26 January 2022 In Diabetes

OBJECTIVE: To evaluate the association of a healthy lifestyle, involving seven low-risk factors mentioned in diabetes management guidelines (no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, less sedentary behavior, adequate sleep duration, and appropriate social connection), with all-cause and cause-specific mortality among individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS: This study included 13,366 participants with baseline type 2 diabetes from the UK Biobank free of cardiovascular disease (CVD) and cancer. Lifestyle information was collected through a baseline questionnaire.

RESULTS: During a median follow-up of 11.7 years, 1,561 deaths were documented, with 625 from cancer, 370 from CVD, 115 from respiratory disease, 81 from digestive disease, and 74 from neurodegenerative disease. In multivariate-adjusted model, each lifestyle factor was significantly associated with all-cause mortality, and hazard ratios associated with the lifestyle score (scoring 6-7 vs. 0-2 unless specified) were 0.42 (95% CI 0.34, 0.52) for all-cause mortality, 0.57 (0.41, 0.80) for cancer mortality, 0.35 (0.22, 0.56) for CVD mortality, 0.26 (0.10, 0.63) for respiratory mortality, and 0.28 (0.14, 0.53) for digestive mortality (scoring 5-7 vs. 0-2). In the population-attributable risk analysis, 29.4% (95% CI 17.9%, 40.9%) of deaths were attributable to a poor lifestyle (scoring 0-5). The association between a healthy lifestyle and all-cause mortality was consistent, irrespective of factors reflecting diabetes severity (diabetes duration, glycemic control, diabetes-related microvascular disease, and diabetes medication).

CONCLUSIONS: A healthy lifestyle was associated with a lower risk of all-cause mortality and mortality due to CVD, cancer, respiratory disease, and digestive disease among individuals with type 2 diabetes.

26 January 2022 In Diabetes

BACKGROUND AND OBJECTIVES: Carotid intima-media thickness (IMT) is a risk predictor for myocardial infarction and stroke. Patients with type 2 diabetes mellitus are at higher risk for such conditions. The association of alcohol consumption with IMT is still controversial.

METHODS AND STUDY DESIGN: We undertook a cross-sectional study of patients hospitalized in the Department of Endocrinology at Zhoushan Hospital from January 1st, 2013 to December 31st, 2015. Patients with a past medical history of cerebrovascular events, acute myocardial ischemia or unable to provide a detailed alcohol consumption history were excluded. Carotid IMT, together with blood biochemical examinations were collected. Data were analyzed using least significant difference t test, Tamhane's T2 test, Levene test, chi2-test and binary logistic regression model.

RESULTS: 281 patients were enrolled in the study. The number of patients with elevated carotid IMT in moderate alcohol consumers was apparently less than alcohol non/heavy-consumers. In addition, the number of participants with elevated carotid IMT in liqueur consumers was higher than alcohol non-consumers and rice wine/beer consumers. Systolic blood pressure, C-reactive protein, glycosylated hemoglobin, low density lipoprotein cholesterol, triglyceride, gamma glutamyl transpeptidase, uric acid, cholesterol and creatinine levels were higher in elevated IMT patients, while high density lipoprotein cholesterol level was levels were significantly lower (p value<0.05).

CONCLUSIONS: Moderate alcohol consumption has a protective effect on atherosclerosis in patients with type 2 diabetes mellitus, requiring consideration to dietary intake and physical activity, among other influences. Inflammation theory and lipid metabolism could be involved in such prophylaxis effects.

22 October 2021 In Diabetes

OBJECTIVE: To assess the prevalence of metabolic syndrome (MetS) in Chinese adults living in Ningbo and to examine the association between alcohol consumption and MetS and its medical components.

DESIGN: A representative survey in Ningbo was conducted in 2015 covering socio-demography. A FFQ together with additional questionnaires was used to collect information on alcohol consumption, diet, demography, lifestyle and medical information. Multivariable logistic regression and generalised linear models were used to examine the association between alcohol consumption and both MetS and its medical components, respectively.

SETTING: Ningbo, China.

PARTICIPANTS: A total of 2853 adults >/= 20 years (44 % men) in this final analysis.

RESULTS: The prevalence of frequent alcohol drinkers and MetS was 29.9 % and 28.0 %, respectively. Significantly higher prevalence of MetS and mean values of medical components were found in the group of frequent alcohol drinkers with an exception for HDL-cholesterol, compared with less or non-alcohol drinkers. Frequent alcohol consumption was associated with higher odds of developing MetS and positively associated with medical components excepting waist circumference.

CONCLUSIONS: Frequent alcohol consumption contributed to a higher prevalence of MetS and unfavourable influence on MetS and its medical components among Chinese adults. A public health intervention on alcohol restriction is necessary for the prevention and control of the ongoing epidemic MetS.

23 September 2021 In 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, SETTINGS 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 78328 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.

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