In the International Organization of Vine and Wine is one of the areas of research focuses on the influence of wine and products from grapes on human health. The expert group “Health, food and wine” is headed by the representative of Moldova, Director of the National Bureau of grapes and wine George Arpentin. Scientists in the framework of the OIV summarized all the studies that were done in different countries about the influence of wine and other alcoholic beverages on the development of type II diabetes (non-insulin dependent diabetes).
Why is it necessary?
The prevalence of diabetes mellitus is escalating worldwide. The disease mainly develops in adults after the age of 45 years. Type 2 diabetes mellitus, which accounts for more than 85% of all incidences of diabetes mellitus, is a disorder characterized by resistance to the effects of circulating insulin. This disorder leads to a substantial increase in risk of cardiovascular disease, which is the major cause of mortality, accounting for up to 80% of all deaths in individuals with type 2 diabetes mellitus.
The age-adjusted relative risk of death due to cardiovascular disease is approximately three-fold higher than in the general population. Approximately 30 to 60% of diabetics have hypertension. In addition, individuals with type 2 diabetes mellitus have coexistent lipid disorders characterized by increased blood triglycerides and reduced HDL-cholesterol, as well as hemostatic and fibrinolytic abnormalities similar to individuals with, or at risk of, cardiovascular disease.
In addition, pre-diabetic individuals, which is defined as having an abnormally high blood glucose level (hyperglycemia), are at higher risk of developing type 2 diabetes in the following five years. There is strong evidence from international, randomized controlled trials that type 2 diabetes mellitus can be prevented in many of these high-risk individuals through weight loss, and changes to diet and exercise.
Alcoholic beverages and diabetes
Apart from obesity and physical inactivity there are few well-established modifiable risk factors for type 2 diabetes mellitus. Recent evidence suggests, however, that alcohol consumption may be a potentially modifiable risk factor for type 2 diabetes mellitus. A J-shaped relationship has been observed between level of alcohol consumption and risk of developing diabetes in both men and women, where regular moderate alcohol consumption is associated with a 30-40% reduced risk of type 2 diabetes.
The most recent meta-analysis of 20 cohort suggested that for women, the risk of developing type 2 diabetes mellitus was observed to be most reduced at 24 g alcohol/day, with a risk reduction of 40% compared with lifetime abstainers. Alcohol consumption remained protective until approximately 50 g/day.
For men, the protective effect of alcohol consumption was greatest at 22 g/day, with the risk of diabetes being 0.87 times that of lifetime abstainers, and remained protective until consumption of 60 g/day. Therefore, for both women and men, the protective effect of alcohol consumption on incident type 2 diabetes mellitus was greatest with the consumption of approximately two drinks per day. Similarly, for both men and women, higher amounts of consumption (above 50 g/day for women and 60 g/day for men) were no longer protective and increased the risk for diabetes. Indeed, as in the general population, there is also a decrease in cardiovascular risk with moderate alcohol consumption in type 2 diabetics.
Wine and diabetes
A review of the literature provided 22 individual studies post 2000 which have specifically assessed the effect of wine consumption on the risk of type 2 diabetes. Of these, 14 assessed the risk of developing type 2 diabetes mellitus and a further six assessed the risk of microvascular and other complications associated with type 2 diabetes mellitus as well as all-cause mortality. Population groups from at least nine different countries were included in the studies.
All studies consistently observed a decreased risk of developing type 2 diabetes mellitus with moderate wine consumption in both men and women, although in some studies a decreased risk was observed at different amounts of wine consumption. The optimal amount of wine appeared to be approximately two drinks/day, where a standard drink in Australia is considered to be 10 g alcohol. Wine consumed with food, and especially as an integral component of Mediterranean-type diet, was inversely associated with type 2 diabetes mellitus. The inverse association was particularly observed for overweight and obese individuals at higher risk of developing the disease, in middle-aged individuals and in elderly individuals.
Above moderate amounts, the risk of developing type 2 diabetes mellitus generally increased with wine consumption similar to the consumption of other alcoholic beverages, and likely related to a dose dependent elevation of blood glucose levels. The increased risk with the heavy consumption of alcoholic beverages may also reflect increases in body weight and changes to the plasma concentration of certain fats such as triglycerides, as well as increases in blood pressure.
Concerning the effect of wine on risk of pre-diabetes, a reduced risk of progressing from normal to impaired fasting glucose and impaired glucose tolerance and to type 2 diabetes mellitus was observed with light to moderate wine consumption in women, where high wine consumption increased the risk of abnormal glucose regulation in men.
These 20 cohort studies did not necessarily differentiate, however, between beer, wine and spirits and an association with type 2 diabetes mellitus. Microvascular and other complications of type 2 diabetes mellitus were also inversely associated with regular moderate wine consumption. Beulens et al. (2010), for example, suggested that one to two drinks/day as wine was associated with a reduced risk of vascular-related deaths such as from coronary heart disease, myocardial infarction and stroke as well as non-fatal events including amputations in diabetic individuals at high risk of cardiovascular disease compared to abstainers.
The literature also suggested that wine consumption may be more protective than beer and spirits for preventing type 2 diabetes mellitus, as well as the microvascular and other complications of type 2 diabetes mellitus.
Interestingly, Rasouli et al. 2012 also observed that moderate wine consumption also decreased the risk of autoimmune diabetes. Autoimmune diabetes is caused by cellular-mediated autoimmune damage of the insulin-producing pancreatic β-cells and includes both Type 1 diabetics and those adults with latent onset autoimmune diabetes. The moderate consumption of alcoholic beverages such as wine has been previously associated with a reduced risk of other autoimmune diseases such as rheumatoid arthritis.
As acknowledged by the World Health Organization (WHO) in 2014, regular moderate wine consumption is causally linked to reduced risk of type 2 diabetes. This has been observed for both genders and for individuals with a low or high body mass index. Conversely, heavy consumption appears to increase the risk of type 2 diabetes mellitus, although sample sizes generally have been too small to draw firm conclusions.
The WHO’s Global Status Report on Alcohol and Health – 2014 edition clearly states that for diabetes mellitus “a dual relationship exists, whereby a low-risk pattern of drinking may be beneficial while heavy drinking is detrimental”. It also states that “for diabetes mellitus, the alcohol attributable fraction (AAF) was negative, meaning that, overall, alcohol consumption exerts a beneficial effect on this disease”.
There are, however, specific areas of research that warrant further study as only approximately 30 to 50 percent of wine’s protective effects on diabetes can be linked to the biomarkers studied to date, such as its overall effect on insulin sensitivity.
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