Alcohol and Metabolic Diseases

Alcohol and Metabolic Diseases

Critique 024.  Moderate alcohol consumption lowers risk of metabolic diseases in a population with high mean alcohol intake. 28 November 2010

Reference:  Clerc O, Nanchen D, Cornuz J, Marques-Vidal P, Gmel G, Daeppen J-B, Paccaud F, Mooser V, Waeber G, Vollenweider P, Rodondi N.  Alcohol drinking, the metabolic syndrome and diabetes in a population with high mean alcohol consumption.  Diabet Med 2010;27:1241–1249.

A cross-sectional analysis of data from subjects in Switzerland related varying levels of alcohol intake to the presence of diabetes mellitus, the “metabolic syndrome,” and an index of insulin resistance (HOMA-IR).  The strengths of this paper include being population-based and having a large number of subjects who reported that they consumed 14 or more drinks/week.  Also, there was a good percentage (27%) of subjects reporting no alcohol intake during the one week of assessment used for classifying subjects.  Another strength is the careful confirmation of drinking status with state-of-the-art laboratory tests.  In multivariate analysis, the prevalence of the metabolic syndrome, diabetes and mean HOMA-IR decreased with low-risk drinking and increased with high-risk drinking.  No differences were noted according to the type of beverage consumed.

This is a cross-sectional analysis, so a causative relation between alcohol intake and the metabolic outcomes cannot be assessed.  Still, the data support much that has been shown in prospective studies.  Several Forum members commented on potential problems when considering a number of physiologic conditions as the “metabolic syndrome” and focusing therapy on the syndrome; they believed that each metabolic factor should be evaluated and treated singly.

Critique 019. Both alcohol and caffeinated coffee intake are associated with lower risk of diabetes in African-American women. 27 September 2010

Reference:  Boggs DA, Rosenberg L, Ruiz-Narvaez EA, Palmer JR.  Coffee, tea, and alcohol intake in relation to risk of type 2 diabetes in African American women.  Am J Clin Nutr 2010;92:960–966.

In a very large cohort of African-American women in the US, the association between the consumption of alcohol, tea, and coffee was related to the development of type 2 diabetes mellitus over a follow-up period averaging 12 years.  Tea and decaffeinated coffee showed no relation with diabetes, but the intake of both caffeinated coffee and alcohol showed a significant inverse association.

This paper is particularly important because some previous studies have not shown a strong association between alcohol and the risk of cardiovascular disease among African-Americans.  African-Americans, especially women, tend to drink little alcohol, yet are at markedly increased risk of diabetes.  In the present study, the approximately 30% lower risk for moderate alcohol drinkers was about the same in these African-American women as has been found in many previous studies of whites.

Critique 003. Moderate alcohol consumption markedly reduces the risk of diabetes mellitus, even among subjects with otherwise very healthy lifestyles 17 May 2010

Reference:  Joosten MM, Grobbee DE, van der A DL, Verschuren WWM, Hendriks HFJ, Beulens JWJ.  Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes.  Am J Clin Nutr 2010;91: 1777-1783.

In a very well-done analysis from a large Dutch population, it was shown that moderate drinking considerably lowers the risk of developing type 2 diabetes even among subjects who are otherwise following a healthy lifestyle (not obese, non-smokers, physically active, eating a healthy diet).  Thus, it indicates that the effect of moderate drinking on lowering the risk of diabetes cannot be explained by other healthy lifestyle habits of such drinkers.  Moderate drinking should be considered as a complement, and not as an alternative, to other healthy lifestyle habits that lower the risk of chronic diseases such as diabetes and coronary heart disease.