Alcohol

- NHANES III
- Defined as having diabetes if answers to NHANES III diabetes questionnaire indicated they had been told they had diabetes and had not been pregnant at the time.
Recruitment
- NHANES III multi-stage stratified random sample of the civilian non-institutionalized population of the US, conducted 1988 to 1994. About 32,000 residients with oversampling of youths seniors, and minorities.
Design
- Grouped number of beverage drinks per month into four categories: None, one to 29, 30 to 59, and 60 or more. There were fewer patients with diabetes who consumed higher amounts of alcoholic beverages and regular soda (N<30), the higher two categories were combined (≤ drinks per month) for these beverages.
Statistical Analysis
- Linear regression and other methods were used for clustered data to examine the assocaition of hbA1c levels with self-reported intake of carbonated drinks, alcohol, coffee, tea juices and milk, using Sudaan 8.0 software.
Timing of Measurements
- Food frequency questionnaire, one-day dietary recall, diabetes questionnaire and measurement of serum HbA1c.
Initial N
- 32,000 NHANES III US conducted 1988 to 1994, including 14,900 adults. Of these, 1,024 reported a physician's diagnosis of diabetes.
- 581 women, 443 men
- 236 aged 18 to 49 years
- 495 aged 50 to 64 years
- 393 aged 65 to 75 years
- 303 non-Hispanic white subjects
- 326 African-Americans
- 364 Mexican-Americans
- 31 of "other" race.
Age
- 18 to 75 years.
Ethnicity
- Youths
- Seniors
- Minorities.
Characteristics of Sample
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14,900 adults: Of these, 1,024 reported a physician's diagnosis of diabetes.
- 581 women, 443 men
- 236 aged 18 to 49 years
- 495 aged 50 to 64 years
- 393 aged 65 to 75 years
- 303 non-Hispanic white subjects
- 326 African-Americans
- 364 Mexican-Americans
- 31 of "other" race.
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Persons with diabetes drank significantly less alcohol than those without diabetes (P< 0.001), about half the amount of beer, wine and hard liquor.
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Adults with diabetes consumed a mean of 30 diet sodas per month, significantly more than the 11 diet sodas per month in those without diabetes.
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Persons with diabetes drank significantly less regular soda than those without diabetes (three vs. 17 sodas per month)
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Persons with and without diabetes reported drinking similar amounts of caffeinated coffee and tea, citric juices and other juices.
Diabetes | No Diabetes | P-Value | |
Diet Soda | 30.4 (2.6) | 11.1 (0.4) | <0.0001 |
Regular Soda | 3.0 (0.60 | 17.0 (0.6) | <0.0001 |
Total Soda | 33.4 (2.7) | 28.2 (0.7) | <0.0001 |
Beer | 2.1 (0.4) | 5.3 (0.2) | <0.0001 |
Wine | 0.8 (0.2) | 1.6 (0.1) | 0.0007 |
Hard Liquor | 1.1 (0.4) | 2.0 (0.1) | 0.06 |
Total Alcohol | 4.8 (0.8) | 8.9 (0.3) | <0.0001 |
Caffeinated Coffee | 36.0 (4.7) | 35.0 (1.1) | 0.43 |
Caffeinated Tea | 10.8 (1.2) | 12.5 (0.8) | 0.39 |
Citric Juice | 14.0 (1.1) | 13.1 (0.3) | 0.76 |
Other Juices | 5.7 (0.6) | 6.9 (0.2) | 0.10 |
Milk | 25.1 (1.2) | 22.5 (0.5) | 0.013 |
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Compared with non-drinkers, subjects who had 30 or more drinks per month of alcohol had mean HbA 1c levels of 1.2 units less (P<0.001) in persons with diabetes and 0.2% less (P<0.001) in persons without diabetes.
