Alcohol consumption and risk of leukemia: A multicenter case–control study
Introduction
Few studies have analysed the relationship between alcohol intake and adult leukemia, but results have been generally inconsistent, with opposite effects, according to different leukemia subtypes and beverage types [1], [2], [3], [4], [5], [6], [7].
The first study on the effects of alcohol consumption for leukemia subtypes suggested a positive but weak association with chronic lymphoid (CLL), chronic myeloid (CML), and acute myeloid leukemia (AML) [1]. Brown et al. [2] in the first population-based case–control study, found non-significantly elevated risks for acute lymphoid leukemia (ALL), and a non-significantly inverse association for AML (Table 1). Wakabayashi et al. [3] found significantly increased risks for AML, while Pogoda et al. [4] found a non-significantly inverse association for AML. A case–control study on alcohol intake and acute leukemia risk found an inverse association for light and moderate beer intake, and, in contrast, a positive association for moderate and heavy wine intake [5]. A recent pooled analysis of nine case–control studies on alcohol consumption and risk on non-Hodgkin's lymphoma (NHL) [6], found an inverse association for moderate alcohol intake for CLL/small lymphocytic lymphoma (SLL) combined, and a subsequent case–control study [7] found a non-significantly inverse association for CLL in men only.
Alcohol has immunomodulatory effects, which may be different according to the degree of intake: there is evidence that heavy drinkers may have an impaired immune function, but light or moderate drinkers may have improved cellular and humoral immune responses [8]. Other mechanisms underlying a potential protective effect of moderate alcohol consumption may include antioxidants, such as resveratrol in wine or flavonoids in beer, improvement of insulin sensitivity by alcohol [9], [10], or the interaction between retinol and ethanol metabolism [11], [12].
Results of the recent pooled analysis on alcohol and NHL risk [6], have induced us to investigate also the relationship between alcohol consumption and leukemia risk in a subset of a large population-based case–control study conducted in Italy.
Section snippets
Materials and methods
The Italian study has been described in detail elsewhere [13], [14], [15], [16]. Briefly, the study covered 11 Italian areas (Varese, Forlì, Siena, Latina, Ragusa, Imperia, Florence, Novara, Vercelli, and Verona provinces plus the city of Turin). The study included all incident leukemia cases (International Classification of Disease, 9th revision [ICD-9] code: 204–208); in particular, ALL (ICD-9 code: 204.0), CLL (ICD-9 code: 204.1), AML (ICD-9 code: 205.0), CML (ICD-9 code: 205.1), and other
Results
A total of 649 leukemia cases (88%) and 1771 controls (81%) completed an interview [13]. Table 2 shows characteristics of the interviewed cases and controls. Direct interviews were available for 80% of cases and 96% of controls. The median ages of cases and controls were, respectively, 62 and 58 years. Males comprised 59% of cases and 52% of controls. Cases and controls did not differ with respect to distribution of educational level. Male individuals were more likely to be current smokers
Discussion
For all leukemias, ALL, AML, and CLL, we found a non-significantly inverse association for moderate levels but a non-significantly increased risk at high levels of alcohol consumption, in particular for wine intake. It seems that there is no clear association between alcohol consumption and leukemia, even though some of the patterns in the risk estimates may be notable, suggesting a possible J-shaped dose–response curve, similar to that found in studies on the relation between alcohol intake
Acknowledgments
This work has been carried out with the cooperation of S. Alberghini Maltoni, S. Barcellini, G. Barni, L. Bellesini, V. Cacciarini, R. Carlini, M. Casale, G. Castellino, G. Cremaschi, L. Davico, A. Fiorio, R. Gibilisco, L. Guzzo, R. Hirvas, S. Legrotti, L. Migliaretti, R. Monteleone, G. Osella, T. Palma, G. Panizza, C. Picoco, G. Piergiovanni, G. Righetti, R. Sguanci, M. Tedeschi, D. Tiberti, G. Tonini, P. Trada, T. Vescio, and M. Zanetta.
We thank the following members of the panel of
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