Trajectories of alcohol consumption prior to the diagnosis of type 2 diabetes: a longitudinal case-cohort study

The Effect of Body Adiposity and Alcohol Consumption on Serum Uric Acid: A Quantile Regression Analysis Based on the China National Health Survey

Adiposity and alcohol consumption are reported to be associated with a higher level of serum uric acid (SUA), but whether their effect differs on SUA percentile distribution is still unclear. In this study, we aimed to investigate how alcohol intake and body fat percentage (%BF) integrated with body mass index (BMI) influence the distribution of SUA in Chinese adults. Data from the China National Health Survey (CNHS) which included adults from 10 provinces of China were used (n = 31,746, aged 20–80 years, 40% male). %BF and BMI were integrated into eight expanded body composition groups to understand how excess body adiposity affects the distribution of SUA in the populational level. Self-report alcohol intake information was collected by face-to-face questionnaire interview. Quantile regression (QR) was used to analyze the data. We found that adiposity and alcohol consumption were associated with SUA, especially at the upper percentile in both sexes. In obese men, the QR coefficients at the 75th and 95th percentiles were 74.0 (63.1–84.9) and 80.9 (52.5–109.3) μmol/L, respectively. The highest quartile of %BF in men had a 92.6 (79.3–105.9) μmol/L higher SUA levels at its 95th percentile than the 5th quartile (p < 0.001). Compared with normal or underweight with the lowest %BF group (NWBF1), the obesity-highest %BF group (OBBF4) had the strongest positive effect on SUA, especially at the higher percentile of SUA. In BMI-defined normal or underweight participants, a higher quartile of %BF had greater effect size in all SUA percentiles. In men, current alcohol drinking had the strongest effect at the 95th percentile of SUA (QR coefficient: 31.8, with 95% CI: 22.6–41.0) comparing with 14.5, 95% CI of 8.4 to 20.6 in the 5th SUA percentile. High risk of alcohol consumption had a greater effect on SUA, especially in the higher SUA percentile. The observation of stronger association at the higher percentile of SUA suggests that decreasing body adiposity and alcohol intake at the populational level may shift the upper tails of the SUA distributions to lower values, thereby reducing the incidence of hyperuricemia.

Trajectories of alcohol consumption up to 30 years before and after the diagnosis of cardiovascular diseases: a longitudinal case-control study of 12 502 participants

BACKGROUND

To examine the longitudinal trajectories of alcohol consumption prior to and following the diagnosis of cardiovascular diseases (CVD).

METHODS

We conducted a case-control study of 2501 incident cases of angina, myocardial infarction or stroke and 10 001 matched controls without the condition. Repeated measures of alcohol were centred on the date of diagnosis, spanning up to 30 years before and after CVD onset. Mean trajectories of weekly consumption were estimated using growth curve models.

RESULTS

For trajectories prior to diagnosis, mean volume of alcohol consumed among male cases increased over time, peaking at around 8 years before diagnosis at 95 (95% CI 60 to 130) g/week and declining afterwards. Trajectories following diagnosis showed mean consumption in male cases dropped from 87 (95% CI 54 to 120) g/week to 74 (95% CI 45 to 102) g/week after the date of diagnosis and then slightly rose to 78 (95% CI 40 to 116) g/week at the subsequent 3.5 years, before gradually declining to 31 (95% CI 2 to 61) g/week at 30 years after diagnosis. Mean consumption among female cases remained stable prior to diagnosis (at about 30 g/week), fell marginally to 25 (95% CI 20 to 30) g/week after the date of diagnosis and kept decreasing afterwards. Similar trajectories were obtained in cases and controls.

CONCLUSIONS

This is the first attempt to show how patients with CVD change their drinking volume over such a wide time span. Future research needs to establish insight into drinking behaviour in other ways (such as frequency and context) and address the impact of changes in drinking on patients with CVD.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort

Background

Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset.

Methods

Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes.

Results

T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (OR_adj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI).

Conclusion

ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Eighteen-year alcohol consumption trajectories and their association with risk of type 2 diabetes and its related factors: the China Health and Nutrition Survey

AIMS/HYPOTHESIS

Alcohol consumption levels frequently fluctuate over the life course, but studies examining the association between alcohol consumption trajectories and type 2 diabetes are limited. This study aims to investigate the association of alcohol consumption trajectories with the risk of type 2 diabetes and its related factors.

METHODS

Weighted longitudinal data were obtained for 12,186 adults who completed a questionnaire about alcohol consumption and diabetes status as part of the China Health and Nutrition Survey (1993-2011). Participants were designated into subgroups based on alcohol consumption trajectory, and subgroup analyses included 5436 individuals who were tested for specified diabetes-related factors. Light alcohol consumption was defined as fewer than seven standard drinks per week; moderate as 7-21 drinks per week; and heavy as more than 21 drinks per week. Latent class trajectory modelling was used to identify different alcohol consumption trajectories by sex. Multivariate Cox regression models and general linear regression models were used to assess association of trajectories with type 2 diabetes and its related factors.

RESULTS

Compared with stable abstainers (individuals who never drank alcohol), two trajectories in men showing reduction to moderate or light levels after heavy alcohol consumption during early adulthood were significantly associated with increased risk of type 2 diabetes (HR 1.66 [95% CI 1.18, 2.33]; HR 1.93 [95% CI 1.01, 3.70]), while no significant association between trajectories and risk of type 2 diabetes was observed in women (p _{for trend} = 0.404). Triacylglycerol, HDL-cholesterol (HDL-C), uric acid and high sensitivity C-reactive protein were significantly higher in these two trajectories than other trajectories in men (all p < 0.05), while only HDL-C showed significant increasing trends in women. Trajectories showing light-stable, or increase to moderate, levels were not associated with reduced risk of type 2 diabetes.

CONCLUSIONS

This study indicated that heavy alcohol consumption in early adulthood is significantly associated with increased risk of type 2 diabetes and higher levels of its biomarkers throughout adulthood in men. Gradually reducing alcohol consumption to moderate levels may not make a difference, which demonstrates the importance of alcohol intervention strategies in early adulthood. Although association between alcohol consumption and increased HDL-C levels has been observed, the results of this study did not support the hypothesis regarding the protective effect of moderate alcohol consumption on risk of type 2 diabetes in the Asian population.

DATA AVAILABILITY

Data from China Health and Nutrition Survey was used in this study, which can be downloaded at www.cpc.unc.edu/projects/china .