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In persons with diabetes, the HbA1c level was associated positively with consumption of diet soda (R=0.14, P=0.025) but not regular soda (R=0.08, P>0.10). In adults with diabetes who drank no diet soda, mean HBA1c level was greater by 0.4% in those who drank some (one to 29 drinks per month), greater by 0.8% in those who drank 30 to 59 diet sodas per month and greater by 0.7% in those who drank 60 or more per month.
Drinks per Month | ||||||
Beverage | Status | None | One to 29 | 30 to 59 | ≥60 | P (Trend) |
Diet Soda | Diabetes | 7.3 | 7.7 | 8.0 | 8.2 | 0.0005 |
No Diabetes | 5.2 | 5.2 | 5.2 | 5.2 | 0.33 | |
Caffeinated Coffee | Diabetes | 7.7 | 7.8 | 7.7 | 8.0 | 0.39 |
No Diabetes | 5.2 | 5.2 | 5.2 | 5.3 | 0.0001 | |
Caffeinated Tea | Diabetes | 7.8 | 7.8 | 7.8 | 7.8 | 0.95 |
No Diabetes | 5.2 | 5.2 | 5.3 | 5.3 | 0.0007 | |
Citric Juice | Diabetes | 7.7 | 8.0 | 7.6 | 8.4 | 0.26 |
No Diabetes | 5.2 | 5.2 | 5.2 | 5.1 | 0.004 | |
Other Juices | Diabetes | 7.7 | 8.0 | 8.0 | 7.1 | 0.51 |
No Diabetes | 5.2 | 5.2 | 5.2 | 5.2 | 0.63 | |
Milk | Diabetes | 7.3 | 7.6 | 8.1 | 8.0 | 0.10 |
No Diabetes | 5.2 | 5.2 | 5.2 | 5.2 | 0.14 | |
Regular Soda | Diabetes | 7.8 | 7.8 | 7.8 | a | 0.88 |
No Diabetes | 5.2 | 5.2 | 5.2 | 5.3 | 0.011 | |
Wine | Diabetes | 7.9 | 7.2 | 6.5 | a | 0.016 |
No Diabetes | 5.2 | 5.2 | 5.1 | 4.7 | 0.00096 | |
Beer | Diabetes | 7.9 | 7.6 | 6.8 | a | 0.054 |
No Diabetes | 5.2 | 5.2 | 5.1 | 5.1 | 0.09 | |
Hard Liquor | Diabetes | 7.9 | 7.2 | 6.7 | a | 0.017 |
No Diabetes | 5.2 | 5.2 | 502 | 5.1 | 0.022 | |
Total Alcohol | Diabetes | 8.0 | 7.5 | 6.7 | a | 0.0015 |
No Diabetes | 5.3 | 5.2 | 5.2 | 5.1 | 0.0002 |
Limitations
- Cross-sectional and cannot make any conclusions about the direction of causality between glucose control and beverage consumption
- Assessment of beverage consumption was through self-reporting
- Food frequency questionnaire had no specifications about portion size
- Limited by survey conducted 10 years ago.
This study shows an inverse cross-sectional association of intake of alcoholic beverages with glucose control in American adults with diabetes and a detrimental association of diet soda consumption with glucose control. These findings indicate the need to investigate further the effect of beverage choice on glucose control by using prospective studies.
University/Hospital: | Dartmouth Medical School |
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | No | |
2. | Was the selection of study subjects/patients free from bias? | No | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | No | |
2.2. | Were criteria applied equally to all study groups? | N/A | |
2.3. | Were health, demographics, and other characteristics of subjects described? | No | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | Yes | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | N/A | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | Yes | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | No | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | No | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | Yes | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | N/A | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | No | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | No | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | No | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | No | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | No | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | Yes | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | No | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | N/A | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | N/A | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | No | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | Yes | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | No | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | No | |
7.7. | Were the measurements conducted consistently across groups? | Yes | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | Yes | |
8.6. | Was clinical significance as well as statistical significance reported? | No | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | No | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | N/A | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |