Specific types of alcoholic beverage consumption and risk of type 2 diabetes: A systematic review and meta-analysis

Wine Consumption and Lung Cancer Risk: A Systematic Review and Meta-Analysis

Background/Objectives: Lung cancer is one of the leading causes of cancer-related mortality, with tobacco smoking being the primary risk factor. However, a significant percentage of lung cancer patients are non-smokers, suggesting the involvement of other risk factors, including alcohol consumption. The IARC classifies ethanol as a Group 1 carcinogen, but unlike other alcoholic beverages, wine contains polyphenols with potential health benefits. Some meta-analyses even suggest a protective effect, which led us to conduct our own meta-analysis to further investigate this possible correlation. Methods: We conducted a systematic review and stratified the risk across population subgroups based on smoking status and gender. We then performed a categorical "highest vs. lowest" meta-analysis, comparing heavy consumers with very occasional drinkers, using a random-effects model. Only studies examining the risk of developing lung cancer in wine drinkers were included, excluding those with different outcomes, non-primary, ineligible populations, or involving pregnant women. The literature search was conducted in three databases: PubMed, Scopus, and Web of Science. The risk of bias was assessed with the Newcastle-Ottawa quality rating scale for both case-control and cohort studies (NOS), while statistical analyses were performed using the ProMeta 3.0 software. Results: The overall analysis showed a non-statistically significant 11% reduction in lung cancer risk (OR = 0.89; 95% CI: 0.77-1.03). The analysis among smokers revealed a significant 22% reduction in lung cancer risk associated with wine consumption (OR = 0.78; 95% CI: 0.62-0.97). However, this effect was lost when the analysis was conducted separately based on the study design. Conclusions: No correlation emerged between wine consumption and lung cancer incidence, either in a protective sense or in terms of increased risk. However, further studies are needed to investigate this correlation more accurately, particularly among non-smokers.

Effect of long-term moderate red wine consumption in CD1 female mice

In the early 80s, the so-called "French paradox" was proposed, that is, a correlation between wine consumption, a diet rich in fats, and low mortality from coronary disease. Conversely, it is well established that excessive alcohol consumption increases the risk of cirrhosis and cancer, but few studies have investigated the effects of moderate alcohol consumption. However, all these conclusions were derived from epidemiological population studies that may be subject to distortions due to multiple factors. Here, the effect of moderate consumption of red wine on health throughout life was examined in a murine model. Different variables were evaluated in groups of female animals that were fed a standard or a fat diet throughout their adult life and given water, or wine or alcohol diluted in water in proportions similar to what is considered moderate consumption in humans. Our results showed few differences in most of the analyzed variables (body weight, liver profile and survival rate) between the different female mouse groups. The most remarkable findings were observed in the fat-diet groups that showed more frequent and severe liver lesions and a lower average ovarian weight. Moreover, moderate and prolonged ethanol consumption significantly affected telomere length only when the diet was high in fat, whereas wine consumption showed no difference compared to water, pointing to a possible predominant role of the compounds, particularly polyphenols present in wine. On the other hand, wine-drinking mice fed a fat diet had more oocytes than those in the ethanol-drinking group. Overall, our data suggest that long-term moderate red wine consumption does not substantially influence the health of female mice.

[Alcohol consumption and incidence of abdominal obesity in participants of the ELSA-Brasil cohort after nine years of follow-up]

The scope of this article is to analyze the correlation between alcohol consumption and abdominal obesity in participants of the ELSA-Brasil cohort after a follow-up period of nine years. A longitudinal analysis was performed with baseline and follow-up data from ELSA-Brasil. At baseline, 15,105 civil servants were enrolled. After exclusions, the final sample consisted of 3,591 participants. Anthropometric and lifestyle data were collected, and abdominal obesity was diagnosed in accordance with the World Health Organization parameters. The t-test and chi-square test were applied, and crude and adjusted Poisson models were assessed. The results revealed that more than 70% of the sample reported alcohol use. In nine years, an increase in abdominal obesity and alcohol consumption was observed among men and women. A total of 1,588 new cases of abdominal obesity were identified. Higher alcohol consumption increased the risk of abdominal obesity in men (1.15, 95%CI 1.01-1.31, p < 0.001). The conclusion drawn was that after a follow-up period of 9 years, the highest risk of abdominal obesity was observed only in men who increased their alcohol consumption.

Alcohol - a scoping review for Nordic Nutrition Recommendations 2023

The objective of this scoping review is to evaluate the updated evidence on the consumption of alcohol and health outcomes regarded as relevant for the Nordic and Baltic countries, including cardiovascular disease, cancer, and all-cause mortality. It is based on the previous Nordic Nutrition Recommendations of 2012 and relevant papers published until 31 May 2021. Current evidence from mainly observational epidemiological studies suggests that regular, moderate alcohol consumption may confer protective effects against myocardial infarction (MI) and type 2 diabetes. Mendelian randomization analyses do not fully support these findings, possibly because these analyses may fail to identify low alcohol intake. For several cancers, it is not possible to set any safe limit. All-cause mortality is not increased with light to moderate alcohol intake in middle-aged and older adults who do not engage in binge drinking. Total abstinence is associated with the lowest risk of mortality in young adults. Observational studies on alcohol consumption are hampered by a number of inherent methodological issues such as ascertainment of alcohol intake, selection of appropriate exposure groups, and insufficient control of confounding variables, colliders, and mediators. It should also be emphasized that there is a socio-economic contribution to the alcohol-health axis with a stronger detrimental effect of alcohol in the lower social classes. The above issues contribute to the complexity of unravelling the causal web between alcohol, mediators, confounders, and health outcome.

Hypertension in Pregnancy Among Immigrant and Swedish Women: A Cohort Study of All Pregnant Women in Sweden

BACKGROUND

Little is known about risks of hypertensive disorders of pregnancy in both first- and second-generation immigrant women in Europe and other Western countries; such knowledge may help elucidate the influence of genetic versus social factors on such risks. We aimed to study both first- and second-generation immigrant women for the presence of all types of hypertension (preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia) during pregnancy.

METHODS AND RESULTS

A cohort study was conducted using data derived from the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% CIs while adjusting for sociodemographic factors and comorbidities. The first-generation study included a total of 1 084 212 deliveries and 68 311 hypertension cases, and the second-generation study included 989 986 deliveries and 67 505 hypertension cases. The fully adjusted HR (with 99% CI) for hypertension in pregnancy among first-generation immigrant women was 0.69 (0.66-0.72), and among second-generation immigrant women, it was 0.88 (0.86-0.91), compared with Swedish-born women with 2 Swedish-born parents. Women born in Finland or with parent(s) from Finland had higher risks, with fully adjusted HRs (99% CIs) of 1.30 (1.18-1.43) and 1.12 (1.07-1.17), respectively.

CONCLUSIONS

Both first- and second-generation immigrant women had overall lower risks of hypertension in pregnancy compared with other Swedish women. However, the risk reduction was less pronounced in second-generation compared with first-generation immigrant women, suggesting that environmental factors in Sweden may have an important influence on risk of hypertension during pregnancy.

Nutritional Strategies for the Management of Type 2 Diabetes Mellitus: A Narrative Review

BACKGROUND

Thinking about greater adherence to dietary planning, it is extremely important to be aware of all nutritional strategies and dietary prescriptions available in the literature, and of which of them is the most efficient for the management of T2DM.

METHODS

A search was carried out in 2023 for randomized clinical trials, systematic reviews, meta-analyses, and guidelines in the following databases: Pubmed, Scielo, Web of Science, CrossRef and Google Scholar. In total, 202 articles were collected and analyzed. The period of publications was 1983-2023.

RESULTS

There is still no consensus on what the best nutritional strategy or ideal dietary prescription is, and individuality is necessary. In any case, these references suggest that Mediterranean Diet may of greater interest for the management of T2DM, with the following recommended dietary prescription: 40-50% carbohydrates; 15-25% proteins; 25-35% fats (<7% saturated, 10% polyunsaturated, and 10% monounsaturated); at least 14 g of fiber for every 1000 kcal consumed; and <2300 mg sodium.

CONCLUSIONS

Individuality is the gold standard for dietary prescriptions, however, the Mediterranean diet with low levels of carbohydrates and fats seems to be the most promising strategy for the management of T2DM.

