneity of the estimates. Publication bias was also investigated by asymmetry of funnel plots. Results. Of the 397 initially reviewed studies, 200 were selected for meta-analysis. Since qualitative characteristics of the studies were often significant sources of heterogeneity among them, the estimates of the pooled dose-response slopes were based only on the 123 studies with higher quality score and/or reporting adjusted estimates of relative risks. Higher alcohol-related risks were found for liver cirrhosis, neoplasms of the upper respiratory and digestive tracts, haemorrhagic stroke and injuries and adverse effects. Weaker bur significant associations were found for colorectum, liver and breast cancers, essential hypertension and chronic pancreatitis. For all these conditions, low intakes, corresponding to daily consumption of two drinks or two glasses of wine (25 g/day), have shown significant risks. Ischaemic stroke and gastric and duodenal ulcer seem independent of alcohol intake. The area in which the study was performed, the study's design and the outcome variable differently affected the slopes. Conclusions. The small number of sufficiently reliable studies, the strong indications of heterogeneity across them and the suspicion of publication bias suggest that there is a great need for well-conducted epidemiological studies performed in several countries, to examine the dose-response relationship between alcohol intake and the risk of several alcohol-related conditions, as well as the role of drinking pattern in determining the risk.