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REPLY
Alcohol Use and Diabetes Mellitus
Andrea A. Howard, MD, MS;
Julia H. Arnsten, MD, MPH; and
Marc N. Gourevitch, MD, MPH
7 September 2004 | Volume 141 Issue 5 | Page 409
IN RESPONSE:
Sone and colleagues report a lack of association between baseline alcohol consumption and CHD incidence among a cohort of Japanese patients with diabetes. These preliminary findings may suggest that racial or ethnic differences are playing an unmeasured role in CHD incidence. However, because nearly half of Sone and colleagues' patients were randomly assigned to a lifestyle modification program that included abstinence from alcohol (1), it is difficult to have confidence in their conclusions without data on alcohol consumption during follow-up.
Drs. Mascitelli and Pezzetta correctly point out that we did not discuss anti-inflammatory effects of alcohol as a mechanism for the association between moderate alcohol consumption and decreased incidence of diabetes and of CHD in persons with diabetes. Instead, we focused on more established risk factors, including insulin resistance and high-density lipoprotein cholesterol levels. Emerging data suggest that inflammation may play a role in the pathogenesis of type 2 diabetes mellitus and cardiovascular disease (2). While the cross-sectional studies cited by Mascitelli and Pezzetta show an association between light to moderate alcohol consumption and lower levels of inflammatory markers, other studies have not found an association (3), and a causal relationship has not been established. Further research is warranted to determine whether alcohol affects systemic inflammation and whether this partially explains the association between moderate alcohol consumption and decreased risk for both diabetes and diabetes-related cardiovascular disease.
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Author and Article Information
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From Montefiore Medical Center, Bronx, NY 10467, and New York University School of Medicine, New York, NY 10016.
1. Sone H, Katagiri A, Ishibashi S, Abe R, Saito Y, Murase T, et al. Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Horm Metab Res. 2002;34:509-15. [PMID: 12384828].[Medline]
2. Pradhan AD, Ridker PM. Do atherosclerosis and type 2 diabetes share a common inflammatory basis? [Editorial] Eur Heart J. 2002;23:831-4. [PMID: 12042000].[Free Full Text]
3. Woodward M, Rumley A, Lowe GD, Tunstall-Pedoe H. C-reactive protein: associations with haematological variables, cardiovascular risk factors and prevalent cardiovascular disease. Br J Haematol. 2003;122:135-41. [PMID: 12823355].[Medline]
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Reviews
Effect of Alcohol Consumption on Diabetes Mellitus: A Systematic Review
Andrea A. Howard, Julia H. Arnsten, AND Marc N. Gourevitch
- Annals 2004 140: 211-219.
[ABSTRACT][SUMMARY][Full Text]
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