Association between a mediterranean lifestyle and Type 2 diabetes incidence: a prospective UK biobank study

BACKGROUND

There is mounting evidence that the Mediterranean diet prevents type 2 diabetes, but little is known about the role of Mediterranean lifestyles other than diet and among non-Mediterranean populations. This work aimed to examine the association between a comprehensive Mediterranean-type lifestyle and type 2 diabetes incidence in a British adult population.

METHODS

We used data from 112,493 individuals free of cardiovascular disease and type 2 diabetes mellitus, aged 40-69 years, from the UK Biobank cohort, who were followed from 2009 to 2010 to 2021. The Mediterranean lifestyle was assessed through the 25-item MEDLIFE index, which comprises three blocks: (a) "Mediterranean food consumption", (b) "Mediterranean dietary habits", (c) "Physical activity, rest, social habits, and conviviality". Diabetes incidence was obtained from clinical records. Cox proportional-hazards regression models were used to analyze associations and adjusted for the main potential confounders.

RESULTS

After a median follow-up of 9.4 years, 2,724 cases of type 2 diabetes were ascertained. Compared to the first quartile of MEDLIFE adherence, the hazard ratios (95% confidence interval) for increasing quartiles of adherence were 0.90 (0.82-0.99), 0.80 (0.72-0.89) and 0.70 (0.62-0.79) (p-trend < 0.001). All three blocks of MEDLIFE were independently associated with lower risk of diabetes.

CONCLUSIONS

Higher adherence to the MEDLIFE index was associated with lower risk of type 2 diabetes in the UK Biobank. A Mediterranean-type lifestyle, culturally adapted to non-Mediterranean populations, could help prevent diabetes.

Alcohol abuse in older adults with type 2 diabetes mellitus in primary health care: a cross-sectional study

This cross-sectional study aimed to analyze alcohol abuse in older adults with type 2 diabetes mellitus in primary health care. Household data were collected from March to October 2018 in the Family Health Strategy in Ribeirão Preto, São Paulo through face-to-face interviews with a form application. The pattern of alcohol consumption was estimated with the Alcohol Use Disorders Identification Test-C. A total of 338 older adults with type 2 diabetes mellitus participated, and 19.2% (95%CI 15.0-23.4) engaged in alcohol abuse. Among them, we observed a higher frequency of males (63.1%), aged 60 to 64 years (35.4%), economic class C (49.2%), 1-4 schooling years (53.8%), and multimorbidity (92.3%). There was a negative association between alcohol abuse and drug therapy adherence (PR = 0.55; 95%CI 0.36-0.86). The frequency of alcohol abuse and non-adherence to drug treatment among those with a high consumption pattern is troubling since it can lead to diabetes complications. Therefore, we underscore the importance of multidimensional elderly care and health education in primary care.

Alcohol Consumption and a Decline in Glomerular Filtration Rate: The Japan Specific Health Checkups Study

Previous studies have reported conflicting results on the clinical impact of alcohol consumption on the glomerular filtration rate (GFR). This retrospective cohort study aimed to assess the dose-dependent association between alcohol consumption and the slope of the estimated GFR (eGFR) in 304,929 participants aged 40-74 years who underwent annual health checkups in Japan between April 2008 and March 2011. The association between the baseline alcohol consumption and eGFR slope during the median observational period of 1.9 years was assessed using linear mixed-effects models with the random intercept and random slope of time adjusting for clinically relevant factors. In men, rare drinkers and daily drinkers with alcohol consumptions of ≥60 g/day had a significantly larger decline in eGFR than occasional drinkers (difference in multivariable-adjusted eGFR slope with 95% confidence interval (mL/min/1.73 m²/year) of rare, occasional, and daily drinkers with ≤19, 20-39, 40-59, and ≥60 g/day: -0.33 [-0.57, -0.09], 0.00 [reference], -0.06 [-0.39, 0.26], -0.16 [-0.43, 0.12], -0.08 [-0.47, 0.30], and -0.79 [-1.40, -0.17], respectively). In women, only rare drinkers were associated with lower eGFR slopes than occasional drinkers. In conclusion, alcohol consumption was associated with the eGFR slope in an inverse U-shaped fashion in men but not in women.

Association of alcohol types, coffee and tea intake with mortality: prospective cohort study of UK Biobank participants

The present study examines how alcohol intake from wine and non-wine alcoholic beverages (non-wine) in g/d, as well as cups of coffee and tea included as continuous covariates and mutually adjusted are associated with all-cause, cancer, non-cancer and CVD mortality. Consumption was assessed in 354 386 participants of the UK Biobank cohort who drank alcohol at least occasionally and survived at least 2 years after baseline with 20 201 deaths occurring over 4·2 million person-years. Hazard ratios (HR) for mortality were assessed with Cox proportional hazard regression models and beverage intake fitted as penalised cubic splines. A significant U-shaped association was detected between wine consumption and all-cause, non-cancer and CVD mortality. Wine consumption with lowest risk of death (nadir) ranged from 19 to 23 g alcohol/d in all participants and both sexes separately. In contrast, non-wine intake was significantly and positively associated in a dose-dependent manner with all mortality types studied except for CVD in females and with the nadir between 0 and 12 g alcohol/d. In all participants, the nadir for all-cause mortality was 2 cups coffee/d with non-coffee drinkers showing a slightly increased risk of death. Tea consumption was significantly and negatively associated with all mortality types in both sexes. Taken together, light to moderate consumption of wine but not non-wine is associated with decreased all-cause and non-cancer mortality. A minor negative association of coffee consumption with mortality cannot be excluded whereas tea intake is associated with a consistently decreased risk of all mortality types studied.

Alcohol consumption and epigenetic age acceleration in young adults

Alcohol is a widely consumed substance in the United States, however its effect on aging remains understudied. In this study of young adults, we examined whether cumulative alcohol consumption, i.e., alcohol years of beer, liquor, wine, and total alcohol, and recent binge drinking, were associated with four measures of age-related epigenetic changes via blood DNA methylation. A random subset of study participants in the Coronary Artery Risk Development in Young Adults Study underwent DNA methylation profiling using the Illumina MethylationEPIC Beadchip. Participants with alcohol consumption and methylation data at examination years 15 (n = 1,030) and 20 (n = 945) were included. Liquor and total alcohol consumption were associated with a 0.31-year (P = 0.002) and a 0.12-year (P = 0.013) greater GrimAge acceleration (GAA) per additional five alcohol years, while beer and wine consumption observed marginal (P = 0.075) and no associations (P = 0.359) with GAA, respectively. Any recent binge drinking and the number of days of binge drinking were associated with a 1.38-year (P < 0.001) and a 0.15-year (P < 0.001) higher GAA, respectively. We observed statistical interactions between cumulative beer (P < 0.001) and total alcohol (P = 0.004) consumption with chronological age, with younger participants exhibiting a higher average in GAA compared to older participants. No associations were observed with the other measures of epigenetic aging. These results suggest cumulative liquor and total alcohol consumption and recent binge drinking may alter age-related epigenetic changes as captured by GAA. With the increasing aging population and widespread consumption of alcohol, these findings may have potential implications for lifestyle modification to promote healthy aging.

A causal relationship between alcohol intake and type 2 diabetes mellitus: A two-sample Mendelian randomization study

BACKGROUND AND AIMS

We investigated whether alcohol intake has a causal relationship with type 2 diabetes mellitus (T2DM) risk in adults of the Korean Genomic Epidemiology Study using two-sample Mendelian randomization (MR) analysis.

METHODS AND RESULTS

Daily alcohol intake was calculated based on the type, average amount, and frequency of alcohol consumption for six months before the interview. The participants were divided into low- and high-alcohol intake of 20 g/day. After adjusting for the covariates related to T2DM, the independent genetic variants (instrumental variables) related to alcohol intake were explored by GWAS analysis in a city hospital-based cohort (n = 58,701). SNPs with a significant level of p-value <5 × 10^-8 and linkage disequilibrium of r² < 0.001 were retrieved. MR methods were used to analyze the causality between alcohol intake and the T2DM risk, and the heterogeneity and leave-one-out sensitivity analyses were conducted in Ansan/Ansung plus rural cohorts (n = 13,598). High alcohol intake increased T2DM risk when the inverse-variance weighted (P = 0.012) and weighted median (P = 0.034) methods were used, but not when the MR-Egger method was used. No significant heterogeneity and horizontal pleiotropy between alcohol intake and T2DM were detected. A single genetic variant did not affect the causal association in a leave-one-out sensitivity analysis.

CONCLUSION

This study supports that heavy alcohol intake appears to be causally associated with T2DM risk.

