Álcool como fator de risco para demência
Data
2015-02-28
Autores
Luna, Hernando Ivan Padilla 
Orientadores
Ferri, Cleusa Pinheiro
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A população está envelhecendo rapidamente e com isso aumentam as doenças crônicas, entre elas a demência que tem um custo alto para o paciente, seus familiares e para a sociedade como um todo. Tem sido sugerido que a demência poderia ser prevenida ou ter seu risco diminuído através do controle de fatores de risco modificáveis. O consumo de álcool tem sido associado ao seu aparecimento, mas os achados são controversos. Métodos: Foram feitos dois estudos: uma revisão sistemática (Estudo I) e uma análise secundária de uma coorte de 9190 pessoas acima de 65 anos de idade de seis países de renda média e baixa (Estudo II) do estudo original feito pelo grupo 10/66 (10/66 Dementia Research Group). Para a revisão, foi utilizada a base de dados do Medline, identificando estudos populacionais longitudinais sobre a incidência de demência que avaliaram o consumo de álcool na linha de base ou em um período anterior. Para a metanálise (usando efeito randômico) foram incluídos apenas estudos que apresentaram alguma homogeneidade nas categorias de comparação quanto ao consumo de álcool (ver abaixo). No Estudo II foi utilizada análise de risco competitivo com modelos de regressão de Cox, comparando o risco de desenvolvimento de demência entre bebedores moderados (até 14 unidades/semana para mulheres e 21 para homens) e abstêmios, e entre bebedores de risco (valores maiores) e abstêmios, nos quatro anos de seguimento. Também se incluiu um termo de interação com APOE4 para testar se o risco entre portadores e não portadores era diferente. Estas análises foram repetidas para três desfechos: qualquer demência, doença de Alzheimer (DA) e demência vascular (DV). Todas as análises foram feitas para cada país separadamente e posteriormente meta analisadas. Resultados: Na revisão sistemática foram identificados cinco estudos elegíveis, e a metanálise dos seus resultados aponta para um efeito protetor do uso moderado de álcool na incidência da demência (RR= 0.56 95%CI 0.44-0.68) para qualquer demência, (RR= 0.62 95%CI 0.54-0.69) para AD e (RR= 0.32 95%CI 0.17-0.47) para DV. Este efeito não foi identificado na análise secundária, sendo a principal diferença entre os estudos incluídos na revisão (Estudo I) e os estudos da analise secundaria (Estudo II) o momento da exposição ao álcool (antes dos 65 anos de idade) nos estudos do grupo 10/66 e uso atual (maioria após os 65 anos de idade) nos estudos incluídos na revisão sistemática. Um risco similar entre bebedores de risco e abstêmios foi visto nos dois estudos. Não foi identificada interação com a APOE. Conclusão: A evidência atual é inconclusiva, sendo os seus maiores problemas a heterogeneidade na definição das categorias de exposição e o período da vida inquirido. São necessários estudos sobre os efeitos doseresposta desta associação para se identificar os diferentes níveis de risco para os diferentes níveis de consumo. Recomendações sobre o consumo de álcool para diminuir o risco para a demência devem ser evitadas até que evidências mais sólidas e robustas possam dar suporte a qualquer recomendação.
