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Gepner Y, Golan R, Harman-Boehm I, Henkin Y, Schwarzfuchs D, Shelef I, Durst R, Kovsan J, Bolotin A, Leitersdorf E, Shpitzen S, Balag S, Shemesh E, Witkow S, Tangi-Rosental O, Chassidim Y, Liberty IF, Sarusi B, Ben-Avraham S, Helander A, Ceglarek U, Stumvoll M, Blüher M, Thiery J, Rudich A, Stampfer MJ, Shai I. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med 2015; 163:569-79. [PMID: 26458258 DOI: 10.7326/m14-1650] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recommendations for moderate alcohol consumption remain controversial, particularly in type 2 diabetes mellitus (T2DM). Long-term randomized, controlled trials (RCTs) are lacking. OBJECTIVE To assess cardiometabolic effects of initiating moderate alcohol intake in persons with T2DM and whether the type of wine matters. DESIGN 2-year RCT (CASCADE [CArdiovaSCulAr Diabetes & Ethanol] trial). (ClinicalTrials.gov: NCT00784433). SETTING Ben-Gurion University of the Negev-Soroka Medical Center and Nuclear Research Center Negev, Israel. PATIENTS Alcohol-abstaining adults with well-controlled T2DM. INTERVENTION Patients were randomly assigned to 150 mL of mineral water, white wine, or red wine with dinner for 2 years. Wines and mineral water were provided. All groups followed a Mediterranean diet without caloric restriction. MEASUREMENTS Primary outcomes were lipid and glycemic control profiles. Genetic measurements were done, and patients were followed for blood pressure, liver biomarkers, medication use, symptoms, and quality of life. RESULTS Of the 224 patients who were randomly assigned, 94% had follow-up data at 1 year and 87% at 2 years. In addition to the changes in the water group (Mediterranean diet only), red wine significantly increased high-density lipoprotein cholesterol (HDL-C) level by 0.05 mmol/L (2.0 mg/dL) (95% CI, 0.04 to 0.06 mmol/L [1.6 to 2.2 mg/dL]; P < 0.001) and apolipoprotein(a)1 level by 0.03 g/L (CI, 0.01 to 0.06 g/L; P = 0.05) and decreased the total cholesterol-HDL-C ratio by 0.27 (CI, -0.52 to -0.01; P = 0.039). Only slow ethanol metabolizers (alcohol dehydrogenase alleles [ADH1B*1] carriers) significantly benefited from the effect of both wines on glycemic control (fasting plasma glucose, homeostatic model assessment of insulin resistance, and hemoglobin A1c) compared with fast ethanol metabolizers (persons homozygous for ADH1B*2). Across the 3 groups, no material differences were identified in blood pressure, adiposity, liver function, drug therapy, symptoms, or quality of life, except that sleep quality improved in both wine groups compared with the water group (P = 0.040). Overall, compared with the changes in the water group, red wine further reduced the number of components of the metabolic syndrome by 0.34 (CI, -0.68 to -0.001; P = 0.049). LIMITATION Participants were not blinded to treatment allocation. CONCLUSION This long-term RCT suggests that initiating moderate wine intake, especially red wine, among well-controlled diabetics as part of a healthy diet is apparently safe and modestly decreases cardiometabolic risk. The genetic interactions suggest that ethanol plays an important role in glucose metabolism, and red wine's effects also involve nonalcoholic constituents. PRIMARY FUNDING SOURCE European Foundation for the Study of Diabetes.
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Affiliation(s)
- Yftach Gepner
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Rachel Golan
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Ilana Harman-Boehm
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Yaakov Henkin
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Dan Schwarzfuchs
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Ilan Shelef
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Ronen Durst
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Julia Kovsan
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Arkady Bolotin
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Eran Leitersdorf
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Shoshana Shpitzen
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Shai Balag
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Elad Shemesh
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Shula Witkow
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Osnat Tangi-Rosental
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Yoash Chassidim
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Idit F. Liberty
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Benjamin Sarusi
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Sivan Ben-Avraham
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Anders Helander
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Uta Ceglarek
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Michael Stumvoll
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Matthias Blüher
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Joachim Thiery
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Assaf Rudich
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Meir J. Stampfer
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
| | - Iris Shai
- From Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheva, Israel; Nuclear Research Center Negev, Dimona, Israel; Hadassah Hebrew University Medical Center, Jerusalem, Israel; Karolinska Institute, Solna, Sweden; University of Leipzig, Leipzig, Germany; and Brigham and Women's Hospital and Harvard School of Public Health, Boston, Massachusetts
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