Alcohol consumption and the risk of diabetes by body mass index levels in a cohort of 5,636 Japanese

Association between alcohol consumption and the risk of type 2 diabetes mellitus across different body mass index categories among Japanese workers

BACKGROUND

While evidence from Western countries links low-to-moderate alcohol consumption to a lower risk of type 2 diabetes mellitus (T2D), findings have been inconsistent in Asia. Since T2D in Asia involves both insulin resistance and deficient insulin secretion, both of which are differently affected by alcohol, we prospectively examined whether the association differs according to body mass index (BMI) categories among the Japanese.

METHODS

Participants were 31,524 health checkup examinees (26,819 males and 4,705 females aged 20-64 years) who were free from diabetes at baseline. Self-reported data on alcohol use were used to estimate the average daily alcohol consumption at the baseline. Incident diabetes was identified at annual checkups during the follow-up period. A Cox proportional hazards model was used to estimate hazard ratios and 95% confidence intervals.

RESULTS

During a median follow-up of 12.0 years, 3,527 male and 287 female participants developed T2D. The association between alcohol consumption and T2D risk differed markedly by BMI in both sexes. Among males, low- and moderate-level alcohol consumption was associated with a lower T2D risk in individuals with BMI ≥25.0 kg/m2, whereas consumption at a level of 2 go/day (approximately 46 g ethanol) was linked to an increased T2D risk in those with BMI ≤22.0 kg/m2. In females, similar patterns were observed, although confidence intervals were broad due to smaller sample size.

CONCLUSIONS

In Japan, low-to-moderate alcohol consumption may lower T2D risk in those with excess body weight, while high alcohol consumption may increase T2D risk in those with lower BMI.

Association between alcohol consumption and incidence of type 2 diabetes in middle-aged Japanese from Panasonic cohort study 12

This retrospective cohort study aimed to investigate the association between alcohol consumption and the onset of type 2 diabetes in middle-aged Japanese individuals. Participants were aged 40 and above from Panasonic Corporation, Osaka, Japan's medical health checkup program from 2008 to 2021. Alcohol consumption was calculated by converting the quantity consumed into daily ethanol consumption. We assessed the association between alcohol consumption and the onset of type 2 diabetes using Cox regression analysis. The total and median follow-up duration was 13 years and 7 (3-13) years (748,090 person-years). Among 102,802 participants, 7,510 participants (7.3%) developed type 2 diabetes during the study period. Alcohol consumption at the level of 0 < to < 22 g/day and 22 to < 39 g/day were negatively associated with developing type 2 diabetes compared to complete alcohol abstainers. Alcohol consumption at levels of 39 to < 66 g/day and at levels of ≥ 66 g/day were positively associated with developing type 2 diabetes in participants with BMI < 25 kg/m2. All levels of alcohol consumption were negatively associated with developing type 2 diabetes in participants with BMI ≥ 25 kg/m2. Moderate-to-heavy alcohol consumption were positively associated with developing type 2 diabetes for participants with BMI < 25 kg/m2, whereas alcohol intake was negatively associated with developing type 2 diabetes among participants with BMI ≥ 25 kg/m2.

Association between alcohol consumption and incidence of type 2 diabetes mellitus in Japanese men: a secondary analysis of a Retrospective Cohort Study

BACKGROUND

Alcohol consumption is known to be associated with an increased risk of type 2 diabetes (T2DM). However, the effect of alcohol intake on the incidence of T2DM remains controversial due to inconsistent results across studies. This study aimed to bridge the gap among available literature in order to better define the association between alcohol consumption and incidence of T2DM.

METHODS

We performed a secondary analysis using open-access data from a retrospective Japanese cohort of 15,464 participants who underwent regular medical examinations at Murakami Memorial Hospital. All participants underwent an initial exam including a questionnaire survey, physical examination, and blood biochemical testing to establish a at baseline. The primary outcome was new-onset T2DM during the follow-up exam. Statistical analysis was conducted using Cox regression and Kaplan-Meier methods to assess the risk of alcohol consumption on T2DM.

RESULTS

During a median follow-up time of 5.39 years, 373 new-onset T2DM events were observed. The cumulative risk of T2DM incidence was higher in the heavy alcohol consumption group vs. the other three groups: none/minimal, light, and moderate consumption (log-rank test, P = 0.0002). Multivariate Cox regression analysis indicated incidental T2DM was independently associated with alcohol consumption. The adjusted hazard ratio relative to the none/minimal consumption group was as follows: 1.02 (95% confidence interval: 0.71, 1.48) for light consumption, 1.06 (0.71, 1.57) for moderate consumption, and 2.06 (1.30, 3.24) for heavy consumption (P value = 0.024). Subsequent subgroup analysis confirmed the association between alcohol consumption and T2DM incidence in men, but not in women.

CONCLUSION

Heavy alcohol consumption was independently associated with an increased risk of new-onset T2DM in Japanese men.

Alcohol-induced impaired insulin secretion in a Japanese population: 5-year follow up in the Gifu Diabetes Study

AIMS/INTRODUCTION

Although moderate alcohol consumption lowers the risk of type 2 diabetes in European populations, the same cannot be assumed for Japanese patients with diabetes related to low insulin secretion rather than resistance. We aimed to evaluate the effects of daily alcohol consumption on glucose tolerance and diabetes development risk in Japanese populations.