Background: The world population is ageing fast and contributing to an increase in the burden of chronic diseases such as dementia, which has a high cost for the patient, their family and for the society as a whole. It has been suggested that dementia could be prevented or its risk decreased trough control of modifiable risk factors. Alcohol consumption has been associated with dementia incidence, but the findings are controversial. Methods: Two studies were conducted: a systematic review (Study I) and a secondary analyses of a cohort of 9190 people aged 65 or over from six low-and middle-income countries (Study II), from the original study made by the 10/66 group (10/66 Dementia Research Group). For the review searches were conducted in Medline, identifying population-based and longitudinal studies of dementia incidence, and had measure exposure to alcohol at the baseline in a previous period. For the metanálises (using random effect) it was included only studies showing some homogeneity regarding the categories of alcohol exposure (see below). In the Study II competitive risk analyses were conducted using Cox regression models to estimate the risk of dementia of moderate alcohol consumption (till 14 units/week for women and 21 for men) compared with abstainers, and at risk drinkers (higher values) compared to abstainers, in the four year follow up. Also it was included an interaction term with APOE 4 to test if there were dementia risk differences between carriers and non-carriers. These analyses were repeated for the three outcomes: any dementia, Alzheimer´s disease (AD) and vascular dementia (VaD). All estimates were conducted separately for each country and then meta-analyzed. Findings: The systematic review identified five eligible studies, and the metanalises of their findings points to a protective effect of moderate alcohol consumption compared to abstainers for dementia incidence (RR= 0.56 95%IC 0.44-0.68) for any dementia, for DA (RR= 0.62 95% CI 0.54-0.69) and for Vad (RR= 0.32 95%CI 0.17-0.47), an effect that was not identified in the secondary analyses. The main difference between studies included in the review and in the secondary analyses studies was the time of exposure to alcohol (before 65 years old) in the studies of the 10/66 group, and current use (most after 65 years old) in the studies of the systematic review. Similar risk was identified between at risk drinkers and abstainers in both studies. APOE interaction was not identified. Conclusion: Current evidence is inconclusive, and the main problems are the heterogeneity of exposure categories definition and life period that was inquired. There is a need for dose ?response studies to identify risk levels for different levels of alcohol consumption. Recommendations about alcohol consumption to decrease dementia risk should be avoided until sufficient and robust evident are available to support any recommendation.
Background: The world population is ageing fast and contributing to an increase in the burden of chronic diseases such as dementia, which has a high cost for the patient, their family and for the society as a whole. It has been suggested that dementia could be prevented or its risk decreased trough control of modifiable risk factors. Alcohol consumption has been associated with dementia incidence, but the findings are controversial. Methods: Two studies were conducted: a systematic review (Study I) and a secondary analyses of a cohort of 9190 people aged 65 or over from six low-and middle-income countries (Study II), from the original study made by the 10/66 group (10/66 Dementia Research Group). For the review searches were conducted in Medline, identifying population-based and longitudinal studies of dementia incidence, and had measure exposure to alcohol at the baseline in a previous period. For the metanálises (using random effect) it was included only studies showing some homogeneity regarding the categories of alcohol exposure (see below). In the Study II competitive risk analyses were conducted using Cox regression models to estimate the risk of dementia of moderate alcohol consumption (till 14 units/week for women and 21 for men) compared with abstainers, and at risk drinkers (higher values) compared to abstainers, in the four year follow up. Also it was included an interaction term with APOE 4 to test if there were dementia risk differences between carriers and non-carriers. These analyses were repeated for the three outcomes: any dementia, Alzheimer´s disease (AD) and vascular dementia (VaD). All estimates were conducted separately for each country and then meta-analyzed. Findings: The systematic review identified five eligible studies, and the metanalises of their findings points to a protective effect of moderate alcohol consumption compared to abstainers for dementia incidence (RR= 0.56 95%IC 0.44-0.68) for any dementia, for DA (RR= 0.62 95% CI 0.54-0.69) and for Vad (RR= 0.32 95%CI 0.17-0.47), an effect that was not identified in the secondary analyses. The main difference between studies included in the review and in the secondary analyses studies was the time of exposure to alcohol (before 65 years old) in the studies of the 10/66 group, and current use (most after 65 years old) in the studies of the systematic review. Similar risk was identified between at risk drinkers and abstainers in both studies. APOE interaction was not identified. Conclusion: Current evidence is inconclusive, and the main problems are the heterogeneity of exposure categories definition and life period that was inquired. There is a need for dose ?response studies to identify risk levels for different levels of alcohol consumption. Recommendations about alcohol consumption to decrease dementia risk should be avoided until sufficient and robust evident are available to support any recommendation.
Descrição
Citação
LUNA, Hernando Ivan Padilla. Álcool como fator de risco para demência. 2015. 133 f. Dissertação (Mestrado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.