23年随访证实适度饮酒可降低中老年人群痴呆风险

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研究人员就饮酒与痴呆之间的相关性进行了前瞻性队列研究，近日发表在英国医学杂志（BMJ）上

1985-1988年间，研究人员招募9087名35-55岁参与者，随访至2017年收集参与者住院医疗、精神服务以及死亡数据；在1985-88以及1991-93年间3次统计参与者酒精消费数据并进行分类——禁酒、每周1-14单位、以及每周超过14单位；依据1985-88以及2002-04年间5次统计结果绘制参与者研究期间的酒精消费轨迹；在1991-93年间依据CAGE问卷评估参与者酒精依赖性；记录1991-2017年间因饮酒导致的慢性疾病住院情况。

23年随访期间总计发生397例痴呆。相对于每周饮酒1-14单位人群，中年禁酒人群的痴呆风险显著增加（HR=1.47）。对于每周饮酒超过14单位的参与者，每增加7单位酒精消费其痴呆风险增加17%。CAGE得分>2（HR=2.19）以及酒精相关住院(4.28)与痴呆风险相关。中年至早老年期间的酒精消费轨迹显示，相比于适度饮酒（周饮酒量1-14单位）人群，长期禁酒(1.74)、突然戒酒(1.55)以及长期酗酒（周饮酒超过14单位，1.40）人群的痴呆风险增加。多状态模型分析表明，痴呆与中年禁酒的相关性一定程度上是由随访过程中的心脏代谢疾病增加导致的，无心脏疾病禁酒人群的痴呆风险为1.33，而心脏病人群则为1.47。

研究发现，中年人群酒精消费与痴呆风险的相关性呈U分布，每周饮酒1-14单位可有效降低中年人群痴呆风险。

作者：zhangfan  

来源：MedSci

原始出处：

Séverine Sabia et al. Alcohol consumption andrisk of dementia： 23 year follow-up ofWhitehall II cohort study. BMJ. August 01 2018.

附：

在英国，1个饮酒单位值（unit）对应8克的纯酒精。

Abstract

Objective To examine the association between alcohol consumption and risk of dementia.

Design Prospective cohort study.

Setting Civil service departments in London(Whitehall II study).

Participants 9087 participants aged 35-55years at study inception (1985/88).

Main outcome measures Incident dementia,identified through linkage to hospital, mental health services, and mortalityregisters until 2017. Measures of alcohol consumption were the mean from three assessments between 1985/88 and 1991/93 (midlife), categorised as abstinence,1-14 units/week, and >14 units/week; 17 year trajectories of alcohol consumption based on five assessments of alcohol consumption between 1985/88and 2002/04; CAGE questionnaire for alcohol dependence assessed in 1991/93; andhospital admission for alcohol related chronic diseases between 1991 and 2017.

Results 397 cases of dementia were recordedover a mean follow-up of 23 years. Abstinence in midlife was associated with ahigher risk of dementia (hazard ratio 1.47, 95% confidence interval 1.15 to1.89) compared with consumption of 1-14 units/week. Among those drinking >14units/week, a 7 unit increase in alcohol consumption was associated with a 17%(95% confidence interval 4% to 32%) increase in risk of dementia. CAGE score>2 (hazard ratio 2.19, 1.29 to 3.71) and alcohol related hospital admission(4.28, 2.72 to 6.73) were also associated with an increased risk of dementia.Alcohol consumption trajectories from midlife to early old age showed long termabstinence (1.74, 1.31 to 2.30), decrease in consumption (1.55, 1.08 to 2.22),and long term consumption >14 units/week (1.40, 1.02 to 1.93) to beassociated with a higher risk of dementia compared with long term consumptionof 1-14 units/week. Analysis using multistate models suggested that the excessrisk of dementia associated with abstinence in midlife was partly explained bycardiometabolic disease over the follow-up as the hazard ratio of dementia inabstainers without cardiometabolic disease was 1.33 (0.88 to 2.02) comparedwith 1.47 (1.15 to 1.89) in the entire population.

Conclusion The risk of dementia wasincreased in people who abstained from alcohol in midlife or consumed >14units/week. In several countries, guidelines define thresholds for harmfulalcohol consumption much higher than 14 units/week. The present findingsencourage the downward revision of such guidelines to promote cognitive healthat older ages.

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