Service Endocrinologie-Diabétologie, CHU Rennes, Université Rennes 1, INSERM UMR 991, Rennes, France.
Diabetologia. 2012 Dec;55(12):3228-37. doi: 10.1007/s00125-012-2701-3. Epub 2012 Aug 31.
AIMS/HYPOTHESIS: Moderate alcohol consumption is associated with a reduced risk of type 2 diabetes with a stronger effect in women. As the underlying mechanisms remain poorly characterised, we investigated its relationship with insulin resistance, insulin secretion, clearance of insulin and glucagon concentration.
One-thousand two-hundred and seventy-six non-diabetic individuals from the RISC (relationship between insulin sensitivity and cardiovascular disease) study without high alcohol consumption were studied; all had a euglycaemic-hyperinsulinaemic clamp and an OGTT with assessment of insulin sensitivity, secretion and clearance.
Alcohol consumption was positively associated with insulin sensitivity in women (β = 0.15, p ( trend ) = 0.005) and in men (β = 0.07, p ( trend ) = 0.07) after controlling for age, centre, waist, smoking and physical activity. In women, this association persisted after adjustment for adiponectin but was attenuated after controlling for HDL-cholesterol, suggesting that part of the protection is related to a higher HDL-cholesterol concentration. Higher alcohol consumption was associated with lower basal insulin secretion in women only (β = -0.10, p ( trend ) = 0.004) and this association persisted after adjustment for insulin sensitivity. In men, increasing alcohol consumption was associated with enhanced insulin clearance and increased fasting NEFA concentrations, independently of insulin sensitivity. Fasting glucagon decreased with increasing alcohol in women only (abstainers 9.2 ± 4.4; <28 g/week 8.6 ± 4.0; 28-64 g/week 8.1 ± 3.7; >64 g/week 7.5 ± 3.1 pmol/l; p ( trend ) = 0.01).
CONCLUSIONS/INTERPRETATION: Light-to-moderate alcohol consumption was associated in healthy women with enhanced insulin sensitivity, reduced basal insulin secretion rate and lower fasting plasma glucagon concentration, providing consistent mechanisms for the reduced risk of diabetes.
目的/假设：适量饮酒与 2 型糖尿病风险降低相关，且对女性的影响更为显著。由于其潜在机制尚不清楚，我们研究了其与胰岛素抵抗、胰岛素分泌、胰岛素清除率和胰高血糖素浓度的关系。
本研究纳入了来自 RISC（胰岛素敏感性与心血管疾病的关系）研究的 1276 名非糖尿病个体，他们均无过量饮酒史，所有个体均接受了正常血糖高胰岛素钳夹试验和口服葡萄糖耐量试验，以评估胰岛素敏感性、分泌和清除率。
在调整年龄、中心、腰围、吸烟和体力活动后，饮酒与女性（β=0.15，p（趋势）=0.005）和男性（β=0.07，p（趋势）=0.07）的胰岛素敏感性呈正相关。在女性中，这种相关性在调整脂联素后仍然存在，但在控制高密度脂蛋白胆固醇后则减弱，表明部分保护作用与较高的高密度脂蛋白胆固醇浓度有关。在女性中，仅发现较高的饮酒量与较低的基础胰岛素分泌相关（β=-0.10，p（趋势）=0.004），且这种相关性在调整胰岛素敏感性后仍然存在。在男性中，随着饮酒量的增加，胰岛素清除率增加，空腹游离脂肪酸浓度升高，且与胰岛素敏感性无关。仅在女性中，随着饮酒量的增加，空腹胰高血糖素降低（不饮酒者 9.2±4.4；每周饮酒 28-64 克者 8.6±4.0；每周饮酒 64-108 克者 8.1±3.7；每周饮酒>108 克者 7.5±3.1 pmol/L；p（趋势）=0.01）。
在健康女性中，适量饮酒与胰岛素敏感性增强、基础胰岛素分泌率降低和空腹血浆胰高血糖素浓度降低相关，为糖尿病风险降低提供了一致的机制。