Adherence to the Mediterranean Diet Is Inversely Associated with the Prevalence of Metabolic Syndrome in Older People from the North of Spain

Background: The aim of this study was to relate adherence to the Mediterranean diet (MedDiet) to the prevalence of metabolic syndrome (MetS) in an elderly population from the north of Spain. Methods: We carried out an observational, descriptive, cross-sectional, and correlational study involving 556 non-institutionalised individuals aged 65 to 79 years. The MEDAS-14 questionnaire score was used to define the degree of adherence to the Mediterranean diet. The diagnosis of MetS was conducted using the International Diabetes Federation (IDF) criteria. Results: In 264 subjects with an average age of 71.9 (SD: ±4.2), 39% of whom were men, 36.4% had good adherence (score ≥ 9 in MEDAS-14), with no differences by gender or age. The prevalence of MetS was 40.2%, with 47.6% in men and 35.4% in women (p < 0.05). The prevalence of MetS was 2.4 times more frequent among individuals who consumed less than two servings (200 g) of vegetables daily compared with those who consumed two or more servings of vegetables daily (OR: 2.368, 95%CI: 1.141−4.916, p = 0.021). Low adherence to the MedDiet (MEDAS-14 score ≤ 8) was associated with an 82% higher prevalence of MetS (OR: 1.817, 95%CI: 1.072−3.081, p = 0.027). Conclusion: An inverse relationship was established between adherence to the MedDiet and the prevalence of MetS.

Alcohol consumption patterns and growth differentiation factor 15 among life-time drinkers aged 65+ years in Spain: a cross-sectional study

AIMS

To examine the association of alcohol consumption patterns with growth differentiation factor 15 (GDF-15) in older drinkers, separately among individuals with cardiovascular disease (CVD)/diabetes and those without them, as GDF-15 is a strong biomarker of chronic disease burden.

DESIGN

Cross-sectional study.

SETTING

Population-based study in Madrid (Spain).

PARTICIPANTS

A total of 2051 life-time drinkers aged 65+ years included in the Seniors-ENRICA-2 study in 2015-17. Participants' mean age was 71.4 years and 55.4% were men.

MEASUREMENTS

According to their average life-time alcohol intake, participants were classified as occasional (≤ 1.43 g/day), low-risk (men: > 1.43-20 g/day; women: > 1.43-10 g/day), moderate-risk (men: > 20-40 g/day; women: > 10-20 g/day) and high-risk drinkers (men: > 40 g/day; women: > 20 g/day; or binge drinkers). We also ascertained wine preference (> 80% of alcohol derived from wine), drinking with meals and adherence to a Mediterranean drinking pattern (MDP) defined as low-risk drinking, wine preference and one of the following: drinking only with meals; higher adherence to the Mediterranean diet; or any of these.

FINDINGS

In participants without CVD/diabetes, GDF-15 increased by 0.27% [95% confidence interval (CI) = 0.06%, 0.48%] per 1 g/day increment in alcohol among high-risk drinkers, but there was no clear evidence of association in those with lower intakes or in the overall group, or across categories of alcohol consumption status. Conversely, among those with CVD/diabetes, GDF-15 rose by 0.19% (95% CI = 0.05%, 0.33%) per 1 g/day increment in the overall group and GDF-15 was 26.89% (95% CI = 12.93%, 42.58%) higher in high-risk versus low-risk drinkers. Drinking with meals did not appear to be related to GDF-15, but among those without CVD/diabetes, wine preference and adherence to the MDP were associated with lower GDF-15, especially when combined with high adherence to the Mediterranean diet.

CONCLUSIONS

Among older life-time drinkers in Madrid, Spain, high-risk drinking was positively associated with growth differentiation factor 15 (a biomarker of chronic disease burden). There was inconclusive evidence of a beneficial association for low-risk consumption.

Alcohol and Health Outcomes: An Umbrella Review of Meta-Analyses Base on Prospective Cohort Studies

An umbrella review of meta-analyses was performed to summarize the evidence of associations between alcohol consumption and health outcomes and to assess its credibility. Meta-analyses of prospective cohort studies reporting the associations of alcohol consumption with health outcomes were identified. We recalculated the random-effects summary effect size and 95% confidence interval, heterogeneity, and small-study effect for each meta-analysis and graded the evidence. Fifty-nine publications reporting 224 meta-analyses of prospective cohort studies with 140 unique health outcomes were included, in which there were 49 beneficial associations and 25 harmful associations with nominally statistically significant summary results. But quality of evidence was rated high only for seven beneficial associations (renal cell carcinoma risk, dementia risk, colorectal cancer mortality, and all-cause mortality in patients with hypertension for low alcohol consumption; renal cell carcinoma risk, cardiovascular disease (CVD) risk in patients with hypertension and all-cause mortality in patients with hypertension for moderate consumption) and four harmful associations (cutaneous basal cell carcinoma risk for low alcohol consumption; cutaneous basal cell carcinoma risk and cutaneous squamous cell carcinoma risk for moderate alcohol consumption; hemorrhagic stroke risk for high alcohol consumption). In this umbrella review, only 11 health outcomes (5 in low alcohol consumption, 5 in moderate alcohol consumption and 1 in high alcohol consumption) with statistically significant showed high quality of epidemiologic evidence. More robust and larger prospective studies are needed to verify our results.

Association of Alcohol Types, Coffee, and Tea Intake with Risk of Dementia: Prospective Cohort Study of UK Biobank Participants

The prevalence of dementia is increasing globally and is linked to obesity and unfavorable dietary habits. The present study analyses the association of alcohol intake from wine and non-wine alcoholic beverages (non-wine) in g/d, as well as coffee and tea in cups/d, with incident dementia. Over 4.2 million person-years, 4270 dementia cases occurred in 351,436 UK Biobank participants. Hazard ratios (HRs) for incident dementia were defined with Cox proportional hazard regression models in which beverage intake was fitted as penalized cubic splines. Wine intake showed a significant U-shaped association with the lowest risk for incident dementia (nadir) ranging from 21 to 23 g alcohol/d in all participants and in males. In contrast, non-wine consumption was significantly and dose-dependently associated with incident dementia, and the nadir was found at 0 g alcohol/d. Coffee consumption was not related to dementia risk, while moderate-to-high tea intake was negatively associated with incident dementia. Taken together, the current study shows on a population level that moderate consumption of wine and moderate-to-high tea intake is associated with a decreased risk of incident dementia. In contrast, non-wine is positively related to dementia risk in a linear fashion, and no clear association is found for coffee.

Associations between Low to Moderate Consumption of Alcoholic Beverage Types and Health Outcomes: A Systematic Review

Aims

There is limited research comparing light to moderate wine, beer and spirits consumption and their impact on long-term health. This systematic review aims to investigate the studies published in the past 10 years and qualitatively assess the similarities and differences between the three main beverages, when consumed at a low to moderate level, for their associations with various health outcomes.

Methods

A systematic search was conducted for comparative studies published in English language (2010 to mid-2021) of beverage-specific low to moderate alcohol consumption associated with all-cause mortality, cancer, cardiovascular disease and diabetes mellitus type II.

Results

The search yielded a total of 24 studies (8 meta-analyses; 15 prospective studies and 1 pooled analysis). Overall, most studies showed similar associations of different alcoholic beverages with chronic conditions, including all-cause mortality, many types of cancer, cardiovascular disease and diabetes mellitus type II. Not all data are consistent. Some studies show more beneficial or detrimental effects of wine than other beverage types, whereas other studies show such effects for other beverages.

Conclusion

Moderate consumption of one specific alcoholic beverage (wine, beer or spirits) may not be consistently associated with higher or lower risks for common health outcomes as compared with moderate consumption of any of the other alcoholic beverages.

Alcohol consumption and overweight in Brazilian adults - CUME Project

This is a cross-sectional study with 2,909 participants (aged ≥18 years) from the baseline of the Cohort of Universities of Minas Gerais [CUME - Coorte de Universidades Mineiras] which verified the association between alcohol consumption and overweight. Data on sociodemographic factors, lifestyle, eating habits, anthropometric factors and clinical conditions were collected through an online questionnaire. Body mass index ≥ 25 kg/m² was considered an indicator of overweight. The daily consumption of alcohol was evaluated in grams (alcohol) and according to type in milliliters (beer, wine, hard liquor). The prevalence of alcohol consumption and overweight was 73.6% and 40.8%, respectively. There was a significant tendency of an increase in overweight with higher beer consumption (tendency p value of 0.038), which was not observed for the other types of alcohol. After sensitivity analyses, alcohol consumption was associated to overweight, with a tendency of increase in prevalence with higher daily consumption. There is a crucial need to curb the widely accepted idea that a low or moderate alcohol consumption is not harmful to one's health, and to be cautious of such a proposition. The influence of alcohol consumption regarding weight gain must be considered in public health policies and policies of alcohol consumption control.

