Bouajila Naouras, Domenighetti Cloé, Aubin Henri-Jean, Naassila Mickael
Inserm Unit UMRS 1247, University of Picardie Jules Verne, Amiens, France.
UVSQ, Univ. Paris-Sud, Inserm, Team "Exposome, Heredity, Cancer, and Health", CESP, University of Paris-Saclay, Villejuif, France.
Front Epidemiol. 2024 Nov 7;4:1385064. doi: 10.3389/fepid.2024.1385064. eCollection 2024.
The health effects of alcohol consumption, particularly regarding potential protective benefits of light to moderate intake compared to abstinence, remain a subject of ongoing debate. However, epidemiological studies face limitations due to imprecise exposure measurements and the potential for bias through residual confounding and reverse causation. To address these limitations, we conducted a systematic review of Mendelian Randomization (MR) studies examining the causal relationship between alcohol consumption and cancers, cardiovascular, liver, and neurological diseases.
We searched PubMed, ScienceDirect and Embase and Europe PMC up to 05/2024 for MR studies investigating the association of genetically predicted alcohol consumption with cancers, cardiovascular, liver and neurological diseases. We assessed methodological quality based on key elements of the MR design a genetic association studies tool.
We included 70 MR studies that matched our inclusion criteria. Our review showed a significant association of alcohol consumption with multiple cancers such as oral and oropharyngeal, esophageal, colorectal cancers, hepatocellular carcinoma and cutaneous melanoma. While the available studies did not consistently confirm the adverse or protective effects of alcohol on other cancers, such as lung cancer, as suggested by observational studies. Additionally, MR studies confirmed a likely causal effect of alcohol on the risk of hypertension, atrial fibrillation, myocardial infraction and vessels disease. However, there was no evidence to support the protective effects of light to moderate alcohol consumption on cognitive function, Alzheimer's disease, and amyotrophic lateral sclerosis, as reported in observational studies while our review revealed an increased risk of epilepsy and multiple sclerosis. The available studies provided limited results on the link between alcohol consumption and liver disease.
Despite the valuable insights into the causal relationship between alcohol consumption and various health outcomes that MR studies provided, it is worth noting that the inconsistent ability of genetic instrumental variables to distinguish between abstainers, light and moderate drinkers makes it difficult to differentiate between U or J-shaped vs. linear relationships between exposure and outcome. Additional research is necessary to establish formal quality assessment tools for MR studies and to conduct more studies in diverse populations, including non-European ancestries.
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246154, Identifier: PROSPERO (CRD42021246154).
饮酒对健康的影响，尤其是与戒酒相比，轻度至中度饮酒的潜在保护益处，仍然是一个持续争论的话题。然而，流行病学研究由于暴露测量不精确以及残留混杂和反向因果关系导致偏倚的可能性而面临局限性。为了解决这些局限性，我们对孟德尔随机化（MR）研究进行了系统综述，以探讨饮酒与癌症、心血管疾病、肝脏疾病和神经系统疾病之间的因果关系。
我们检索了截至2024年5月的PubMed、ScienceDirect、Embase和欧洲PMC，以查找研究基因预测饮酒与癌症、心血管疾病、肝脏疾病和神经系统疾病之间关联的MR研究。我们基于MR设计的关键要素（一种基因关联研究工具）评估方法学质量。
我们纳入了70项符合纳入标准的MR研究。我们的综述表明，饮酒与多种癌症显著相关，如口腔和口咽癌、食管癌、结直肠癌、肝细胞癌和皮肤黑色素瘤。虽然现有研究并未一致证实饮酒对其他癌症（如肺癌）的不良或保护作用，而观察性研究曾有此暗示。此外，MR研究证实饮酒可能对高血压、心房颤动、心肌梗死和血管疾病的风险有因果影响。然而，没有证据支持观察性研究中所报道的轻度至中度饮酒对认知功能、阿尔茨海默病和肌萎缩侧索硬化症的保护作用，而我们的综述显示癫痫和多发性硬化症的风险增加。现有研究关于饮酒与肝脏疾病之间的联系提供的结果有限。
尽管MR研究为饮酒与各种健康结局之间的因果关系提供了有价值的见解，但值得注意的是，基因工具变量区分戒酒者、轻度和中度饮酒者的能力不一致，使得难以区分暴露与结局之间的U型或J型与线性关系。有必要进行更多研究，以建立MR研究的正式质量评估工具，并在包括非欧洲血统在内的不同人群中开展更多研究。
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246154，标识符：PROSPERO（CRD42021246154）。