MATERIALS AND METHODS

This retrospective study randomly enrolled 452 men and 659 women aged 40-78 years in 2005 (Gifu, Japan). The participants completed a 75-g oral glucose tolerance test and medical questionnaire. The homeostasis model assessment of insulin resistance, homeostasis model assessment of β-cell function and insulinogenic index were used to estimate insulin sensitivity and secretion. The relationships between alcohol consumption and these parameters were analyzed using logistic regression after adjusting for potential confounders. The 5-year changes in hemoglobin A1c levels were also evaluated.

RESULTS

The adjusted odds ratios for elevated homeostasis model assessment of β-cell function values (<40%) in the 0-19.9 g/day, 20.0-39.9 g/day and ≥ 40 g/day alcohol consumption groups were 0.98, 1.46 and 2.68, respectively. Alcohol consumption induced a significant decrease in the insulin secretion level among the ≥40 g/day drinkers, especially in men. However, there was no risk of increased insulin resistance based on the homeostasis model assessment of insulin resistance (<2.5) results. The 5-year risk of elevated hemoglobin A1c levels (≥6.5%) was increased according to increase in alcohol consumption in both men and women.

CONCLUSIONS

Daily alcohol consumption was associated with reduced insulin secretion and an increased diabetes development risk in Japanese populations.

Effect of alcohol consumption and the presence of fatty liver on the risk for incident type 2 diabetes: a population-based longitudinal study

INTRODUCTION

Both fatty liver disease (FLD) and alcohol consumption have been reported to affect incident type 2 diabetes mellitus. The aim of this study was to evaluate the combined effect of FLD and alcohol consumption on incident type 2 diabetes.

RESEARCH DESIGN AND METHODS

In this historical cohort study involving 9948 men, we investigated the influence of the presence of FLD and the grades of alcohol consumption on incident type 2 diabetes using Cox proportional hazards models. We categorized the participants into the following four groups: none or minimal alcohol consumption, <40 g/week; light, 40-140 g/week; moderate, 140-280 g/week; or heavy alcohol consumption, >280 g/week. FLD was diagnosed by abdominal ultrasonography.

RESULTS

During the median 6.0-year follow-up, 568 participants developed type 2 diabetes. Heavy alcohol consumers with FLD showed a higher risk for developing type 2 diabetes compared with the other groups. Moderate alcohol consumers without FLD had a significantly higher risk for developing incident type 2 diabetes, compared with none or minimal and light alcohol consumers without FLD. In contrast, there was no apparent difference in the risk for incident type 2 diabetes between none or minimal, light, and moderate alcohol consumers with FLD. Furthermore, there was no statistically significant difference in the risk for incident type 2 diabetes between a moderate and heavy alcohol consumer without FLD and a none or minimal, light, and moderate alcohol consumer with FLD.

CONCLUSIONS

To prevent incident type 2 diabetes, we should acknowledge that the impact of alcohol consumption may vary in the presence of FLD.

Alcohol Consumption, Diabetes Risk, and Cardiovascular Disease Within Diabetes

PURPOSE OF REVIEW

The purpose of the study is to examine and summarize studies reporting on the epidemiology, the risk of developing diabetes, and the cardiovascular effects on individuals with diabetes of different levels of alcohol consumption.

RECENT FINDINGS

Men consume more alcohol than women in populations with and without diabetes. Light-to-moderate alcohol consumption decreases the incidence of diabetes in the majority of the studies, whereas heavy drinkers and binge drinkers are at increased risk for diabetes. Among people with diabetes, light-to-moderate alcohol consumption reduces risks of cardiovascular diseases and all-cause mortality. Alcohol consumption is less common among populations with diabetes compared to the general population. Moderate alcohol consumption reduces the risk of diabetes and, as in the general population, improves cardiovascular health in patients with diabetes. Type of alcoholic beverage, gender, and body mass index are factors that affect these outcomes.

Association between alcohol consumption pattern and the incidence risk of type 2 diabetes in Korean men: A 12-years follow-up study

Moderate alcohol consumption is generally associated with reduced risk of type 2 diabetes. However, this beneficial effects of alcohol intake remains controversial due to inconsistent results across studies. The analysis was performed using data from the Ansung-Ansan cohort study. We categorized the participants into four groups-based on the baseline (one-point measure; non-drinking, <5 g/day, ≥5, <30 g/day, and ≥30 g/day) and follow-up (consumption pattern; never-drinking, light, moderate, and heavy drinking) measurement. At baseline, ≥30 g/day alcohol consumption increased the risk of incident diabetes (HR: 1.42; 95% CI, 1.10-1.85), but ≥5, <30 g/day alcohol consumption had no effects on the incident diabetes. Meanwhile, when using the alcohol consumption pattern, a heavy-drinking pattern increased the risk of incident diabetes (HR = 1.32, 1.01-1.73), but the light and moderate consumption pattern was associated with a reduced risk of type 2 diabetes (HR: 0.66; 0.50-0.87 and HR: 0.74; 0.57-0.95, respectively). At the end point of follow-up, the insulinogenic index (IGI), but not the insulin sensitivity index (ISI), differed among the groups. Alcohol consumption pattern had a J-shaped association with the incident type 2 diabetes in Korean men. The IGI showed an inverted J-shaped association according to alcohol drinking pattern, but the ISI was not a J-shape.