Wine, Polyphenols, and Mediterranean Diets. What Else Is There to Say?

A considerable amount of literature has been published claiming the cardiovascular benefits of moderate (red) wine drinking, which has been considered a distinguishing trait of the Mediterranean diet. Indeed, red wine contains relevant amounts of polyphenols, for which evidence of their biological activity and positive health effects are abundant; however, it is also well-known that alcohol, even at a low level of intake, may have severe consequences for health. Among others, it is directly related to a number of non-communicable diseases, like liver cirrhosis or diverse types of cancer. The IARC classifies alcohol as a Group 1 carcinogen, causally associated with the development of cancers of the upper digestive tract and liver, and, with sufficient evidence, can be positively associated with colorectum and female breast cancer. In these circumstances, it is tricky, if not irresponsible, to spread any message on the benefits of moderate wine drinking, about which no actual consensus exists. It should be further considered that other hallmarks of the Mediterranean diet are the richness in virgin olive oil, fruits, grains, and vegetables, which are also good sources of polyphenols and other phytochemicals, and lack the risks of wine. All of these aspects are reviewed in this article.

Association of Habitual Alcohol Consumption With Long-term Risk of Type 2 Diabetes Among Women With a History of Gestational Diabetes

IMPORTANCE

Women with gestational diabetes are at high risk for type 2 diabetes. Identifying modifiable dietary and lifestyle factors, such as alcohol intake, that can be useful in delaying or preventing progression to overt type 2 diabetes is of particular interest.

OBJECTIVE

To evaluate the association between alcohol consumption and risk for type 2 diabetes among women with a history of gestational diabetes.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included women from the Nurses' Health Study II cohort who reported a history of gestational diabetes and were followed up from January 1, 1991, to December 31, 2017, as part of the Diabetes & Women's Health Study. Data analysis was performed from 2020 to 2021.

EXPOSURES

Dietary intakes, including alcohol, were assessed every 4 years using validated food-frequency questionnaires.

MAIN OUTCOMES AND MEASURES

Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for the association of alcohol intake with risk for incident type 2 diabetes after a pregnancy during which gestational diabetes was diagnosed.

RESULTS

A total of 4740 women were included in the study; the mean (SD) age at baseline was 38.2 (5.0) years, and the median follow-up time was 24 years (interquartile range, 18-28 years), resulting in 78 328 person-years of follow-up. During this period, 897 incident cases of type 2 diabetes were reported. After adjustment for major dietary and lifestyle factors, compared with women who did not consume any alcohol, only alcohol consumption of 5.0 to 14.9 g/d was associated with decreased risk for incident type 2 diabetes (HR, 0.45; 95% CI, 0.33-0.61); there was no association of alcohol consumption of 0.1 to 4.9 g/d or 15.0 g/d or more (maximum, 74.2 g/d) with risk of type 2 diabetes (0.1 to 4.9 g/d: HR, 0.87 [95% CI, 0.73-1.03]; ≥15.0 g/d: HR, 0.62 [95% CI, 0.37-1.04]). After additional adjustment for body mass index, women who reported alcohol consumption of 5.0 to 14.9 g/d had a 41% lower risk for developing incident type 2 diabetes (HR, 0.59; 95% CI, 0.42-0.81); consumption of 0.1 to 4.9 g/d and consumption of 15.0 g/d or more were still not associated with risk of type 2 diabetes, but the results were attenuated (0.1-4.9 g/d: HR, 1.02 [95% CI, 0.85-1.23]; ≥15.0 g/d: HR, 0.75 [95% CI, 0.42-1.33]).

CONCLUSIONS AND RELEVANCE

In this cohort study, among women with a history of gestational diabetes, usual alcohol intake of 5.0 to 14.9 g/d (approximately 0.5-1 drinks per day) was associated with a lower risk for type 2 diabetes. These findings should be interpreted in the context of other known risks and benefits of alcohol consumption when considering clinical recommendations for individual women with a history of gestational diabetes.

Impact of intra-category food substitutions on the risk of type 2 diabetes: a modelling study on the pizza category

Advice on replacing unhealthy foods with healthier alternatives within the same food category may be more acceptable and might ease the transition towards a healthy diet. Here, we studied the potential impact of substitutions within the pizza category on the risk of type 2 diabetes (T2D). The study sample consisted of 2510 adults from the INCA2 French national survey. Based on their nutritional characteristics, the 353 pizzas marketed in France were grouped into 100 clusters that were used to run various scenarios of pizza substitutions, which were either isoenergetic (IE) or non-isoenergetic (NIE). We then used a model structurally similar to the Preventable Risk Integrated ModEl to assess the expected rate of change in risk of T2D. Pizzas characterised by a low energy, high vegetable content and whole grain dough were associated with a greater reduction in the risk of T2D. The rates of change in risk of T2D were markedly stronger in men and for NIE substitutions. When the rates of change were estimated in the subsample of pizza consumers, replacing the observed pizzas with the best pizza resulted in a T2D risk reduction of -6·7 % (-8·4 %; -4·9 %, IE) and -8·9 % (-11·2 %; -6·3 %, NIE), assuming that this is their usual diets. The greatest risk reduction induced by an IE substitution of the observed pizza with a mixed dish was similar to that observed with the best pizzas. Overall, this modelling study suggests that healthy swaps within a category can effectively supplement broader dietary changes towards a healthier diet.

Moderate alcohol consumption is associated with impaired insulin secretion and fasting glucose in non-obese non-diabetic men

AIMS/INTRODUCTION

A low insulin secretion capacity has been implicated in the high prevalence of non-obese diabetes in East Asians. As alcohol consumption alters insulin and glucose metabolism, we tested the hypothesis that alcohol consumption contributes to impaired insulin secretion and glucose intolerance in lean/normal-weight non-diabetic Japanese men.

MATERIALS AND METHODS

This cross-sectional study was undertaken among the residents of Shika town, Japan, between 2011 and 2017. A total of 402 non-diabetic men, including participants with normal fasting plasma glucose (FPG) and impaired FPG (FPG 5.6-6.9 mmol/L), and aged ≥40 years, were examined. FPG, the homeostasis model assessment of insulin secretion capacity (HOMA-B) and alcohol consumption were evaluated and compared between the body mass index (BMI) <25 and BMI ≥25 groups.

RESULTS

HOMA-B levels were lower in the BMI <25 group than in the BMI ≥25 group. Alcohol consumption correlated with a low HOMA-B level regardless of BMI, and, thus, the HOMA-B levels of alcohol drinkers were significantly lower in the BMI <25 group. A multivariable logistic regression analysis showed that alcohol consumption, even light-to-moderate consumption (1-25 g/day), was associated with significantly low levels of HOMA-B and impaired FPG in the BMI <25 group. Among participants with impaired FPG, a low level of HOMA-B was observed in alcohol drinkers, but not in non-drinkers. In contrast, light-to-moderate alcohol consumption was not related to HOMA-B or FPG in the BMI ≥25-group.

CONCLUSION

Alcohol consumption, even a small amount, might contribute to reductions in HOMA-B levels and impaired FPG in lean/normal-weight Japanese men.

The effect of grape products containing polyphenols on oxidative stress: a systematic review and meta-analysis of randomized clinical trials

BACKGROUND

The literature showed that Grape Products Containing Polyphenols (GPCP) had anti-oxidant activity. However, the effects of GPCP on different biomarkers of oxidative stress are still controversial. In this regard, this systematic review and meta-analysis aimed to evaluate the effect of Grape Products Containing Polyphenols (GPCP) intake on oxidative stress markers.

METHODS

PubMed, Scopus, Web of Science, and Google Scholar data bases were searched up to August 20, 2020. A random-effects model, weighted mean difference (WMD), and 95% confidence interval (CI) were applied for data analysis. Meta-analysis was conducted over 17 eligible RCTs with a total of 633 participants. The study registration number is CRD42019116696.

