American Diabetes Association
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The relationship between alcohol consumption, body mass index and type 2 diabetes: A systematic review and dose-response meta-analysis

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posted on 2023-10-27, 17:56 authored by Laura Llamosas-Falcón, Jürgen Rehm, Sophie BrightSophie Bright, Charlotte BuckleyCharlotte Buckley, Tessa Carr, Carolin KilianCarolin Kilian, Aurélie M. Lasserre, Julia M Lemp, Yachen Zhu, Charlotte ProbstCharlotte Probst

Background: Moderate alcohol use may be associated with lower risk of type 2 diabetes (T2DM). Previous reviews have reached mixed conclusions.

Purpose: Quantify the dose-response relationship between alcohol consumption and T2DM, accounting for differential effects by sex and BMI.

Data Sources: Systematic review searching Medline, Embase, Web of Science, and one secondary data source.

Study Selection: Cohort studies on the relationship between alcohol use and T2DM.

Data Extraction: 55 studies, and one secondary data source, were included with a combined sample size of 1,363,355 men and 1,290,628 women, and 89,983 and 57,974 cases, respectively.

Data Synthesis: Multivariate dose-response meta-analytic random-effect models were used. For women, a J-shaped relationship was found with a maximum risk reduction of 31% (RR 0.69, 95% CI 0.64-0.74) at an intake of 16 grams of pure alcohol per day compared to lifetime abstainers. The protective association ceased above 49 grams per day (RR 0.82, 95% CI 0.68-0.99). For men, no statistically significant relationship was identified. When stratifying by BMI, the protective association was only found in overweigh and obese women.

Limitations: Our analysis relied on aggregate data, we included some papers that determined exposure and cases via self-report and the studies did not account for temporal variations in alcohol use.

Conclusions: The observed reduced risk seems to be specific to women in general and women with a BMI above 25 kg/m2. Our findings allow for a more precise prediction of the sex-specific relationship between T2DM and alcohol use as our results differ from previous studies.


Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA028009. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


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