The Relationship Between Alcohol Consumption, BMI, and Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies.
PubMed 37890103 · doi:10.2337/dc23-1015
What was done
A systematic review and multivariate dose-response meta-analysis was conducted across Medline, Embase, Web of Science, and one secondary data source to evaluate the relationship between alcohol consumption and type 2 diabetes mellitus (T2DM) by sex and BMI. The analysis included 55 cohort studies and one secondary source comprising 1,363,355 men (89,983 T2DM cases) and 1,290,628 women (57,974 T2DM cases), using random-effects models and comparing intake against lifetime abstainers.
What was found
In women, alcohol consumption exhibited a J-shaped association with T2DM risk, reaching a peak risk reduction of 31% (RR 0.69, 95% CI 0.64–0.74) at 16 g of pure alcohol per day compared with lifetime abstainers. The protective association ceased at intakes exceeding 49 g per day (RR 0.82, 95% CI 0.68–0.99). In men, no statistically significant association was observed across intake levels. When stratified by BMI, the protective association was observed only in overweight and obese women (BMI ≥25 kg/m²).
Why it matters
This meta-analysis clarifies prior conflicting evidence by demonstrating that apparent protective associations between moderate alcohol intake and lower T2DM incidence are restricted to women with higher BMI rather than the general population.
Limits
The meta-analysis depended on study-level aggregate data rather than individual participant data. Several included studies relied on self-reported alcohol intake and self-reported diabetes diagnoses, and original cohorts failed to account for temporal changes in drinking habits over time.
Cited by
- supports When only studies comparing against lifelong non-drinkers were analyzed, the protective effect of alcohol against type 2 diabetes disappeared for men and was only observed in women.