RESULTS

A significant increase was observed in Total Antioxidant Capacity (TAC) (weighted mean difference (WMD) = 1.524 mmol/L, 95% confidence interval (CI): 0.83, 2.21). Intake of GPCP enhanced Superoxide Dismutase (SOD) (WMD = 0.450 mmol/L, 95% CI: 0.23, 0.66), TAC (WMD = 2.829 mmol/L, 95% CI: 0.13, 5.52), and Oxygen Radical Absorbance Capacity (ORAC) (WMD = 0.524 μmol/L, 95% CI: 0.42, 0.62) among healthy participants. Higher GPCP doses increased SOD (WMD = 0.539 U/mgHb, 95% CI: 0.24, 0.82) and ORAC (WMD = 0.377 μmol/L, 95% CI: 0.08, 0.67), whereas longer intervention periods enhanced ORAC (WMD = 0.543 μmol/L, 95% CI: 0.43, 0.64).

CONCLUSION

GPCP intake may partly improve status of oxidative stress, but further well-designed trials are required to confirm these results.

Moderate Consumption of Beer and Its Effects on Cardiovascular and Metabolic Health: An Updated Review of Recent Scientific Evidence

There is growing interest in the potential health-related effects of moderate alcohol consumption and, specifically, of beer. This review provides an assessment of beer-associated effects on cardiovascular and metabolic risk factors to identify a consumption level that can be considered “moderate”. We identified all prospective clinical studies and systematic reviews that evaluated the health effects of beer published between January 2007 and April 2020. Five of six selected studies found a protective effect of moderate alcohol drinking on cardiovascular disease (beer up to 385 g/week) vs. abstainers or occasional drinkers. Four out of five papers showed an association between moderate alcohol consumption (beer intake of 84 g alcohol/week) and decreased mortality risk. We concluded that moderate beer consumption of up to 16 g alcohol/day (1 drink/day) for women and 28 g/day (1–2 drinks/day) for men is associated with decreased incidence of cardiovascular disease and overall mortality, among other metabolic health benefits.

Biochemical and Behavioral Consequences of Ethanol Intake in a Mouse Model of Metabolic Syndrome

Ethanol abuse is a common issue in individuals with sedentary lifestyles, unbalanced diets, and metabolic syndrome. Both ethanol abuse and metabolic syndrome have negative impacts on the central nervous system, with effects including cognitive impairment and brain oxidative status deterioration. The combined effects of ethanol abuse and metabolic syndrome at a central level have not yet been elucidated in detail. Thus, this work aims to determine the effects of ethanol intake on a mouse model of metabolic syndrome at the behavioral and biochemical levels. Seven-week-old male control (B6.V-Lep ob/+JRj) and leptin-deficient (metabolic syndrome) (B6.V-Lep ob/obJRj) mice were used in the study. Animals were divided into four groups: control, ethanol, obese, and obese-ethanol. Ethanol consumption was monitored for 6 weeks. Basal glycemia, insulin, and glucose overload tests were performed. To assess short- and long-term memory, an object recognition test was used. In order to assess oxidative status in mouse brain samples, antioxidant enzyme activity was analyzed with regard to glutathione peroxidase, glutathione reductase, glutathione, glutathione disulfide, lipid peroxidation products, and malondialdehyde. Ethanol intake modulated the insulin response and impaired the oxidative status in the ob mouse brain.

Benefits and hazards of alcohol-the J-shaped curve and public health

Purpose

The purpose of this paper is a review of updated evidence of a J-shaped association between alcohol consumption and the risk of coronary heart disease (CHD) and all-cause mortality in relation to public health issues to create a basis for sensible individual health deliberations.

Design/methodology/approach

A review of the evidence from the first observation of a J-shaped association between a moderate alcohol intake and CHD in 1926 to recent studies of the effect of healthy lifestyles (including moderate alcohol intake) on life expectancy free of cardiovascular disease (CVD), cancer and Type 2 diabetes. An update on the biological plausibility of the J-shaped association with focus on recent findings of the association of alcohol intake and blood lipid levels.

Findings

Plausible J-shaped relations between light to moderate alcohol consumption and the risk of CHD, CVD mortality and all-cause mortality have been found in a large number of robust epidemiological studies. Among the potential mechanisms underlying the proposed protective effects are higher levels of high-density lipoprotein lacking apolipoprotein C3, reduced platelet aggregability, increased level of endothelial cell fibrinolysis, increased insulin sensitivity and decreased inflammation.

Originality/value

The existence of a J-shaped association between alcohol consumption and the risk of CHD and all-cause mortality is based on observational evidence and accordingly challenged by a degree of uncertainty leading some public health circles to state: “there is no safe level of alcohol consumption.” The authors propose that communication on the pros and cons of alcohol intake should emphasize the nadir of a J-shaped curve as a healthy range for the general population while advice regarding the consumption of alcohol should be adjusted to factor in the risks and potential benefits for each individual patient considering age, sex, family history, personal drinking history and specific medical history.

[Differential health effects of alcoholic beverages: an umbrella review of observational studies.]

BACKGROUND

There is great controversy about whether the consumption of different types of alcoholic beverages has different effects on health. The objective was to carry out an umbrella review of the studies that described the association between the consumption of different types of alcoholic beverages and various health indicators.

METHODS

Search through PubMed (from January 2000 to February 2019) of systematic reviews and meta-analysis that reported quantitative results of the association between the consumption of different types of alcoholic beverages and health effects. 26 studies were identified: 21 related to cancer, three to cardiometabolic diseases, two to neurodegenerative diseases, and one to general mortality.

RESULTS

The results were heterogeneous. The great methodological differences in the estimation of alcohol intake, control of confounding variables, and the evaluation of statistical difference between types of beverages, made it very difficult to conclude whether they cause an unequal effect on health. In general mortality and cardiometabolic diseases, it was suggested that beer and spirits appear to have a greater negative effect than wine, but the differences were not statistically significant. Regarding cancer, in those types where the causal evidence is totally consistent: oropharynx, colorectal and breast (women), the reviews did not show a differentiated effect according to the type of alcoholic beverages. Regarding neurodegenerative diseases, the available information did not allow clear conclusions to be drawn.

CONCLUSIONS

The reviewed evidence does not allow to conclude that the consumption of wine, beer or spirits, has a differential effect on cardiometabolic, cancer or neurodegenerative diseases.

Experiencing earthquake in the first trimester of the fetal life increases subsequent diabetes risk in the adulthood: a cross-sectional study

OBJECTIVE

To investigate the long-term effect of prenatal exposure to earthquake stress on diabetes risk in the adulthood.

METHODS

This study included employees of Tangshan Kailuan Mining Group between July 29, 1976 and April 28, 1977. The exposure group included subjects who experienced the Tangshan Earthquake during their prenatal period and who had lived in Tangshan since birth. The non-exposure group included subjects who were born 1-1.9 years after the earthquake and who had lived in Tangshan since birth. A questionnaire was designed that included sociodemographic information, conditions during pregnancy, and earthquake experience. Anthropometric measurements including height and weight, body mass index (BMI), waist circumference were made. Fasting plasma glucose (FPG) and lipid profiles were also determined.

RESULTS

Totally 947 subjects were included with 397 subjects in the exposed group and 550 subjects in the non-exposed group. The diabetes rate is significant different in these four groups(χ² =8.045, P = 0.045). Moreover, 11.8, 7.5 and 8.0% of the subjects who were exposed to earthquake in the 1st, 2nd, and 3rd trimester of pregnancy had diabetes. 5.1% of the subjects had diabetes in non-exposure group. Our multivariate analysis showed that 1st trimester (OR 2.481, 95%CI 1.02, 6.034; P = 0.045) and loss of family members during earthquake (OR 2.452, 95%CI 1.293, 4.653; P = 0.006) were associated with significantly increased risk of diabetes.

CONCLUSIONS

Exposure to earthquake during the first trimester of pregnancy and experience of family member loss in the earthquake significantly increased the subsequent risk of diabetes in the middle age (36-39 years of age). Our data suggest that earthquake experience in the early pregnancy has a longer-term effect on diabetes risk during adulthood.

Wine Intake in the Framework of a Mediterranean Diet and Chronic Non-Communicable Diseases: A Short Literature Review of the Last 5 Years

Dietary habits are a determining factor of the higher incidence and prevalence of chronic non-communicable diseases (NCDs). In the aim to find a possible preventive and intervention strategy, the Mediterranean diet (MedDiet) has been proposed as an effective approach. Within the MedDiet, moderate wine consumption with meals is a positive item in the MedDiet score; however, recent studies have reported a dose-response association between alcohol consumption and higher risk of a large number of NCDs. This review aimed to evaluate the association between NCDs and wine consumption in the framework of the MedDiet, with a simple review of 22 studies of the highest-level literature published over the last five years. We found that the information regarding the effects of wine in different health outcomes has not varied widely over the past five years, finding inconclusive results among the studies evaluated. Most of the literature agrees that light to moderate wine intake seems to have beneficial effects to some extent in NCDs, such as hypertension, cancer, dyslipidemia and dementia, but no definitive recommendations can be made on a specific dose intake that can benefit most diseases.

