The Relationship Between Alcohol Consumption, BMI, and Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis

BACKGROUND 

Moderate alcohol use may be associated with lower risk of type 2 diabetes mellitus (T2DM). Previous reviews have reached mixed conclusions. PURPOSE To quantify the dose-response relationship between alcohol consumption and T2DM, accounting for differential effects by sex and BMI. 

DATA SOURCES 

Medline, Embase, Web of Science, and one secondary data source. 

STUDY SELECTION 

Cohort studies on the relationship between alcohol use and T2DM. 

DATA EXTRACTION 

Fifty-five studies, and one secondary data source, were included with a combined sample size of 1,363,355men and 1,290,628 women, with 89,983 and 57,974 individuals, respectively, diagnosed with T2DM. 

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% (relative risk [RR] 0.69, 95% CI 0.64–0.74) at an intake of 16 g of pure alcohol per day compared with lifetime abstainers. The protective association ceased above 49 g per day (RR 0.82, 95% CI 0.68–0.99). For men, no statistically significant relationship was identified. When results were stratified by BMI, the protective association was only found in overweight and obese women. 

LIMITATIONS 

Our analysis relied on aggregate data. We included some articles 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 ≥25 kg/m ². Our findings allow for a more precise prediction of the sexspecific relationship between T2DM and alcohol use, as our results differ from those of previous studies.