Association between alcohol consumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis

BACKGROUND

Previous cohort studies have shown that moderate alcohol consumption was associated with a lower risk of type 2 diabetes (T2D). However, whether these associations differ according to the characteristics of patients with T2D remains controversial.

OBJECTIVE

The purpose of this study was to explore and summarize the evidence on the strength of the association between alcohol consumption and the subsequent risk of T2D by using a dose-response meta-analytic approach.

DESIGN

We identified potential studies by searching the PubMed, Embase, and Cochrane Library databases up to 24 March 2015. Prospective observational studies that evaluated the relation between alcohol consumption and the risk of T2D and reported its effect estimates with 95% CIs were included.

RESULTS

Analyses were based on 706,716 individuals (275,711 men and 431,005 women) from 26 studies with 31,621 T2D cases. We detected a nonlinear relation between alcohol consumption and the risk of T2D, which was identified in all cohorts (P-trend < 0.001, P-nonlinearity < 0.001), in men (P-trend < 0.001, P-nonlinearity < 0.001), and in women (P-trend < 0.001, P-nonlinearity < 0.001). Compared with the minimal category of alcohol consumption, light (RR: 0.83; 95% CI: 0.73, 0.95; P = 0.005) and moderate (RR: 0.74; 95% CI: 0.67, 0.82; P < 0.001) alcohol consumption was associated with a lower risk of T2D. However, heavy alcohol consumption had little or no effect on subsequent T2D risk. Furthermore, the summary RR ratio (RRR; male to female) of the comparison between moderate alcohol consumption and the minimal alcohol categories for T2D was significantly higher, and the pooled RRR (current smoker to never smoker) of light alcohol consumption was significantly reduced.

CONCLUSIONS

Light and moderate alcohol consumption was associated with a lower risk of T2D, whereas heavy alcohol consumption was not related to the risk of T2D.

Light to moderate alcohol consumption is protective for type 2 diabetes mellitus in normal weight and overweight individuals but not the obese

OBJECTIVE

To examine the association between alcohol consumption and risk of type 2 diabetes mellitus (T2DM) overall and by body mass index.

METHODS

Cross-sectional study of employed individuals. Daily alcohol intakes were calculated from a self-administered food frequency questionnaire by 5,512 Maori, Pacific Island, and European workers (3,992 men, 1520 women) aged 40 years and above.

RESULTS

There were 170 new cases of T2DM. Compared to the group with no alcohol consumption and adjusting for age, sex, and ethnicity, the group consuming alcohol had relative risks of T2DM of 0.23 (95% CI: 0.08, 0.65) in normal weight individuals, 0.38 (0.18, 0.81) in overweight individuals, and 0.99 (0.59, 1.67) in obese individuals. After further adjusting for total cholesterol, HDL-cholesterol, triglycerides, smoking habit, physical activity, socioeconomic status, body mass index, and hypertension, the relative risks of T2DM were 0.16 (0.05, 0.50) in normal weight individuals, 0.43 (0.19, 0.97) in overweight individuals, and 0.92 (0.52, 1.60) in overweight individuals. Across the categories of alcohol consumption, there was an approximate U-shaped relationship for new cases of T2DM. There was no significant association between alcohol consumption and IGT.

CONCLUSIONS

Alcohol consumption was protective against diagnosis of T2DM in normal and overweight individuals but not in the obese.

Alcohol consumption and risk of type 2 diabetes in European men and women: influence of beverage type and body size The EPIC-InterAct study

OBJECTIVE

To investigate the association between alcohol consumption and type 2 diabetes, and determine whether this is modified by sex, body mass index (BMI) and beverage type.

DESIGN

Multicentre prospective case-cohort study.

SETTING

Eight countries from the European Prospective Investigation into Cancer and Nutrition cohort.

SUBJECTS

A representative baseline sample of 16 154 participants and 12 403 incident cases of type 2 diabetes.

INTERVENTIONS

Alcohol consumption assessed using validated dietary questionnaires.

MAIN OUTCOME MEASURES

Occurrence of type 2 diabetes based on multiple sources (mainly self-reports), verified against medical information.

RESULTS

Amongst men, moderate alcohol consumption was nonsignificantly associated with a lower incidence of diabetes with a hazard ratio (HR) of 0.90 (95% CI: 0.78-1.05) for 6.1-12.0 versus 0.1-6.0 g day(-1) , adjusted for dietary and diabetes risk factors. However, the lowest risk was observed at higher intakes of 24.1-96.0 g day(-1) with an HR of 0.86 (95% CI: 0.75-0.98). Amongst women, moderate alcohol consumption was associated with a lower incidence of diabetes with a hazard ratio of 0.82 (95% CI: 0.72-0.92) for 6.1-12.0 g day(-1) (P interaction gender <0.01). The inverse association between alcohol consumption and diabetes was more pronounced amongst overweight (BMI ≥ 25 kg m(-2) ) than normal-weight men and women (P interaction < 0.05). Adjusting for waist and hip circumference did not alter the results for men, but attenuated the association for women (HR=0.90, 95% CI: 0.79-1.03 for 6.1-12.0 g day(-1) ). Wine consumption for men and fortified wine consumption for women were most strongly associated with a reduced risk of diabetes.