Alcohol and illicit drug use in people with diabetes

As the prevalence of type 1 and type 2 diabetes increases and population-level patterns of alcohol and illicit drug use evolve, clinicians will continue to encounter people with diabetes whose substance use is affecting health outcomes. Substance use contributes substantially to the population-level prevalence of cardiovascular events, cerebrovascular events, cancers, mental health conditions, road trauma, and domestic violence. Alcohol and drug use also have a measurable effect on diabetes incidence and the development of both acute and chronic diabetes-related complications. In this Review, we examine the effect of alcohol and illicit drug use on people with type 1 or type 2 diabetes. We describe evidence for substance use as a risk factor for new-onset diabetes, prevalence of use in people with diabetes, evidence linking substance use with diabetes-related health outcomes, and evidence on the management of these co-occurring conditions.

Smoking and Alcohol Intake but Not Muscle Strength in Young Men Increase Fracture Risk at Middle Age: A Cohort Study Linked to the Swedish National Patient Registry

We aimed to determine the relationship between handgrip strength, smoking, and alcohol consumption in young men and fracture risk at middle age. Thus, we carried out a cohort study including young men undergoing conscription examination in Sweden from September 1969 to May 1970 at a typical age of 18 years. Data on muscle strength, height, weight, and lifestyle factors were linked to the National Patient Register 1987-2010. Handgrip strength was considered the main exposure and smoking and alcohol consumption as secondary exposures. Outcomes were all fractures (except face, skull, digits), major osteoporotic fractures (thoracic/lumbar spine, proximal humerus, distal forearm or hip), and major traumatic fractures (shaft of humerus, forearm, femur, or lower leg) based on ICD-9 and -10 codes. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) according to handgrip strength as a continuous variable (per 1 SD), after adjustment for weight, height, parental education, smoking, and alcohol consumption. A total of 40,112 men were included, contributing 892,572 person-years. Overall, 3974 men fractured in middle age with the incidence rate (95% CI) of 44.5 (43.2-45.9) per 1000 person-years. The corresponding rates were12.2 and 5.6 per 1000 person-years for major osteoporotic and traumatic fractures, respectively. Handgrip strength-adjusted HR (95% CI) was 1.01 (0.98-1.05), 0.94 (0.88-1.00), and 0.98 (0.88-1.08) per SD for all, major osteoporotic, and major traumatic fractures, respectively. Adjusted HR (95% CI) for smokers (>21 cigarettes/d) was 1.44 (1.21, 1.71) for all fractures, while the association between alcohol consumption and hazards of fracture was J-shaped. Therefore, young adult handgrip strength was not associated with fracture risk in middle-age men, although smoking and high alcohol consumption did confer an increased risk. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.

Adherence to healthy lifestyles and incidence of diabetes and mortality among individuals with diabetes: a systematic review and meta-analysis of prospective studies

Introduction

Lifestyle factors in combination have been hypothesised to be associated with the prevention of type 2 diabetes (T2D) and mortality among individuals with T2D. The aim was to conduct a systematic review and meta-analysis to quantify the association between lifestyle indices and incident T2D as well as mortality in individuals with T2D.

Methods

PubMed and Web of Science were searched up to September 2019. We included prospective cohort studies investigating at least three lifestyle factors in association with T2D, or all-cause mortality in individuals with diabetes. We conducted pairwise and dose-response meta-analyses to calculate summary relative risks (SRR) by using random effects model.

Results

In total, 19 studies were included. Adhering to a healthy lifestyle (mostly favourable diet, physical activity, non-smoking, moderate alcohol intake and normal weight) was associated with a reduced SRR of 78% for T2D (SRR: 0.22; 95% CI: 0.16 to 0.32; n=14) and 57% for mortality (SRR: 0.43; 95% CI: 0.31 to 0.58; n=5) compared with low adherence to a healthy lifestyle. In dose-response analyses, the adherence to every additional healthy lifestyle factor was associated with a reduced relative risk of 32% (95% CI: 28% to 36%) for T2D and 21% (95% CI: 15% to 26%) for mortality.

Conclusions

Our findings underline the importance of the joint adherence to healthy lifestyle factors to prevent T2D and improve survival among individuals with diabetes. Adherence to every additional health lifestyle factor play a role in the T2D prevention and progression.

PROSPERO registration number

CRD42018091409.

The Dose-Response Relationship between Alcohol Consumption and the Risk of Type 2 Diabetes among Asian Men: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

The objective of this review was to provide a summary of the literature on the dose-response relationship between alcohol consumption and risk of type 2 diabetes (T2D) in Asian populations, particularly men. The present study was recorded in PROSPERO as CRD 42019121073. We searched the PubMed-Medline, Web of Science, and Cochrane Library for studies published in any language since the database inception to January 2019. Prospective cohort studies were included in the meta-analysis. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for random-effects models and dose-response meta-analyses. In total, 8 prospective cohort studies were included. High alcohol intake was significantly associated with increased risk of T2D (RR = 1.16, 95% CI: 1.04-1.29; Q statistic p = 0.326) compared to the lowest category of alcohol intake. Nonlinear association was observed between alcohol consumption and T2D risk in men (p = 0.003). Dose-wise, consuming ≤57 g/day of alcohol was not associated with the risk of T2D in this study; however, alcohol intake >57 g/day was associated with increased risk of T2D in men. Overall, the association between alcohol consumption and T2D among Asian men was J-shaped. Lifestyle recommendations for prevention of T2D should include advice on limiting alcohol intake. This trial is registered with Prospero registration: CRD 42019121073.

Beer and its non-alcoholic compounds in health and disease

Moderate alcohol consumption has been associated with beneficial effects on human health. Specifically, consumption of red wine and beer has shown a J-shape relation with many important diseases. While a role of ethanol cannot be excluded, the high content of polyphenols in both beverages has been proposed to contribute to these effects, with beer having the advantage over wine that it is lower in alcohol. In addition to ethanol, beer contains a wide variety of compounds with known medicinal potential such as kaempferol, quercetin, tyrosol and phenolic acids, and it is the main dietary source for the flavones xanthohumol and 8-prenylnaringenin, and bitter acids such as humulones and lupulones. Clinical and pre-clinical evidence for the protective effects of moderate beer consumption against cardiovascular disease and other diseases has been accumulating since the 1990s, and the non-alcoholic compounds of beer likely exert most of the observed beneficial effects. In this review, we summarize and discuss the effects of beer consumption in health and disease as well as the clinical potential of its non-alcoholic compounds which may be promising candidates for new therapies against common chronic diseases.

Consumption of Alcoholic Beverages and the Prevalence of Metabolic Syndrome and Its Components

The relationship between alcohol consumption and the prevalence of metabolic syndrome is not consistent and may vary between populations, depending on age, sex, ethnicity, cultural traditions and lifestyle. We have hypothesized that moderate alcohol consumption will be associated with the lowest risk of the syndrome. The aim of the present study is to examine the relationship between the current consumption of alcohol and the prevalence of metabolic syndrome and its components. The research material includes data obtained from 12,285 men and women, in the age range of 37–66 years. Multiple logistic regression was used in the statistical analysis. Metabolic syndrome (MetS) was defined according to the International Diabetes Federation. In men, a current consumption of >30 g of alcohol/day was significantly associated with a higher risk of metabolic syndrome (OR = 1.73, 95% CI = 1.25–2.39), high blood pressure (OR = 2.76, 95% CI = 1.64–4.65), elevated glucose concentration (OR = 1.70, 95% CI = 1.24–2.32), and abdominal obesity (OR = 1.77; 95% CI = 1.07–2.92). In women, the consumption from 10.1 to 15.0 g of alcohol was associated only with a higher risk of abnormal glucose concentration (OR = 1.65; 95% CI = 1.14–2.38.) In both sexes, current alcohol consumption was associated with higher high-density lipoproteins (HDL)-cholesterol concentration (p < 0.05). No relationship was found between alcohol consumption and triglyceride concentration. It is difficult to formulate unequivocal recommendations regarding alcohol intake in MetS prophylaxis due to its different association with particular MetS components. In order to explain the causal relationship between alcohol consumption and MetS and its components, prospective studies are necessary.

