Study findings are broadly consistent with the results of a prospective case-control study of children of alcoholics, which was not included in the review and found that earlier AFD was unrelated to alcohol dependence when confounding factors were taken into account.27 A similar pattern of results was seen in two studies based on the very large (more than 40 000 participants) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) cohort, representative of the population of the USA.28 29 These were excluded from the present review by virtue of the absence of AFD measurement in adolescence and are thus vulnerable to recall and related biases. Both found small effects of AFD on adult outcomes.