CONCLUSIONS

The results of this study show that moderate alcohol consumption is associated with a lower risk of type 2 diabetes amongst women only. However, this risk reduction is in part explained by fat distribution. The relation between alcohol consumption and type 2 diabetes was stronger for overweight than normal-weight women and men.

Obesity-independent inverse association between regular alcohol consumption and hemoglobin A(1C)

OBJECTIVE

The aim of this study was to determine whether obesity influences relationships between habitual alcohol drinking and hemoglobin A(1C) (HbA(1C)) level.

METHODS

Japanese men (35-70 years old, n = 24858) were divided into non-, light (<22 g ethanol/day), moderate (≥22 and <44 g ethanol/day), and heavy (≥44 g ethanol/day) drinkers. Relationships of alcohol with HbA(1C) were investigated in overall subjects and subjects of quartile groups for degree of obesity.

RESULTS

HbA(1C) tended to be higher as quartiles of BMI and waist-to-height ratio increased. HbA(1C) was significantly lower in light, moderate and heavy drinkers than in nondrinkers. These associations in overall subjects were also found in all of the quartiles of BMI and waist-to-height ratio, except for light drinkers in the 3rd and 4th quartiles of BMI and the 4th quartile of waist-to-height ratio. Odds ratios versus nondrinkers for high HbA(1C) were significantly lower than a reference level of 1.0 in all drinker groups, and these associations were not altered after adjustment for age, history of smoking, and BMI or waist-to-height ratio.

CONCLUSION

The results suggest that alcohol consumption is associated with lower HbA(1C) level independent of degree of obesity.

Alcohol consumption and higher incidence of impaired fasting glucose or type 2 diabetes in obese Korean men

It is inconclusive whether moderate alcohol consumption reduces the diabetes risk. We observed the development of impaired fasting glucose or type 2 diabetes according to the amount of alcohol intake and body mass index. The annual health evaluation data of 2,500 male workers from 2002 to 2006 were reviewed retrospectively deleting personal identification code. The information contained sex, age, medical history, smoking status, alcohol consumption, participating regular exercise, anthropometric, and biochemistry measurement. Impaired fasting glucose or diabetes was determined when fasting plasma glucose was > or =100mg/dL. Thousand seven hundred seven subjects were eligible after excluding medical history of diabetes or fasting glucose > or =100mg/dL at baseline. The relative risks of its development in group of taking 1-14, 15-29, and > or =30.0g ethanol were 0.842 (95% confidence interval [CI], 0.603-1.176), 1.068 (95% CI, 0.736-1.551), and 1.019 (95% CI, 0.662-1.568) within normal weight group, 1.164 (95% CI, 0.795-1.705), 1.421 (95% CI, 0.947-2.133), and 1.604 (95% CI, 1.031-2.495) within overweight group, and 1.498 (95% CI, 1.042-2.153), 1.634 (95% CI, 1.091-2.447), and 1.563 (95% CI, 1.019-2.396) within obese group each after adjusting age, family history of diabetes, smoking, exercise, serum fasting glucose, aspartate aminotransferase, and gamma-glutamyltransferase with nondrinkers as a reference group. Not only high alcohol consumption but also moderate drinking was related with higher incidence of impaired fasting glucose or diabetes in obese Korean men.

Smoking as an independent risk factor for hypertension: a 14-year longitudinal study in male Japanese workers

There have been few large longitudinal studies on the relationship between smoking and blood pressure and those results have been inconsistent. The aim of this study was to clarify the influence of smoking on the onset of hypertension. A 14-year longitudinal study was conducted in Japanese male workers at a steel company between 1991 and 2005. We adopted three different endpoints of observation, hypertension [systolic blood pressure (SBP) >or= 140 mmHg and diastolic blood pressure (DBP) >or= 90 mmHg], systolic hypertension (SBP >or= 140 mmHg), and diastolic hypertension (DBP >or= 90 mmHg), with initiation of antihypertensive medication. The cohort for each endpoint (hypertension: n = 5,512, systolic hypertension: n = 5,765, diastolic hypertension: n = 6,063) was selected, excluding the subjects whose blood pressure was higher than above criteria at their first health examination from all 8,251 workers. The strict criteria for hypertension resulted in exclusion of more subjects, yielding smaller cohort for hypertension. The association between smoking and each endpoint was investigated adjusting for age, body mass index, drinking, habitual exercise, job schedule type, hemoglobin A1c, total cholesterol, creatinine, aspartic aminotransferase, gamma-glutamyl transpeptidase, and uric acid by pooled logistic regression analyses. The significant odds ratios (and 95% confidence intervals) of smoking were 1.13 (1.03 to 1.23) for hypertension and 1.15 (1.05 to 1.25) for systolic hypertension. This study revealed that smoking is independently related to the onset of hypertension and systolic hypertension in Japanese male workers. These results provide important information necessary to define the effect of smoking on blood pressure.

Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus

Recent studies suggest that diabetes mellitus increases the risk of developing hepatocellular carcinoma (HCC). The aim of this study is to quantify the risk of HCC among patients with both diabetes mellitus and hepatitis C in a large cohort of patients with chronic hepatitis C and advanced fibrosis. We included 541 patients of whom 85 (16%) had diabetes mellitus. The median age at inclusion was 50 years. The prevalence of diabetes mellitus was 10.5% for patients with Ishak fibrosis score 4, 12.5% for Ishak score 5, and 19.1% for Ishak score 6. Multiple logistic regression analysis showed an increased risk of diabetes mellitus for patients with an elevated body mass index (BMI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00-1.11; P = 0.060) and a decreased risk of diabetes mellitus for patients with higher serum albumin levels (OR, 0.81; 95% CI, 0.63-1.04; P = 0.095). During a median follow-up of 4.0 years (interquartile range, 2.0-6.7), 11 patients (13%) with diabetes mellitus versus 27 patients (5.9%) without diabetes mellitus developed HCC, the 5-year occurrence of HCC being 11.4% (95% CI, 3.0-19.8) and 5.0% (95% CI, 2.2-7.8), respectively (P = 0.013). Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes mellitus was independently associated with the development of HCC (hazard ratio, 3.28; 95% CI, 1.35-7.97; P = 0.009).

CONCLUSION

For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC.

The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry

BACKGROUND

Alcohol consumption is a common behavior. Little is known about the relationship between alcohol consumption and glycemic control among people with diabetes.

OBJECTIVE

To evaluate the association between alcohol consumption and glycemic control.

DESIGN

Survey follow-up study, 1994-1997, among Kaiser Permanente Northern California members.

PATIENTS

38,564 adult diabetes patients.

MEASUREMENTS

Self-reported alcohol consumption, and hemoglobin A1C (A1C), assessed within 1 year of survey date. Linear regression of A1C by alcohol consumption was performed, adjusted for sociodemographic variables, clinical variables, and diabetes disease severity. Least squares means estimates were derived.

RESULTS

In multivariate-adjusted models, A1C values were 8.88 (lifetime abstainers), 8.79 (former drinkers), 8.90 (<0.1 drink/day), 8.71 (0.1-0.9 drink/day), 8.51 (1-1.9 drinks/day), 8.39 (2-2.9 drinks/day), and 8.47 (>/=3 drinks/day). Alcohol consumption was linearly (p < 0.001) and inversely (p = 0.001) associated with A1C among diabetes patients.

CONCLUSIONS

Alcohol consumption is inversely associated with glycemic control among diabetes patients. This supports current clinical guidelines for moderate levels of alcohol consumption among diabetes patients. As glycemic control affects incidence of complications of diabetes, the lower A1C levels associated with moderate alcohol consumption may translate into lower risk for complications.

Japan: alcohol today

AIMS

The purpose of this paper is to outline alcohol availability, alcohol consumption and related harm, alcohol control policy and prevention programmes in Japan, few of which have been discussed in either the Japanese or English literature.

METHODS

Data were collected primarily from the following two sources: statistics and survey results issued by the national government, including surveys funded by the government; and papers published since 2000, identified by searching the MEDLINE and Igaku-Chuo-Zasshi databases. These data were assessed regarding their quality and summarized. Some data presented here were produced specifically for this review.

RESULTS

Although per capita alcohol consumption has tended to decline for more than 10 years, it has remained at a high level. Diversification of the drinking population has progressed rapidly, specifically in women, among whom alcohol consumption has increased sharply. Cross-sectional data suggest that alcohol consumption is associated with serious health and social consequences. Existing longitudinal data suggest that alcohol-related problems, especially health problems, have increased steadily over the past several decades, with few exceptions, including alcohol-related fatal road traffic accidents. Alcohol policy and prevention programmes have not developed to a level that can control these problems adequately. Specifically, the high availability of alcoholic beverages, including the lack of restrictions on sales and advertising and decreasing prices, are noted.

CONCLUSIONS

This review provides basic information regarding alcohol availability and alcohol consumption and related harm that may facilitate the improvement of existing alcohol control measures in Japan and encourage the development of new alcohol control measures. This research revealed the scarcity of longitudinal data regarding alcohol consumption and its consequences, and the lack of several important variables, such as disability adjusted life years, for improving our understanding of the comprehensive status of alcohol in Japan.

Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study

OBJECTIVE

The objective was to examine the role of total and beverage-specific alcohol consumption on the incidence of type 2 diabetes mellitus (DM) among elderly men and women.

RESEARCH METHODS AND PROCEDURES

We studied prospectively 4655 participants of the Cardiovascular Health Study who were free of DM at baseline. Alcohol consumption was obtained at baseline and during follow-up examinations. DM was defined using fasting glucose and/or use of hypoglycemic medications. We used Cox proportional hazard models to estimate adjusted relative risks of diabetes across alcohol categories.

