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Table 3 Triangulation of included studies with reviews of the broader observational literature

From: Are there non-linear relationships between alcohol consumption and long-term health?: a systematic review of observational studies employing approaches to improve causal inference

Outcome Study/ies first author (year) Simplified summary of findings Consistent with broader literature? Details
Prostate cancer Dickerman (2018) -Reverse J-shaped relationship No A 2016 meta-analysis found a monotonically increasing relationship [60]
All-cause mortality Sipila (2016) -Monotonically increasing Yes A 2016 meta-analysis found a monotonically increasing relationship [16]
Diabetes biomarkers:
–FBG Peng (2016) -Positive linear relationship Yes A 2017 review found results consistent with a positive linear relationship [61]
–Glucose tolerance, insulin sensitivity and glycated haemoglobin Peng (2016) -Positive linear relationships for P2hBG (glucose tolerance) and HOMA-IR (insulin sensitivity)
-Lack of relationship for HbA1c (glycated haemoglobin) and HOMA-beta (insulin sensitivity)
N/A A 2017 review found that, for the other diabetes biomarkers included in this review,
there was not enough/consistent evidence from which to draw conclusions [61]
CVD biomarkers:
–Blood pressure Silverwood (2014)
Peng (2019)
-Non-linear relationship (small protective effect of light drinking) for SBP
-Positive linear relationships for both SBP and DBP
No
Yes
A 2018 meta-analysis found no protective effect for hypeternsion [62]
–Obesity anthropometrics Silverwood (2014)
Peng (2019)
-Non-linear relationship (small protective effect of light drinking) for BMI and waist circumference
-Positive linear relationships for BMI, waist circumference, and hip circumference, with no relationship for waist-to-hip ratio
Mixed
Mixed
A 2011 review found mixed evidence on the relationship between alcohol and weight/measures of
abdominal adiposity, with heavy drinking generally associated with increased values, but moderate
consumption either associated with lower values or not associated at all (suggested that discrepancies
may depend on type of alcohol consumed) [63]
–Inflammatory markers Silverwood (2014) -Non-linear relationship (small protective effect of light drinking) for CRP but a positive linear relationship for IL-6 N/A A 2021 review of studies from the previous decade found no relevant longitudinal observational studies that
were capable of detecting non-linear relationships [64]
–Lipids: HDL-C Silverwood (2014)
Peng (2019)
Vu (2016)
-No relationship for HDL-C
-No relationship for HDL-C
-No relationship for HDL-C, or HDL-3C, but an inverted reverse J-shaped relationship for HDL-2C (a beneficial effect)
No
No
Mixed
A 2021 review of studies from the previous decade found just one longitudinal observational study,
which reported a reverse J-shaped relationship in decreases in HDL-C from baseline [64]
–Lipids: other Silverwood (2014)
Peng (2019)
Vu (2016
-No relationship for TG, but a non-linear relationship (small protective effect of light drinking) for non-HDL-C
-Positive linear relationships for TG, non-HDL-C, and TC
-Reverse J-shaped relationships for LDL-C, TG and TC, no relationship for Lp(a), and monotonically decreasing relationships for sdLDL-C and apoB
N/A A 2021 review of studies from the previous decade found no relevant longitudinal observational studies [64]
CVD events/diagnoses:
–Myocardial infarction Ilomaki (2011)
Millwood (2019)
-J-shaped relationship
-No relationship
No A 2017 review found alcohol was detrimental for myocarditis [2], but no reviews on myocardial infarction
were found
–Stroke Kadlecova (2015)
Millwood (2019)
-Reverse J-shaped relationship for stroke and TIA
-Monotonically increasing relationships for ischaemic stroke, intracerebral haemorrhage and total stroke
Mixed A 2016 meta-analysis found J-shaped relationships for ischaemic stroke, but monotonically increasing
relationships for intracerebral haemorrhage and subarachnoid haemorrhage [65]
–Total coronary heart disease Millwood (2019) -No relationship No A 2016 meta-analysis found a U-shaped relationship [66]
–Circulatory system diagnoses Ropponen (2014) -No clear functional form N/A Most reviews evaluate CVD sub-conditions, finding divergent functional forms
Dementia Handing (2015) -J-shaped relationship Yes A 2021 review found most recent evidence is consistent with a J-shaped relationship [67]
Mental health Gemes (2019)
Samuelsson (2013)
-U−/J-shaped relationship
-Non-linear relationship with abstainers at increased risk over light frequent drinkers
Yes A 2020 meta-analysis found a J-shaped relationship with depressive symptoms [68]
HIV seroconversion Sander (2013) -Monotonically increasing relationship N/A There is a lack of dose-response information on alcohol’s relationship with HIV [69, 70]
Musculoskeletal disorders Pietikainen (2011)
Ropponen (2014)
Ropponen (2011)
-Monotonically increasing relationship
-No clear functional form
-No clear functional form, but abstainers have lowest risk
N/A No reviews on the relationship between alcohol and musculoskeletal disorders were found
  1. Note: Risk for type 2 diabetes (Carlsson et al.) is excluded from this table as the analyses were critically underpowered, and thus the results are not appropriate for inclusion in the triangulation process. Findings from RCTs were not integrated into triangulation as they are almost exclusively conducted in short-term time frames, which is not of interest to this review