Review of Evidence on Alcohol and Health (2025)
Chapter: Appendix C: Timeline of Screening for Eligibility
Appendix C
Timeline of Screening for Eligibility
All searches were completed by the National Academies Research Center. The literature search approach was iterative based on search results and ongoing committee discussion. Because the Dietary Guidelines for Americans (DGA) was supported by a new systematic review for all-cause mortality, the search frame included studies published between January 2019 and September 2023. The final search frame for other study questions included studies published between January 2010 (the date of the previous edition of the DGA that covered alcohol and health) and February 2024. These steps are described below.
Initial Search
This search included primary studies and systematic reviews between 2019 and 2023 for all-cause mortality, weight changes, cancer, cardiovascular disease, neurocognition, and lactation questions.
- Articles were screened for inclusion/exclusion by the committee.
- Studies meeting criteria for all-cause mortality were submitted for systematic review and meta-analysis.
Committee Action
The DGA 2020–2025 included only an updated systematic review for all-cause mortality, while the DGA was based on systematic reviews for all other topics other than lactation. The committee requested an additional
search to include studies published since the DGA 2010–2015 and a complete search of Embase and PubMed for lactation.
Second Search
This search included systematic reviews between 2010 and 2024 for cardiovascular disease, neurocognitive health, cancer, and overweight/obesity questions; also, a complete search of Embase and PubMed was completed for all primary articles on lactation.
- Articles included in these systematic reviews were screened for inclusion/exclusion by National Academies staff and the committee due to time constraints.
- Committee members recused themselves from screening articles if they were an author on an article.
Committee Action
During inclusion/exclusion review of the articles on cardiovascular disease, neurocognitive health, cancer, and weight changes questions identified in the first two searches, the committee chose to exclude articles for which data collection ended prior to 2010 to avoid potential bias that might be associated with older studies.
Prior to finalizing the report, the committee chose to harmonize the search strategies for consistency across the topics and alignment with best practice for study inclusion. Therefore, instead of excluding articles with data collection ending prior to 2010, the committee chose to reconsider these articles for inclusion. Articles for cardiovascular disease, neurocognitive health, cancer, and overweight/obesity questions that were excluded based on end of data collection year were re-screened for inclusion/exclusion by the committee. As a result, the committee asked for the systematic review and meta-analysis to be repeated to include two additional articles related to cardiovascular disease, one for breast cancer, one for colon cancer, and one for neurocognition. The review for the lactation questions was similarly restricted to the same search time frame and data collection time frame, and the chapter was revised accordingly. These additional analyses did not change any of the committee’s conclusions.
Impact on Findings
When two publications on cardiovascular disease (CVD) were added, this resulted in one additional study (Liu et al., 2022) for the CVD mortality outcome. The impact of this addition (with data collection that ended prior to 2010) was relative risk difference of 0.01 and within the confidence interval, i.e., four studies (RR = 0.81 [0.73, 0.89] versus three studies (RR = 0.82 [0.76, 0.89]).