RESULTS

During a mean follow-up of 6.3 years, 234 incident cases of DM were documented. Compared with never drinkers, hazard ratios [95% confidence interval (CI)] for DM were 0.7 (0.3 to 1.4), 0.5 (0.3 to 0.9), 0.6 (0.4 to 1.1), and 0.8 (0.4 to 1.3) for former drinkers and current drinkers of <1, 1 to 6, and 7+ drinks per week, respectively, for men after adjustment for age, BMI, education, and smoking. Corresponding values for women were 1.2 (0.6 to 2.3), 0.7 (0.4 to 1.1), 0.6 (0.3 to 1.1), and 0.4 (0.2 to 1.0), respectively. A reduced risk of DM was observed with all types of beverage consumed. Similar findings were observed when we repeated the above analyses using simple or weighted cumulative alcohol update and covariates over time.

DISCUSSION

Light to moderate alcohol consumption was associated with a lower incidence of DM among elderly people, irrespective of the type of beverage consumed.

Diabetes and cancer risk for all and specific sites among Japanese men and women

Associations between diabetes and multisite cancer risk were examined in a case-control study of 11,672 incident cancer cases (5341 men and 6331 women) and 47,768 cancer-free controls (14,199 men and 33,569 women). Using an unconditional logistic regression model and controlling for potential confounding factors, a past/present history of diabetes was associated with cancer risks for all sites in both men and women (odds ratios=1.44 and 1.39, 95% confidence intervals=1.28-1.62 and 1.19-1.62), respectively. Significantly increased risk was found for cancers of the pharynx, esophagus, colorectum, liver, pancreas, larynx and lung among men, and of the stomach, liver, lung and cervix uteri among women. Among participants with a family history of diabetes, a past/present history of diabetes was also associated with cancer risks of all sites among men and women (odds ratios=1.41 and 1.96, 95% confidence intervals=1.04-1.93 and 1.44-2.68, respectively). The associations were highest for pancreatic cancer among men and the stomach, colorectum and corpus uteri among women. Our findings support the conclusion that diabetes is associated with the etiology of cancer development, and we suggest that a family history of diabetes should be considered as a risk factor for several cancer sites among participants with a past/present history of diabetes.

Gene-environmental interactions between alcohol-drinking behavior and ALDH2 and CYP2E1 polymorphisms and their impact on micronuclei frequency in human lymphocytes

Ethanol is converted to acetaldehyde by alcohol dehydrogenase (ADH), cytochrome p4502E1 (CYP2E1) and catalase. This metabolite is then detoxified by aldehyde dehydrogenase 2 (ALDH2), a key enzyme in the elimination of acetaldehyde, via further oxidation to acetic acid. The toxic effects of acetaldehyde are well documented and may be partially mediated by genotoxic damage. In the present study, we investigated the effects of alcohol-drinking behavior and genetic polymorphisms in two different genes (ALDH2 and CYP2E1) on the micronuclei (MN) frequency in 248 healthy Japanese men. Genotyping was performed by PCR-RFLP analysis. The ALDH2 variant (deficient type) was significantly associated with an increased MN frequency in subjects drinking more than three times/wk, while habitual drinkers with wild-type CYP2E1 also had a significantly increased MN frequency. Furthermore, when the subjects were divided into eight groups according to their drinking frequency and genotypes of ALDH2 and CYP2E1, we found that habitual drinkers with homozygous CYP2E1*1/*1 and heterozygous ALDH2*1/*2 or homozygous ALDH2*2/*2 showed the highest mean MN frequency. In the present study, we found clear associations among ALDH2 and CYP2E1 gene polymorphisms, alcohol-drinking behavior and genotoxic effects in a healthy Japanese population. Therefore, analysis of the polymorphisms of alcohol-metabolizing enzymes may lead to elucidation of the mechanism(s) for individual susceptibilities to the toxicity of ethanol metabolites.

Longevity-associated mitochondrial DNA 5178 C/A polymorphism is associated with fasting plasma glucose levels and glucose tolerance in Japanese men

Mitochondrial DNA 5178 cytosine/adenine (Mt5178 C/A) polymorphism is reportedly associated with longevity in the Japanese population, and the Mt5178A genotype may resist the onset of type 2 diabetes. To investigate whether Mt5178 C/A polymorphism is associated with glucose tolerance, we conducted a cross-sectional study using the 75-g oral glucose tolerance test (OGTT) in which non-diabetic Japanese male subjects were classified into three subgroups by body mass index (BMI): BMI<22 (n=91); 22< or =BMI<25 (n=138); and BMI> or =25 (n=67). The frequency of Mt5178A was significantly lower among 'BMI<22' subjects exhibiting impaired fasting glucose and impaired glucose tolerance than among those with normal glucose tolerance. In the 'BMI<22' group, fasting plasma glucose (FPG) levels and plasma glucose levels at 60 and 120 min after glucose load (OGTT-1h and OGTT-2h, respectively) were significantly lower in the Mt5178A genotype than in the Mt5178C genotype. After adjusting for age, BMI, habitual smoking, habitual drinking and family history of diabetes, FPG levels and OGTT-2h levels were still significantly lower in the Mt5178A genotype than in the Mt5178C genotype. However, after adjusting for covariates, in both the '22< or =BMI<25' and 'BMI> or =25' groups, FPG levels were significantly higher in the Mt5178A genotype than in the Mt5178C genotype. Differences in the effect of alcohol consumption on FPG levels and glucose tolerance between the Mt5178 C/A genotypes were observed. The present results suggest that Mt5178 C/A polymorphism may be associated with FPG levels and glucose tolerance in middle-aged Japanese men.

