Crandall Jill P, Polsky Sarit, Howard Andrea A, Perreault Leigh, Bray George A, Barrett-Connor Elizabeth, Brown-Friday Janet, Whittington Tracy, Foo Sandra, Ma Yong, Edelstein Sharon L
Albert Einstein College of Medicine, Bronx, NY, USA.
Am J Clin Nutr. 2009 Sep;90(3):595-601. doi: 10.3945/ajcn.2008.27382. Epub 2009 Jul 29.
Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes in the general population, but little is known about the effects in individuals at high risk of diabetes.
The objectives were to determine associations between alcohol consumption and diabetes risk factors and whether alcohol consumption was a predictor of incident diabetes in individuals enrolled in the Diabetes Prevention Program (DPP).
DPP participants (n = 3175) had impaired glucose tolerance (2-h glucose: 7.8-11.1 mmol/L), elevated fasting glucose (5.3-7.0 mmol/L), and a body mass index (in kg/m(2)) > or =24. Participants were randomly assigned to placebo, metformin, or lifestyle modification and were followed for a mean of 3.2 y. Alcohol intake was assessed at baseline and year 1 by using a semiquantitative food-frequency questionnaire. Diabetes was diagnosed by annual oral-glucose-tolerance testing and semiannual fasting plasma glucose measurement.
Participants who reported higher alcohol consumption tended to be male, older, white, and less obese and to have a higher calorie intake and a higher HDL-cholesterol concentration. Higher alcohol consumption was associated with lower insulin secretion at any level of insulin sensitivity. We found lower incidence rates of diabetes with higher alcohol consumption in the metformin (P < 0.01 for trend) and lifestyle modification (P = 0.02 for trend) groups, which remained significant after adjustment for multiple baseline covariates. No similar association was observed in the placebo group.
Despite overall low rates of alcohol consumption, there was a reduced risk of incident diabetes in those who reported modest daily alcohol intake and were assigned to metformin or lifestyle modification. Moderate daily alcohol intake is associated with lower insulin secretion-an effect that warrants further investigation. This trial was registered at clinicaltrials.gov as NCT00038727.
在普通人群中，适度饮酒与2型糖尿病风险降低有关，但对于糖尿病高危个体的影响知之甚少。
确定饮酒与糖尿病危险因素之间的关联，以及饮酒是否是糖尿病预防计划（DPP）参与者发生糖尿病的预测因素。
DPP参与者（n = 3175）有糖耐量受损（2小时血糖：7.8 - 11.1 mmol/L）、空腹血糖升高（5.3 - 7.0 mmol/L）且体重指数（kg/m²）≥24。参与者被随机分配到安慰剂组、二甲双胍组或生活方式干预组，并随访平均3.2年。在基线和第1年通过使用半定量食物频率问卷评估酒精摄入量。通过年度口服葡萄糖耐量试验和半年一次的空腹血糖测量诊断糖尿病。
报告饮酒量较高的参与者往往为男性、年龄较大、为白人、肥胖程度较低，且热量摄入较高、高密度脂蛋白胆固醇浓度较高。在任何胰岛素敏感性水平下，较高的酒精摄入量与较低的胰岛素分泌相关。我们发现，在二甲双胍组（趋势P < 0.01）和生活方式干预组（趋势P = 0.02）中，酒精摄入量较高者糖尿病发病率较低，在对多个基线协变量进行调整后仍具有显著性。在安慰剂组未观察到类似关联。
尽管总体酒精摄入量较低，但报告每日适度饮酒且被分配到二甲双胍组或生活方式干预组的参与者发生糖尿病的风险降低。每日适度饮酒与较低的胰岛素分泌相关——这一效应值得进一步研究。该试验在clinicaltrials.gov注册，注册号为NCT00038727。
