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Microvascular complications of diabetes are those long-term complications that affect small blood vessels. These typically include diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy.

The current study examined whether various lifestyle behaviors such as non-smoking, normal body weight, physical activity, a healthy diet, and moderate consumption of alcoholic beverages could jointly affect these long-term complications of type 2 diabetics, and whether metabolic biomarkers (blood sugar control, systemic inflammation, blood lipids and liver function) could be improved. The results of this research with data from the UK Biobank study showed that type 2 diabetic patients adhering to a greater number of lifestyle habits had significantly less of these diabetic microvascular complications and suggested that 25% of these microvascular complications could have been avoided, if the type 2 diabetic patients had 4 or more healthy lifestyle behaviors. In addition, these favorable changes were mediated through improving the biomarkers of blood glucose control, inflammation, blood lipids and liver function.

For more information about this abstract, click here

 

Geng T, Zhu K, Lu Q, Wan Z, Chen X, Liu L, Pan A, Liu G. Healthy lifestyle behaviors, mediating biomarkers, and risk of microvascular complications among individuals with type 2 diabetes: A cohort study. PLoS Med. 2023 Jan 10;20(1):e1004135. doi: 10.1371/journal.pmed.1004135. PMID: 36626356; PMCID: PMC9831321.

It is long known that a Mediterranean dietary pattern with lots of fish, vegetables, nuts, and native olive oil is healthy. It is also known that alcoholic beverages are traditionally consumed in Mediterranean countries and contribute considerably to linked health benefits and a longer life expectancy. A Spanish study examined this phenomenon now more closely. 

The Mediterranean diet is one of the healthiest eating patterns. It has been shown that adhering to such a diet is associated with a longer life expectancy. One component of the Mediterranean diet is the regular moderate consumption of wine. Wine is indeed one component of the scores that are used to help assess the adherence to a Mediterranean dietary pattern. However, a Mediterranean drinking pattern consists of more than just the type of alcoholic beverage and the amount consumed.

A Spanish research team developed their own score to assess the adherence to the traditional Mediterranean alcohol drinking pattern (MADP).

Mediterranean Alcohol Drinking Pattern (MADP)-Score: 0-9 points

The score for a Mediterranean drinking pattern includes the following criteria:

  1. Moderate consumption: For women 5-25 g of alcohol/day and for men 10 – 50 g/day
    Preference for wine, at least 75% of the total amount of alcoholic beverages consumed
  2. Preference for red wine, as it is customary in Spain (and many other Mediterranean countries), at least 75% of the total amount consumed
  3. Consumption with the meals
  4. Low consumption of spirits (less than 25% of the total amount consumed)
  5. Consumption distributed throughout the week
  6. Avoidance of “binge drinking”, which is more than 5 drinks per occasion  

After analysing the questionnaires, the drinking pattern was evaluated:

  • Score < 3: low adherence to MADP
  • between 4-5: moderate adherence to MADP
  • between 6-9: high adherence to MADP

Participants with a low adherence to MADP served as the control group.

 

Those who drink wine regular with meals live the longest

In this prospective study, the data of 2226 - mostly male (82%) – university graduates from the Spanish university of Navarra were analysed. At the start of the study, the men were at least 50 and the women at least 55 years old.

This so-called SUN cohort (Seguimiento Universidad de Navarra) consisted of educated and highly motivated study participants and is not representative of the general population. Nevertheless, the results can be generalized based on biological plausibility. 

With regards to drinking pattern, the results showed that:

  • Within 14 years, those who do not or hardly adhere to a MADP show the highest mortality rate, especially related to cancer.
  • , both abstinence (mortality rate -40%) as well as a moderate MADP (-35%) perform better.  
  • The lowest mortality risk (-46%) was observed with a high adherence to a MADP. 

Lower cancer risk with high adherence to MADP

  • When only cancer deaths were considered in the analysis, a higher protective effect and a significant 62% reduction in the mortality risk was observed with high adherence to a MADP. The authors comment that theses results may seem contradictory to the available evidence on the harmful effects on cancer, however, these studies only consider the grams of alcohol consumed and not the drinking pattern as studied in this analysis. They further note that this result arises from comparison with the category of low adherence to the MADP and shows that moderate wine consumption with meals spread out over the week reduces the cancer mortality compared to both higher and occasional consumption.

The authors conclude that this publication reflects an important and applicable public health message: if you drink alcoholic beverages, follow the Mediterranean drinking pattern. For a longer life, it seems to be ideal to regularly consume wine at meals which is spread throughout the week and avoiding binge drinking.