Alcohol for the prevention of type 2 diabetes mellitus?

While diabetes mellitus is recognized clinically as a complication of alcohol dependence, in the last 15 years several large prospective studies have demonstrated a significant reduction in risk of incident type 2 diabetes in moderate drinkers. In this article, we review prospective studies on the association between alcohol consumption and incidence of diabetes. Few prospective studies have demonstrated an unequivocal positive association between alcohol use and incidence of diabetes. A number of large prospective studies have now demonstrated an inverse association: typically a 40% risk reduction after controlling for other major risk factors. Studies based on cohorts of health professionals have not demonstrated an increased risk of diabetes with heavier consumption, but these cohorts contain few heavy drinkers. Some cohorts drawn from the general population have shown a J- or U-shaped association between level of alcohol consumption and incidence of diabetes. Frequent moderate drinking has been reported to be associated with lower risk than infrequent drinking. There have been contradictory reports on the importance of the type of alcoholic beverage and whether the effect of alcohol differs according to the bodyweight of the drinker. We conclude that like many other chronic diseases, there is a delicate balance between the harmful and beneficial effects of alcohol on the incidence of diabetes. In moderate amounts, drinking is associated with a reduced risk of diabetes, whereas in higher amounts with an increased risk.

Alcohol consumption and type 2 diabetes Meta-analysis of epidemiological studies indicates a U-shaped relationship

To clarify the relationship between alcohol consumption and type 2 diabetes we conducted a meta-analysis of published epidemiological studies. Data from 13 cohorts were included in the analysis. The results of these studies are consistent with regard to moderate alcohol consumption, indicating a protective effect in the order of 30% (relative risk [RR]meta = 0.72, 95% CI = 0.67-0.77). The reduced risk is seen in men as well as in women, although few studies investigated women. No protective effect of high alcohol consumption was seen and one cannot rule out that large intakes of alcohol may increase the risk of type 2 diabetes. Results from published studies suggest a U-shaped relationship between alcohol and type 2 diabetes, but this is based on rather few studies with heterogeneous design and definitions. It seems important to further investigate if, and to what extent, high alcohol consumption increases the risk of type 2 diabetes. Aspects of moderate alcohol consumption also need further investigation; these include type of drink, frequency of drinking, sex and ethnic differences.

Primary prevention of diabetes: what can be done and how much can be prevented?

Although it is widely believed that type 2 diabetes mellitus is the result of a complex interplay between genetic and environmental factors, compelling evidence from epidemiologic studies indicates that the current worldwide diabetes epidemic is largely due to changes in diet and lifestyle. Prospective cohort studies and randomized clinical trials have demonstrated that type 2 diabetes can be prevented largely through moderate diet and lifestyle modifications. Excess adiposity is the most important risk factor for diabetes, and thus, maintaining a healthy body weight and avoiding weight gain during adulthood is the cornerstone of diabetes prevention. Increasing physical activity and reducing sedentary behaviors such as prolonged TV watching are important both for maintaining body weight and improving insulin sensitivity. There is increasing evidence that the quality of fat and carbohydrate plays a more important role than does the quantity, and thus, public health strategies should emphasize replacing saturated and trans fats with unsaturated fats and replacing refined grain products with whole grains. Recent studies have also suggested a potential role for coffee, dairy, nuts, magnesium, and calcium in preventing diabetes. Overall, a healthy diet, together with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption, and avoidance of sedentary behaviors and smoking, could nearly eliminate type 2 diabetes. However, there is still a wide gap between what we know and what we practice in the field of public health; how to narrow that gap remains a major public health challenge.

Alcohol consumption and other risk factors for self-reported diabetes among middle-aged Japanese: a population-based prospective study in the JPHC study cohort I

AIMS

Few prospective studies have examined the relationship between lifestyle characteristics and the incidence of diabetes mellitus in an Asian general population. This study was undertaken to evaluate the risk factors for Type 2 diabetes in a population-based prospective study of middle-aged Japanese.

METHODS

We investigated 12,913 men and 15,980 women, aged 40-59 years at baseline (year 0), who participated in the Japan Public Health Center-based prospective study on cancer and cardiovascular diseases (JPHC Study) Cohort I. The participants were followed for up to 10 years. Incident cases of diabetes were identified by self-reporting of a physician's diagnosis on two questionnaires sent to each participant, one at year 5 and the second at year 10.

RESULTS

During the 10-year follow-up, 703 men and 482 women reported newly diagnosed diabetes. Age, body mass index (BMI), family history of diabetes and cigarette smoking were independent risk factors in both genders by multivariate analysis. Among men with a BMI < or = 22 kg/m2, a significant positive association was observed between the diabetes incidence and moderate (23.0 < 46.0 g/day) to high (> 46.0 g/day) alcohol consumption, odds ratio 1.91 (95% CI, 1.05-3.46) and 2.89 (1.63-5.11), respectively. Among men with a BMI > 22 kg/m2, a small non-significant increase in odds ratio was observed with alcohol consumption.

