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Research paper
Association between alcohol exposure and the risk of amyotrophic lateral sclerosis in the Euro-MOTOR study
  1. Fabrizio D’Ovidio1,
  2. James P K Rooney2,
  3. Anne E Visser3,
  4. Umberto Manera1,
  5. Ettore Beghi4,
  6. Giancarlo Logroscino5,
  7. Roel C H Vermeulen6,
  8. Jan Herman Veldink3,
  9. Leonard H van den Berg3,
  10. Orla Hardiman2,
  11. Adriano Chiò1
  12. for the Euro-MOTOR consortium
    1. 1 ‘Rita Levi Montalcini’ Department of Neurosciences, University of Turin, Turin, Italy
    2. 2 Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
    3. 3 Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
    4. 4 Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
    5. 5 Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
    6. 6 Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
    1. Correspondence to Dr Fabrizio D’Ovidio, ‘Rita Levi Montalcini’ Department of Neurosciences, University of Turin, Turin 10126, Italy; fabrizio.dovidio{at}unito.it

    Abstract

    Objectives Several studies focused on the association between alcohol consumption and amyotrophic lateral sclerosis (ALS), although with inconsistent findings. Antioxidants may play a role since lyophilised red wine was found to prolong SOD1 mice lifespan. The aim of this international population-based case–control study performed in Ireland, The Netherlands and Italy was to assess the role of alcohol, and red wine in particular, in developing ALS.

    Methods Euro-MOTOR is a case–control study where patients with incident ALS and controls matched for gender, age and area of residency were recruited in a population-based design. Logistic regression models adjusted for sex, age, cohort, education, leisure time physical activity, smoking, heart problems, hypertension, stroke, cholesterol and diabetes were performed.

    Results 1557 patients with ALS and 2922 controls were enrolled in the study. Exposure to alcohol drinking was not significantly associated with ALS risk. A stratified analysis of exposure to alcohol by cohort revealed significant ORs in The Netherlands and in Apulia, with opposite directions (respectively 0.68 and 2.38). With regard to red wine consumption, only in Apulia the double-fold increased risk (OR 2.53) remained significant. A decreased risk was found for current alcohol drinkers (OR 0.83), while a significantly increased risk was detected among former drinkers (OR 1.63). Analysis of cumulative exposure to alcohol revealed no significant associations with ALS risk.

    Conclusion With few exceptions, no significant association was found between alcohol consumption and ALS. The study of the association between alcohol and ALS requires a thorough exploration, especially considering the role of different type of alcoholic beverages.

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    Footnotes

    • FD, JPKR and AEV contributed equally.

    • Collaborators Apulia region, Italy: Chiara Zecca, DrBiol (University of Bari ‘A. Moro’, at Pia Fondazione ‘Card. G. Panico’, Tricase, Research Assistant); Rosanna Tortelli, MD PhD (University of Bari ‘A. Moro’, at Pia Fondazione ‘Card. G. Panico’, Tricase, Site Investigator and Apulia region Project Supervisor). Lombardy region, Italy: Elisabetta Pupillo, PharmD (IRCCS Mario Negri Institute of Pharmacological Research, Milan, Site investigator and Lombardy region Project Supervisor); Giancarlo Comi, MD (IRCCS San Raffaele Hospital, Milan, Site Investigator); Nilo Riva, MD (IRCCS San Raffaele Hospital, Milan, Site Investigator); Christian Lunetta, MD (Niguarda Ca’ Granda Hospital, Milan, Site Investigator); Francesca Gerardi, DrBT (Niguarda Ca’ Granda Hospital, Milan, Site Investigator); Massimiliano Filosto, MD (Civil Hospital of Brescia, Brescia, Site Investigator); Maria Sofia Cotelli, MD (Civil Hospital of Brescia, Brescia, Site Investigator); Fabrizio Rinaldi, MD (Civil Hospital of Brescia, Brescia, Site Investigator); Luca Chiveri, MD (Ospedale Valduce, Como, Italy, Site Investigator); Maria Cristina Guaita, MD (A.O. Civil Hospital, Legnano, Site Investigator); Patrizia Perrone, MD (A.O. Civil Hospital, Legnano, Italy, Site Investigator); Ceroni Mauro, MD (IRCCS National Neurorological Institute C.Mondino, Site Investigator); Luca Diamanti MD (IRCCS National Neurorological Institute C.Mondino, Site Investigator). Pavia: Carlo Ferrarese, MD (University of Milano-Bicocca, San Gerardo Hospital, Monza, Site Investigator); Lucio Tremolizzo MD (University of Milano-Bicocca, San Gerardo Hospital, Monza, Site Investigator); Angelo Maurizio Clerici MD (Ospedale di Circolo, Fondazione Macchi, Varese, Site Investigator); Marco Mauri MD (Ospedale di Circolo, Fondazione Macchi, Varese, Site Investigator); Giorgio Bono MD (Ospedale di Circolo, Fondazione Macchi, Varese, Site Investigator). Ireland: Mark Heverin, MSc (Trinity College Dublin, Project Supervisor and data manager); Alice Vajda, PhD MSc (Trinity College Dublin, Project Supervisor and data manager); Meabhdh O’Sullivan, BSc (Trinity College Dublin, Research Assistant); Nadia Breen, MSc (Trinity College Dublin, Research Assistant); Emma Quinlan, MSc (Trinity College Dublin, Research Assistant); Emma Kirby, MSc (Trinity College Dublin, Research Nurse); Anna Kinsella, MSc (Trinity College Dublin, Research Assistant); Caoifa Madden MSc (Trinity College Dublin, Research Assistant). The Netherlands: Anneke J van der Kooi, MD, PhD (Department of Neurology, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Site Investigator); Joost Raaphorst, MD, PhD (Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, Site Investigator); Calvin Ge, MSc (Institute for Risk Assessment Sciences, Utrecht University, Utrecht). Piedmont and Valle D’Aosta: Federico Casale, PhD (University of Turin, Piedmont and Valle D’Aosta Project Supervisor and data manager); Letizia Mazzini, MD (University of Turin, Site Investigator); Andrea Calvo, MD, PhD (University of Turin, Piedmont and Valle D’Aosta Project Supervisor and Site Investigator); Antonio Canosa, MD, PhD (University of Turin, Site Investigator); Cristina Moglia, MD, PhD (University of Turin, Site Investigator); Davide Bertuzzo, MD (University of Turin, Site Investigator); Letizia Mazzini, MD (Maggiore della Carità University Hospital, Novara, Site Investigator); Enrica Bersano, MD (Maggiore della Carità University Hospital, Novara, Site Investigator).