 

Barbería-Latasa, M et al.: Mediterranean Alcohol-Drinking Patterns and All-Cause Mortality in Women More Than 55 Years Old and Men More Than 50 Years Old in the “Seguimiento Universidad de Navarra” (SUN) Cohort. Nutrients 2022;14:5310

For more information about this abstract, click here

 

23 November 2022 In Drinking Patterns 0 comment

Every year, one member state of the International Organisation of Vine and Wine (OIV) invites scientists from all over the world to present and discuss new research data. This year, the host was Mexico and Wine in Moderation (WiM) and the Deutsche Weinakademie (DWA) participated with a presentation.

Approximately 1200 wine and viticultural experts from all over the world followed the invitation of OIV (Organisation Internationale de la Vigne et du Vin) and came to Ensenada in Baja California, Mexico, where the 43rd congress took place from October 31st to November 4th. As representative of WiM, the Wine Information Council and DWA, Ursula Fradera, Scientific Coordinator, presented the future Wine in Moderation Educational tool for wine professionals as well as the topic “Wine consumption and cancer risk in context”.

 “Wine consumption and cancer risk in context”

The context is important

At the beginning of her talk on the topic of wine and cancer risk, Ursula Fradera emphasized that while existing research is largely consistent with regards to the harms of heavy/excessive drinking and binge drinking in terms of both cancer risk and other health problems, there are disparate messages regarding the safety of light to moderate consumption of wine/alcoholic beverages.

Most organizations advocate zero alcohol consumption to prevent various cancers. They argue that there is ‘no safe limit of alcohol’, mainly based on an increased cancer risk, these can often be found in modelling studies. However, in these modelling studies, important influencing factors for the cancer risk such as drinking pattern, type of alcoholic beverage and other lifestyle factors are not considered.

 Lifestyle factors – important influence on cancer risk

Since cancer is a multi-factorial disease, which takes a long time to develop, the cancer risk cannot be evaluated in isolation. Ms. Fradera explained that lifestyle factors such as eating and drinking patterns are important risk factors for cancer. Accordingly, the consumption of alcoholic beverages cannot be accurately evaluated in insolation from the other risk factors. The effect of alcohol on cancer risk will depend on the context, such as whether the alcoholic beverage is consumed with or without a meal, the type of foods consumed as well as smoking at the same time.

 According to the World Health Organisation (WHO) and the World Cancer Research Fund (WCRF), one third of the cancers could be prevented by adopting a healthy lifestyle (such as avoiding smoking, maintaining a normal body weight, being physically active, avoiding excessive consumption of alcoholic beverages and keeping a healthy dietary pattern). This therefore shows that the influence of alcohol cannot be evaluated in isolation. Indeed, when light to moderate consumption as well as the type of alcoholic beverage were assessed in the context of a Mediterranean Diet and a healthy lifestyle, the results were different, and no increased cancer risk was observed. 

Wine and Mediterranean-type eating pattern

The Mediterranean Diet (Med Diet) is considered as one of the healthiest diets in the world. The Mediterranean cuisine includes not only vegetables, fruit, fish, cheese, nuts and olive oil but also a glass of wine with the meal. Several meta-analyses confirm that a higher adherence to the Med diet is associated with a lower cancer risk. Wine provides large amounts of several bioactive compounds - polyphenols - that may be potentially responsible for some of the wine’s anti-cancer effects and the observed positive health effects of light to moderate wine consumption may be - at least in part - linked to the protective effects of specific bioactive ingredients in wine (polyphenols) as well as in the foods consumed, with higher abundance in the Mediterranean diet.

 Ms. Fradera concluded that considering the scientific evidence of wine/alcohol consumption in the context of the Mediterranean diet and a healthy lifestyle, no increased risk with light to moderate intake (for women up to 1.5 glasses of wine or up to 20 g of alcohol/day, for men: up to 2 glasses of wine or up to 30 g of alcohol/day) is observed. 

New education package for wine professionals – from responsible service to a sustainable consumption of wine

In a 2nd presentation, Ursula Fradera presented – on behalf of Nadia Frittella - the various modules of the new Wine in Moderation education tool for wine professionals which will be announced soon. She introduced the basics of the Wine in Moderation initiative and highlighted the fact that education of all wine professionals plays an important role for a sustainable and responsible consumption of wine. 

The many questions at the end of her presentation showed the enormous interest in this topic but also the need for education about sustainable wine consumption. More information about the new Wine in Moderation educational tool will be released next Spring.

Geng T, Zhu K, Lu Q, Wan Z, Chen X, Liu L, Pan A, Liu G. Healthy lifestyle behaviors, mediating biomarkers, and risk of microvascular complications among individuals with type 2 diabetes: A cohort study. PLoS Med. 2023 Jan 10;20(1):e1004135. doi: 10.1371/journal.pmed.1004135. PMID: 36626356; PMCID: PMC9831321.