CONCLUSIONS

Established risk factors for diabetes in western populations were also identified as predictors of the disease among Japanese. Moderate to high alcohol consumption was positively associated with the incidence of diabetes in Japanese lean (BMI < or = 22 kg/m2) men.

Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies

OBJECTIVE

This meta-analysis was undertaken to obtain insight regarding the shape and strength of the relationship between alcohol consumption and the risk of type 2 diabetes, the effects of adjustment for confounders, and the effect of modification by type 2 diabetes definition, sex, and BMI.

RESEARCH DESIGN AND METHODS

The 15 original prospective cohort studies that were included comprise 11,959 incident cases of type 2 diabetes in 369,862 individuals who, on average, were followed for 12 years.

RESULTS

After pooling the data, a U-shaped relationship was found. Compared with nonconsumers, the relative risk (RR) for type 2 diabetes in those who consumed </=6 g/day alcohol was 0.87 (95% CI 0.79-0.95). For the moderate consumption ranges of 6-12, 12-24, and 24-48 g/day, RRs of 0.70 (0.61-0.79), 0.69 (0.58-0.81), and 0.72 (0.62-0.84) were found, respectively. The risk of type 2 diabetes in heavy drinkers (>/=48 g/day) was equal to that in nonconsumers (1.04 [0.84-1.29]). In general, nonsignificant trends for larger RR reduction associated with moderate alcohol consumption were observed for women compared with men, for crude compared with multivariate-adjusted analyses, and for studies that used self-reports instead of testing for type 2 diabetes definition. No differences in RR reductions were found between individuals with low or high BMI.

CONCLUSIONS

The present evidence from observational studies suggests an approximately 30% reduced risk of type 2 diabetes in moderate alcohol consumers, whereas no risk reduction is observed in consumers of >/=48 g/day.

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Specific alcoholic beverage and blood pressure in a middle-aged Japanese population: the High-risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) Study

The purpose of this study was to clarify the effects of popular Japanese alcoholic beverages on blood pressure. We performed a cross-sectional study on 4335 Japanese male workers using baseline data from an intervention study. We defined six groups according to the type of alcoholic beverage that provided two-thirds of the subject's total alcohol consumption: beer, sake (rice wine), shochu (traditional Japanese spirits), whiskey, wine and others. The partial regression coefficients of daily alcohol intake (1 drink=11.5 g of ethanol) to systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 0.87(P<0.001, standard error (s.e.)=0.09) and 0.77(P<0.001, s.e.=0.06), respectively. A comparison among the types of alcoholic beverages mainly consumed revealed significant differences in SBP and DBP. Both SBP and DBP were highest in the shochu group. However, an analysis of covariance adjusting for total alcohol consumption resulted in the disappearance of these differences. Although after adjustment for total alcohol consumption, the shochu group exhibited a significant positive association with 'high-normal blood pressure or greater' (odds ratio 1.43, 95% confidence interval 1.06-1.95) compared with the beer group, this significant relation disappeared after adjusting for the body mass index (BMI), urinary sodium and potassium excretion. The pressor effect, per se, of popular Japanese alcoholic beverages on blood pressure may not be different among the types of alcoholic beverages after adjusting for other lifestyle factors.

Effects of ALDH2 gene polymorphisms and alcohol-drinking behavior on micronuclei frequency in non-smokers

Alcohol abuse is a serious health problem, leading to life-threatening damage to most of the important organ systems. Genotoxic damage is used as an early effect indicator in the surveillance of human exposure to genotoxic substances. Intra- and inter-individual variations of baseline frequencies of micronuclei (MN) in peripheral blood lymphocytes of human populations have been reported previously. Polymorphisms in a few metabolic enzyme genes seem to account for a proportion of this variability, but the impact of specific genetic variants on MN frequencies has not yet been clarified. In 42 healthy Japanese non-smoking men, we investigated the relationship between the MN frequency levels and genetic polymorphisms in three different genes: aldehyde dehydrogenase 2 (ALDH2), X-ray repair cross-complementing group 1 (XRCC1) and excision repair cross-complementing group 2 (ERCC2). Genotyping was performed by PCR-RFLP analysis. The ALDH2 variant (deficient-type) was significantly associated with increased MN frequency levels in subjects with drinking more than three times per week, whereas the XRCC1 and ERCC2 variants seemed to be unrelated to the MN frequency. The ALDH2-deficient habitual drinkers had an average MN frequency of 5.88+/-0.58 (+/- S.E.) compared with 3.20 +/- 0.80 in the ALDH2-proficient habitual drinkers (P<0.05). The ALDH2-proficient non-habitual drinkers had the lowest MN frequency (1.56 +/- 0.41). Furthermore, subjects with highest levels of mean MN frequency, who consumed more than 100g of alcohol per week and more than three times per week, had A2 genotype of ALDH2. A significant odds ratio (12.25, P<0.05) for the MN frequency levels above the 50th percentile value was observed for the ALDH2-deficient individuals versus the ALDH2-proficient individuals after adjustment for several confounders. These results strongly suggest that human early genotoxic effect studies based on the cytogenetic markers of MN should take into account both the individual ALDH2 polymorphism and the potential confounding effect of the drinking behavior.