title: Alcohol Consumption as a Risk Factor for Acute and Chronic Pancreatitis: A Systematic Review and a Series of Meta-analyses.
abstract: BACKGROUND
  Pancreatitis is a highly prevalent medical condition associated with a spectrum of endocrine and exocrine pancreatic insufficiencies. While high alcohol consumption is an established risk factor for pancreatitis, its relationship with specific types of pancreatitis and a potential threshold have not been systematically examined.
  
  
  METHODS
  We conducted a systematic literature search for studies on the association between alcohol consumption and pancreatitis based on PRISMA guidelines. Non-linear and linear random-effect dose-response meta-analyses using restricted cubic spline meta-regressions and categorical meta-analyses in relation to abstainers were conducted.
  
  
  RESULTS
  Seven studies with 157,026 participants and 3618 cases of pancreatitis were included into analyses. The dose-response relationship between average volume of alcohol consumption and risk of pancreatitis was monotonic with no evidence of non-linearity for chronic pancreatitis (CP) for both sexes (p = 0.091) and acute pancreatitis (AP) in men (p = 0.396); it was non-linear for AP in women (p = 0.008). Compared to abstention, there was a significant decrease in risk (RR = 0.76, 95%CI: 0.60-0.97) of AP in women below the threshold of 40 g/day. No such association was found in men (RR = 1.1, 95%CI: 0.69-1.74). The RR for CP at 100 g/day was 6.29 (95%CI: 3.04-13.02).
  
  
  CONCLUSIONS
  The dose-response relationships between alcohol consumption and risk of pancreatitis were monotonic for CP and AP in men, and non-linear for AP in women. Alcohol consumption below 40 g/day was associated with reduced risk of AP in women. Alcohol consumption beyond this level was increasingly detrimental for any type of pancreatitis.
  
  
  BACKGROUND
  The work was financially supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (R21AA023521) to the last author.
authors: Centre for Addiction and Mental Health, Social and Epidemiological Research Department, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
authors: Andriy V
authors: AV
authors: Samokhvalov
authors: Centre for Addiction and Mental Health, Social and Epidemiological Research Department, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany; WHO Collaborating Centre on Mental Health and Addiction, Toronto, Canada.
authors: Jürgen
authors: J
authors: Rehm
authors: Centre for Addiction and Mental Health, Social and Epidemiological Research Department, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; WHO Collaborating Centre on Mental Health and Addiction, Toronto, Canada.
authors: Michael
authors: M
authors: Roerecke
mesh_terms: D000208:Acute Disease; D000428:Alcohol Drinking / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D017594:Publication Bias; D012307:Risk Factors
keywords: Acute pancreatitis; Alcohol; Chronic pancreatitis; Meta-analysis; Pancreatitis