 

The 2022 Global Burden of Disease (GBD) study (1) is a meta-analysis and modelling study, where 22 alcohol-related health risks in 204 countries were examined. Unlike the study results released in 2018, the alcohol-related health risks in every country were taken into account this time. The results show that the risks from the consumption of alcoholic beverages vary greatly depending on the disease, age, and region. The study confirms a J-shaped risk association between heart attack and stroke mortality – the main causes of death in the industrialised world – and the consumption of alcoholic beverages. The lowest risk was at 1-2 drinks/day for ischemic stroke and 3-4 drinks/day for the ischemic heart attack. 1 drink is the equivalent of 10 g of alcohol.

Globally and averaged for all regions of the world, all age groups and both men and women, the theoretical lowest risk for alcohol-related diseases is 0.5 drinks/day, however, at 1.5 drinks, the risk would be the same as with abstinence.

However, such “global“ calculations do not consider the cultural differences, lifestyle factors, drinking pattern, type of alcoholic beverage, the exactness of consumption levels and many other influencing factors;  these numbers can therefore not be applied to anyone.

The new GBD study demonstrates abundantly clear that the results depend considerably on the respective calculation methods, estimates and assumptions that were used. But the new modelling calculations confirm the previous data that young people do not have measurable health benefits from alcohol consumption; these benefits only show up from the age of 45 and older, when the age-related health risks start to increase.

According to the current calculations, a 45-year-old woman in Western Europe in the year 2020, for example, would have the lowest theoretical risk for an alcohol-related health problem with half a drink daily. However, she could also have one drink daily without having a higher risk than non-drinkers. In men of the same age, the respective lowest risk would also be at 0.5 drinks daily but with 1.4 drinks their risk would not be higher than an abstinent individual.

In contrast, the lowest risk of a 70-year-old woman would be at 0.7 drinks per day but with 4.2 drinks, she would have the same risk as a non-drinker in her age group. For a 70-year-old man, the respective number would be 0.7 drinks and up to 4.3 drinks per day.

Thus, study results show that a moderate consumption of alcoholic beverages for individuals above 40 years of age can provide health benefits, such as a lower risk of cardiovascular diseases and diabetes. The influence of alcohol on health is described by a J-shaped curve. Based on their results, the authors recommend drinking guidelines varying according to age and location.

 

GBD scientists correct their own data

The new Lancet publication (1) and the respective press release made the headlines. The reason was the quote of one of the authors: Dr. Emmanuela Gakidou (professor, Health Metrics Sciences at the Medical Faculty of the University of Washington): “Our message is simple: young people should not drink, but older people may benefit from drinking small amounts”. The same scientists contradict/correct their own data from the publication of 2018 (2), where the existence of a J-curve was denied and consequently, no safe level of alcohol existed.

 

Limitations of the study:

Already in 2018, the authors presented the limitations of their study:

  1. Estimation of sales data:

The actual alcohol consumption was not measured or received through questionnaires; it was estimated from sales data (illicit production/unrecorded consumption). This lack of raw data was corrected with comprehensive modelling of the data (alcohol consumption of tourists, stored alcohol which wasn’t consumed, etc.). 

  1. Drinking pattern, cultural context, eating pattern and lifestyle factors were not considered:

Drinking pattern were not considered. The study assumes that all individuals drink the same way (no differentiation between binge drinking and moderate regular consumption with the meals).

  1. No differentiation between alcoholic beverages:

The different health effect of distilled and fermented beverages because of the non-alcoholic compounds – polyphenols has not been considered.

  1. Data regarding alcohol-related accidents is restricted to the US.
  2. Lack of robust data about alcohol-related violence
  3. Lack of data of the age group < 15 years
  4. "End points" according to the “comparative risk assessment approach“ of the GBD study:

The 22 alcohol-related health risks are no medical end points (such as death, heart attack, stroke, diabetes complications), but associations. It is not possible to set these against each other.

  1. Relative vs. absolute risk:

To assess the health risk or impact, the absolute risk is necessary and not the relative risk. Relative risk is only suitable to compare the risk of non-drinkers and drinkers WITHIN an age group but not BETWEEN age groups.

 

References:

(1) GBD 2020 Collaborators, Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020, Lancet 2022, https://doi.org/10.1016/S0140-6736(22)00847-9

 For more information about this abstract, click here.

(2) GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7. Epub 2018 Nov 8. Erratum in: Lancet. 2019 Jun 22;393(10190):e44. PMID: 30496104; PMCID: PMC6227754.

 

 

 

(**) Definitions:

DALY (disability adjusted life years): lost years due to disability and death

NDE (non-drinker equivalent): measures the level of alcohol consumption at which the risk of health loss for a drinker is equivalent to that of a non-drinker; this NDE is considered as safe level of drinking.

TMREL (theoretical minimum exposure level) – lowest level of the curve, where the risk is the lowest.

Standard drink: 10g alcohol/day

 

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