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

OBJECTIVE

To summarise the evidence of associations between dietary factors and incidence of type 2 diabetes and to evaluate the strength and validity of these associations.

DESIGN

Umbrella review of systematic reviews with meta-analyses of prospective observational studies.

DATA SOURCES

PubMed, Web of Science, and Embase, searched up to August 2018.

ELIGIBILITY CRITERIA

Systematic reviews with meta-analyses reporting summary risk estimates for the associations between incidence of type 2 diabetes and dietary behaviours or diet quality indices, food groups, foods, beverages, alcoholic beverages, macronutrients, and micronutrients.

RESULTS

53 publications were included, with 153 adjusted summary hazard ratios on dietary behaviours or diet quality indices (n=12), food groups and foods (n=56), beverages (n=10), alcoholic beverages (n=12), macronutrients (n=32), and micronutrients (n=31), regarding incidence of type 2 diabetes. Methodological quality was high for 75% (n=115) of meta-analyses, moderate for 23% (n=35), and low for 2% (n=3). Quality of evidence was rated high for an inverse association for type 2 diabetes incidence with increased intake of whole grains (for an increment of 30 g/day, adjusted summary hazard ratio 0.87 (95% confidence interval 0.82 to 0.93)) and cereal fibre (for an increment of 10 g/day, 0.75 (0.65 to 0.86)), as well as for moderate intake of total alcohol (for an intake of 12-24 g/day v no consumption, 0.75 (0.67 to 0.83)). Quality of evidence was also high for the association for increased incidence of type 2 diabetes with higher intake of red meat (for an increment of 100 g/day, 1.17 (1.08 to 1.26)), processed meat (for an increment of 50 g/day, 1.37 (1.22 to 1.54)), bacon (per two slices/day, 2.07 (1.40 to 3.05)), and sugar sweetened beverages (for an increase of one serving/day, 1.26 (1.11 to 1.43)).

CONCLUSIONS

Overall, the association between dietary factors and type 2 diabetes has been extensively studied, but few of the associations were graded as high quality of evidence. Further factors are likely to be important in type 2 diabetes prevention; thus, more well conducted research, with more detailed assessment of diet, is needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018088106.

Mediterranean Diet Pyramid: A Proposal for Italian People. A Systematic Review of Prospective Studies to Derive Serving Sizes

In the last decade, a number of meta-analyses of mostly observational studies evaluated the relation between the intake of food groups and the risk of noncommunicable diseases (NCDs). In this study, we systematically reviewed dose-response meta-analyses of prospective studies with the aim to derive the quantities of food to consume to attain a protective (Mediterranean food) or a non-adverse (non-Mediterranean food) effect toward selected NCDs such as cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke, type 2 diabetes (T2DM), colorectal (CRC) and breast cancer. These derived quantities, wherever possible, were suggested for a quantification of food servings of the Mediterranean Diet Pyramid proposed for Italian People (MDPPI). This pyramid came from the Modern Mediterranean Diet Pyramid developed in 2009 for Italian people. A weekly menu plan was built on the advice about frequency of intakes and serving sizes of such pyramid and the nutritional composition of this diet was compared with the Reference Italian Mediterranean Diet followed in 1960 in Nicotera. The diet built according the advice of MDPPI was very similar to that of Nicotera in the late 1950s that has been chosen as Italian Reference Mediterranean Diet with the exception of percentage of energy provided by cereals that was lower and of fruits and vegetables that was higher. Saturated fatty acids were only the 6% of daily energy intake. Also the Mediterranean Adequacy Index (MAI) was very similar to that of the aforementioned diet.

Population attributable fractions of the main type 2 diabetes mellitus risk factors in women: Findings from the French E3N cohort

BACKGROUND

Although many type 2 diabetes mellitus (T2DM) risk factors have been identified, little is known regarding their contributions to the diabetes burden at the population level.

METHODS

The study included 72 655 French women from the Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective cohort followed between 1993 and 2011. Cox multivariable models including the main T2DM risk factors (metabolic, dietary, clinical, socioeconomic and hormonal) and a healthy lifestyle index combining five characteristics (smoking, body mass index [BMI], alcohol consumption, fruit and vegetable consumption, and physical activity) were used to estimate hazard ratios and population attributable fractions (PAFs) for T2DM.

RESULTS

In multivariate models, factors with the strongest effect on T2DM risk were, in decreasing order, BMI ≥ 30 kg/m² (PAF = 43%; 95% confidence interval [CI] 37-47), high adherence to a Western dietary pattern (PAF = 30%; 95% CI 20-40), hypertension (PAF = 26%; 95% CI 20-32), an acidogenic diet (PAF = 24%; 95% CI 16-32), a family history of diabetes (PAF = 20%; 95% CI 17-22), and, with a negative correlation, moderate alcohol consumption (PAF-19%; 95% CI -34, -4). The PAF for an unhealthy lifestyle was 57% (95% CI 50-63).

CONCLUSIONS

We have been able to sort out and quantify the effect of various dietary and biological T2DM risk factors simultaneously in a single population, and to highlight the importance of a healthy lifestyle for primary prevention: more than half the T2DM cases could have been prevented through a healthier lifestyle.

Sex differences and risk factors for diabetes mellitus - an international study from 193 countries

Background

Increases in overweight and obesity among youths have resulted in the diagnosis of Type 2 diabetes mellitus (T2DM) at earlier ages. The impact of lifestyle-related factors has been implicated; however, its relation to morbidity and mortality and sex differences remain unclear. We aimed to document the changes in risk factors and sex differences associated with T2DM-related morbidity and mortality during 1995–2015.

Method

We used mortality rates and morbidity estimates from the Global Burden of Diseases Study 2016 using Disability-Adjusted Life Years (DALY). Multiple linear regression analyses were used to determine associations between T2DM-related mortality and related risk factors. DALYs were grouped by country income level, and were stratified by sex.

Results

Increases in mortality were observed for both sexes, and females tended to have higher mortality rates per 100,000 persons. Body mass index (BMI) continued to be the leading risk factor for T2DM-related mortality, and increases in BMI were more common in low- and middle-income countries (LIC and MIC). Low physical activity was strongly associated with mortality rates, followed by dietary risks and smoking (2.4; 1.4; 0.8 per 100,000 persons, respectively). Similar patterns were observed after adjustments for income level, sex, and age. DALYs continued to show increasing trends across all income levels during 1995–2015 (high-income (HIC):16%; MIC: 36%; LIC: 12%). Stratification by sex showed similar results; males had fewer T2DM DALYs than females, though a greater increase was observed among males.

Conclusion

Overall, T2DM related mortality was higher among females. Compared to in HIC, there appeared to be a considerable increase in the burden of T2DM in MIC and LIC, where BMI is the leading risk factor for T2DM-related mortality. Prevention programs should emphasize related risk factors according to the existing standard of care.

Alcohol Intake Interacts with CDKAL1, HHEX, and OAS3 Genetic Variants, Associated with the Risk of Type 2 Diabetes by Lowering Insulin Secretion in Korean Adults

BACKGROUND

Since alcohol intake increases the prevalence of type 2 diabetes (T2DM) in Koreans, we tested the hypothesis that the interactions of genetic variants involved in β-cell function and mass with alcohol intake increase the T2DM risk.

METHODS

The single nucleotide polymorphisms (SNPs) were selected by genome-wide association study for insulin secretion after adjusting for age, gender, area of residence, body mass index, and alcohol intake (p < 1 × 10^-4 ) in 8,842 middle-aged adults in the Ansan/Ansung cohort. Genetic risk scores (GRSs) were calculated by summing the risk alleles of 4 selected SNPs, CDKAL1 rs7754840 and rs9460546, HHEX rs5015480, and OAS3 rs2072134. The GRSs were categorized into 3 groups by tertiles, and the association between GRS and insulin secretion was measured using logistic regression after adjusting for confounding factors in the Ansan/Ansung cohort. The results were confirmed by the Rural cohort.

