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Study Title and Description

Alcohol, caffeine and smoking in relation to age at menopause.



Key Questions Addressed
1 For [population], is caffeine intake above [exposure dose], compared to intakes [exposure dose] or less, associated with adverse effects on reproductive and developmental outcomes?
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Primary Publication Information
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TitleData
Title Alcohol, caffeine and smoking in relation to age at menopause.
Author A Kinney,J Kline,B Levin,
Country
Year 2006
Numbers

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Reproductive Toxicity - Design Details
Arms
No arms have been defined in this extraction form.

Design Details
Question... Follow Up Answer Follow-up Answer
Refid 16260101
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What outcome is being evaluated in this paper? Reproductive and Development
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What is the objective of the study (as reported by the authors)? Exposures which might influence age at natural menopause have been extensively studied but, with the exception of cigarette smoking, results have been inconsistent.We sought to determine: (i) whether alcohol and caffeine intake are associated with age at menopause; (ii) whether the association of cigarette smoking with age at menopause is confined to current smokers.
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Provide a general description of the methods as reported by the authors. Information should be extracted based on relevance to the SR (i.e., caffeine related methods) Women in this study previously participated in a New York City hospital-based case-control study (1974–1986) of spontaneous abortion. Analyses drew on longitudinal data from 494 women, aged 44–60 in 1993, of whom 159 experienced menopause before intake or during follow-up. Because the primary hypotheses linked age at menopause with trisomy, recruitmentwas restricted towomen whose index spontaneous abortion had been trisomic (n = 150) or chromosomally normal (n = 209) and a portion of the original control group with chromosomally normal livebirths (n = 264). The outcome under consideration was self-reported and estimated age at ascertained natural menopause, defined, in keeping with convention, as 12 months of amenorrhea in the absence of known causes of amenorrhea. The intake interview asked about the 6 months preceding the interview. Frequency of consumption and size of serving were collected; estimated caffeine content as 135 mg/8 oz cup of caffeinated coffee, 5 mg/8 oz cup of decaffeinated coffee, 50 mg/8 oz cup of caffeinated tea, and 37.5 mg/12 oz can of caffeinated cola. The primary analyses defined caffeine consumption in four categories of mg/day of caffeine: 0 to <100, 100 to <200, 200 to <400, and 400+. We also defined caffeine dichotomously (<100 mg/day versus 100+) and divided the highest intake category to examine effects in women who drank 500+ mg/day. We used parametric logistic survival analysis to estimate shifts in median age at menopause for women who drink alcohol or caffeine or who smoke cigarettes.
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How many outcome-specific endpoints are evaluated? 1
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What is the (or one of the) endpoint(s) evaluated? (Each endpoint listed separately) Age at menopause
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List additional health endpoints (separately).
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List additional health endpoints (separately)
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Notes
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Clinical Clinical
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Physiological
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Other
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What is the study design? Cross-sectional
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Randomized or Non-Randomized?
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What were the diagnostics or methods used to measure the outcome? Subjective
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Optional: Name of Method or short description At intake, we asked each woman whether she had menstruated during the preceding 12 months and, if so, the date. We also asked whether, in the month before her most recent menstrual period, she had taken estrogen, oral contraceptives, or other medications that affect periods and, if so, the date of the period before she began the medication. At each follow-up interview, we obtained similar information. At each interview, we also asked about gynecologic surgery, chemotherapy, and radiotherapy.
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Caffeine (general) Caffeine (general)
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Coffee Coffee
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Chocolate
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Energy drinks
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Gum
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Medicine/Supplement
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Soda Soda
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Tea Tea
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Measured
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Self-report Self-report
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Children
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Adolescents
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Adults Adults
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Pregnant Women
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What was the reference, comparison, or control group(s)? (e.g. high vs low consumption, number of cups, etc.) mg/day of caffeine: 0 to <100, 100 to <200, 200 to <400, and >/= 400
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What were the listed confounders or modifying factors as stated by the authors? (e.g. multi-variable components of models.  Copy from methods) Adjusted for the design variable: outcome of the index pregnancy (chromosomally normal livebirth, chromosomally normal spontaneous abortion, trisomy spontaneous abortion). Also adjusted for smoking and alcohol, body mass index, education and ethnicity.
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Provide a general description of results (as reported by the authors). Caffeine was not associated with age at menopause at any level. For women who drank 400+ mg/day, the estimated median age at menopause was 1.0 (95% CI −2.4, 0.6) year earlier than itwas forwomen who drank <100 mg/day. For <100 mg/day versus 100+, the estimated shift was −0.4 (95% CI −1.6, 0.7) years. For 500+ mg/day, the estimated shift was −1.2 (95% CI −3.0, 0.6) years (data not shown).
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Did the authors perform a dose-response analysis (or trend/related analysis)? No
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What were the authors's observations re: trend analysis?
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What were the author's conclusions? Our study does not suggest an association between caffeine and age at menopause, although the estimates leave open the possibility of earlier age with increased consumption. The detectable effect size (α = 0.05, power = 0.80, two-tailed) for caffeine intake of 400+ mg/day was large—a shift of 2.1 years.
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What were the sources of funding? This work was supported, in part, by National Institute on Aging grants R01 AG 10251 and R01 AG 15386.
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What conflicts of interest were reported? None reported
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Does the exposure (dose) need to be standardized to the SR? No
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Provide calculations/conversions for the exposure based on the decision tree in the guide (for all endpoints/exposure levels of interest).
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List all the endpoint(s) followed by the dose (mg) which will be used in comparison to Nawrot.  Characterize value as LOAEL/NOAEL, etc. if possible.  NOAEL = >400 mg/day for age at menopause
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Notes regarding selection/listing of endpoints and exposures/doses to be compared to Nawrot. Shift in median age at menopause at highest dose (400 mg/day) was 1.0; 95% CI −2.4, 0.6
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What is the importance of the study with respect to the adverseness of the outcome? Critcal
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Baseline Characteristics
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Results & Comparisons

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Adverse Events
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