    • Contributors FD, JPKR, AEV, EB, GL, OH, LHvdB, JHV and AC contributed to the study concept and design. FD, JPKR, AEV, UM, EB, GL, OH, LHvdB, JHV and AC participated in data collection and processing. FD, JPKR and AEV performed the statistical analyses. FD, JPKR, AEV, UM, RCHV, EB, GL, OH, LHvdB, JHV and AC contributed to the analysis and interpretation of data. FD wrote the manuscript. JPKR, AEV, UM, RCVH, EB, GL, OH, LHvdB, JHV and AC revised the manuscript for important intellectual content. RCHV, EB, GL, OH, LHvdB, JHV and AC provided study supervision. EB, GL, OH, LHvdB, JHV and AC obtained funding.

    • Funding The research leading to these results has received funding from the European Community’s Health Seventh Framework Programme (FP7/2007–2013; grant agreements no. 259867).

    • Competing interests JPKR was funded by the Health Research Board Clinical Fellowship Programme (HPF-2014-527). EB reports grants from UCB-Pharma, grants from Shire, grants from EISAI, personal fees from Viropharma, grants from Italian Ministry of Health, grants from Fondazione Borgonovo, grants from Associazione IDIC 15, grants from European Union, outside the submitted work. OH is funded by the Health Research Board Clinician Scientist Programme and Science Foundation Ireland; has received speaking honoraria from Novartis, Biogen Idec, Sanofi Aventis and Merck-Serono; has been a member of advisory panels for Biogen Idec, Allergen, Ono Pharmaceuticals, Novartis, Cytokinetics and Sanofi Aventis; and serves as editor-in-chief of Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. LHvdB reports grants from European Union Health Seventh Framework Programme (EUROMOTOR project), Netherlands ALS Foundation and The Netherlands Organization for Health Research and Development (Vici scheme), serves on scientific advisory boards for the Prinses Beatrix Spierfonds, Thierry Latran Foundation, Biogen, Cytokinetics, Orion and Sarepta; serves on the editorial board of Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration and The Journal of Neurology, Neurosurgery, and Psychiatry. AC serves on the editorial advisory board of Amyotrophic Lateral Sclerosis; receives research support from the Italian Ministry of Health (Ricerca Finalizzata), Regione Piemonte (Ricerca Finalizzata), University of Turin, Fondazione Vialli e Mauro onlus and the European Commission (Health Seventh Framework Programme); and serves on scientific advisory boards for Biogen Idec, Cytokinetics, Italfarmaco, Neuraltus and Mitsubishi Tanabe. FD, AEV, UM, RCHV, GL and JHV report no disclosures relevant to the manuscript.

    • Patient consent Obtained.

    • Ethics approval Overarching ethical approval for this study was obtained from the Medical Ethics Committee of University Medical Centre, Utrecht (Ref: AvG/sv/05/08022).

    • Provenance and peer review Not commissioned; externally peer reviewed.

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