RESULTS

HOMA-IR was higher and HOMA-B was much lower in the High-GRS than the Low-GRS in both cohorts. T2DM risk was higher by approximately 1.5-fold in the High-GRS than in the Low-GRS in both cohorts. In the High-GRS group, HOMA-B decreased by 0.89- and 0.62-fold in comparison with the Low-GRS in the Ansan/Ansung cohort and Rural cohort. The GRS interacted with alcohol intake to increase the risk of developing T2DM in the Ansan/Ansung cohort (p = 0.036) and Rural cohort (p = 0.071). The risk of T2DM increased in the High-GRS group with high alcohol intake and it was associated with decreased HOMA-B. High alcohol intake decreased HOMA-B regardless of GRS, and HOMA-B was lower in the descending order of Medium-GRS, Low-GRS, and High-GRS. However, HOMA-IR was not altered by alcohol intake, but was elevated in the High-GRS more than in the other groups.

CONCLUSIONS

Subjects with a High-GRS had an elevated risk of T2DM even with moderate alcohol intakes due to lower HOMA-B. High alcohol intake appears to be a risk factor for all Asians regardless of alcohol intake.

Cannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease

BACKGROUND

Abusive alcohol use has well-established health risks including causing liver disease (ALD) characterized by alcoholic steatosis (AS), steatohepatitis (AH), fibrosis, cirrhosis (AC) and hepatocellular carcinoma (HCC). Strikingly, a significant number of individuals who abuse alcohol also use Cannabis, which has seen increased legalization globally. While cannabis has demonstrated anti-inflammatory properties, its combined use with alcohol and the development of liver disease remain unclear.

AIM

The aim of this study was to determine the effects of cannabis use on the incidence of liver disease in individuals who abuse alcohol.

METHODS

We analysed the 2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) discharge records of patients 18 years and older, who had a past or current history of abusive alcohol use (n = 319 514). Using the International Classification of Disease, Ninth Edition codes, we studied the four distinct phases of progressive ALD with respect to three cannabis exposure groups: non-cannabis users (90.39%), non-dependent cannabis users (8.26%) and dependent cannabis users (1.36%). We accounted for the complex survey sampling methodology and estimated the adjusted odds ratio (AOR) for developing AS, AH, AC and HCC with respect to cannabis use (SAS 9.4).

RESULTS

Our study revealed that among alcohol users, individuals who additionally use cannabis (dependent and non-dependent cannabis use) showed significantly lower odds of developing AS, AH, AC and HCC (AOR: 0.55 [0.48-0.64], 0.57 [0.53-0.61], 0.45 [0.43-0.48] and 0.62 [0.51-0.76]). Furthermore, dependent users had significantly lower odds than non-dependent users for developing liver disease.

CONCLUSIONS

Our findings suggest that cannabis use is associated with a reduced incidence of liver disease in alcoholics.

Polyphenol exposure and risk of type 2 diabetes: dose-response meta-analyses and systematic review of prospective cohort studies

Background

Type 2 diabetes is characterized by impaired glucose metabolism. Bioactive compounds in fruits and vegetables such as polyphenols have been suggested to influence glucose metabolism.

Objective

The aim of the current study was to systematically review the literature and conduct dose-response meta-analyses to summarize evidence of polyphenol exposure in association with incident type 2 diabetes.

Design

Prospective epidemiologic studies published before January 2018 were searched through 2 databases. Log-transformed multivariable adjusted hazard and odds ratios were combined in a random-effects model. Meta-analyses comparing extreme quantiles of polyphenol exposure were further explored with the use of linear and nonlinear dose-response meta-analyses.

Results

Eighteen studies investigated the association between polyphenols (51 different compounds in total) and type 2 diabetes. A comparison of extreme quantiles revealed inverse associations for intakes of polyphenols (HR: 0.56; 95% CI: 0.34, 0.93), flavonoids (HR: 0.88; 95% CI: 0.81, 0.96), flavonols (HR: 0.92; 95% CI: 0.85, 0.98), flavan-3-ols (HR: 0.89; 95% CI: 0.81, 0.99), catechins (HR: 0.86; 95% CI: 0.75, 0.97), anthocyanidins (HR: 0.86; 95% CI: 0.81, 0.91), isoflavones (HR: 0.92; 0.86, 0.97), daidzein (HR: 0.89; 95% CI: 0.83, 0.95), genistein (HR: 0.92; 95% CI: 0.86, 0.99), and stilbenes (HR: 0.44; 95% CI: 0.26, 0.72), and biomarkers of daidzein (HR: 0.81; 95% CI: 0.66, 0.99) and genistein (HR: 0.79; 95% CI: 0.62, 0.99). In the dose-response meta-analysis, nonlinear associations were observed for intakes of polyphenols, flavonoids, flavanones, anthocyanidins, anthocyanins, and biomarkers of genistein. A linear dose-response association was observed for phenolic acids.

Conclusions

This study adds to the evidence showing that diets rich in polyphenols, and particularly flavonoids, play a role in the prevention of type 2 diabetes. For most associations evidence for nonlinearity was found, suggesting a recommendable amount of intake associated with the lowest risk of type 2 diabetes. Therefore, future studies are warranted in which nonlinear associations are further explored.

Wine and its metabolic effects. A comprehensive review of clinical trials

The introduction of the term "French Paradox" motivated an extensive and in-depth research into health benefits of moderate wine consumption. The superiority of wine is thought to be attributed to its micro-constituents and consequent effort was made to isolate and identify these bioactive compounds as well as to elucidate the mechanisms of their action. Controlled trials offer more concrete answers to several raised questions than observational studies. Under this perspective, clinical trials have been implemented, mainly in healthy volunteers and rarely in patients, in order to investigate the acute or chronic effect of wine consumption on metabolism and physio-pathological systems, which are mainly associated with cardiovascular diseases. The aim of this review is to update the knowledge about the acute and long term effect of wine consumption on lipid and glucose/insulin metabolism as well as on the inflammatory and haemostatic systems, based on the reported data of controlled clinical trials. In conclusion, the most repeated result of wine consumption is on lipid metabolism, attributed mainly to ethanol, while wine micro-constituents seem to have an important role mainly in haemostatic and inflammatory/endothelial systems.

Alcohol consumption and incidence of proteinuria: a retrospective cohort study

BACKGROUND

Previous studies report conflicting results of a dose-dependent association between alcohol consumption and incidence of chronic kidney disease. Only a few studies have assessed the clinical impact of > 45-65 g/day of critically high alcohol consumption.

METHODS

This retrospective cohort study included 88,647 males and 88,925 females with dipstick urinary protein ≤ ± and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m² at their first annual health examinations between April 2008 and March 2010 in Japan. The exposure was the self-reported alcohol consumption. The outcome was proteinuria defined as dipstick urinary protein ≥ 1 + or ≥ 2 +.

RESULTS

During median 1.8 years (interquartile range 1.0-2.1) of the observational period, 5416 (6.1%) males and 3262 (3.7%) females developed proteinuria defined as dipstick urinary protein ≥ 1 +. In males, a U-shape association between alcohol consumption and proteinuria was observed in a multivariable-adjusted Poisson regression model [incidence rate ratio (95% confidence interval) of rare, occasional, and daily drinkers with ≤ 19, 20-39, 40-59, and ≥ 60 g/day: 1.00 (reference), 0.86 (0.79-0.94), 0.70 (0.64-0.78), 0.82 (0.75-0.90), 1.00 (0.90-1.11), and 1.00 (0.85-1.17), respectively], whereas a J-shape association was observed in females [1.00 (reference), 0.81 (0.75-0.87), 0.74 (0.64-0.85), 0.93 (0.78-1.11), 1.09 (0.83-1.44), and 1.45 (1.02-2.08), respectively]. Similar associations with dipstick urinary protein ≥ 2 + were shown in males and females.

CONCLUSIONS

Moderate alcohol consumption was associated with lower risk of proteinuria in both males and females. Females with ≥ 60 g/day of high alcohol consumption were at higher risk of proteinuria, whereas males were not. Females were more vulnerable to high alcohol consumption, than males.

The bidirectional impacts of alcohol consumption and the metabolic syndrome: Cofactors for progressive fatty liver disease

Current medical practice artificially dichotomises a diagnosis of fatty liver disease into one of two common forms: alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). Together, these account for the majority of chronic liver diseases worldwide. In recent years, there has been a dramatic increase in the prevalence of obesity and metabolic syndrome within the general population. These factors now coexist with alcohol consumption in a substantial proportion of the population. Each exposure sensitises the liver to the injurious effects of the other; an interaction that drives and potentially accelerates the genesis of liver disease. We review the epidemiological evidence and scientific literature that considers how alcohol consumption interacts with components of the metabolic syndrome to exert synergistic or supra-additive effects on the development and progression of liver disease, before discussing how these interactions may be addressed in clinical practice.