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1 University of New Mexico School of Medicine, Albuquerque.
2 Department of Internal Medicine
3 Aging and Genetic Epidemiology Program
4 Department of Pathology, University of New Mexico School of Medicine, Albuquerque.
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Abstract |
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Methods. A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, aged 
65 years, undergoing a home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included a history of frequency, type, and quantity of alcohol ingested. Serum samples were obtained after an overnight fast and 2 hours after ingestion of 75 grams of glucose for determination of glucose and insulin levels. Height and weight was measured for determination of body mass index.
Results. Participants who consumed alcohol daily had significantly lower fasting and 2-hour postglucose serum insulin concentrations compared with those who abstained from alcohol intake, when adjusted using linear logistic regression models for serum glucose concentration, gender, ethnicity, age, and body mass index.
Conclusions. Abstainers with their relative hyperinsulinemia appear to be more insulin resistant than daily moderate drinkers. This difference in insulin sensitivity may explain the lower prevalence of diabetes in drinkers compared with abstainers observed in various epidemiological studies.
Differences in insulin sensitivity (resistance) could explain the differences in prevalence rates of type 2 diabetes mellitus between drinkers and nondrinkers. Using various measures of insulin sensitivity (fasting insulin, postglucose load insulin, fasting insulin resistance index, and homeostasis models), several studies (8–11) suggest that moderate drinkers are more insulin sensitive than nondrinkers. Kiechl and colleagues (11) reported an inverse linear relationship between alcohol intake and insulin resistance, measuring fasting plasma insulin, postload insulin, and homeostasis models to quantify insulin resistance, adjusting for differences in gender, BMI, exercise, smoking, medications, and diet.
Previous studies have examined the relationships between alcohol intake, the prevalence of diabetes mellitus, and insulin sensitivity (resistance) in younger subjects. The New Mexico Elder Health Survey (NMEHS) was a study of health and health-related issues conducted between 1993 and 1995 on nearly equal numbers of elderly (aged 65 years) Hispanic and non-Hispanic white (NHW) men and women randomly selected from the Health Care Financing Administration (HCFA) (Medicare) rolls of Bernalillo County (Albuquerque), New Mexico (12–14). The prevalence rates for diabetes mellitus in our study population were 24.5% in those who never consumed alcohol compared with 11.8% in those who drank daily (RR 2.3; 95% CI 1.4–3.4; p <.001) (12). The purpose of this study is to examine the relationship between alcohol intake and insulin sensitivity (resistance) comparing daily drinkers with abstainers, first by comparing fasting and 2-hour postglucola serum glucose and insulin concentrations for all participants adjusted for differences in age, gender, ethnicity, and BMIs, then stratifying by diabetic status (diabetes, impaired glucose tolerance, and normal glucose tolerance).
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METHODS |
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Interview and Examination
Interviews were obtained directly from 96% of the participants, and from a spouse, relative, or caretaker in 4% of the cases. A history of alcohol intake was obtained by the nurse, who asked the question, "How often do you drink alcoholic beverages?" Possible answers were: (a) never, (b) 1 or fewer days per week, (c) 2 to 5 days per week, (d) daily, less than 4 drinks per day, and (e) daily, 4 or more drinks per day. Comparisons were made between Group 1 (nondrinkers/abstainers) and Groups 4 and 5 combined (daily drinkers). Groups 2 and 3 were combined and examined as a group with intermediate alcohol intake. Height and weight were obtained on each participant by the nurse, and BMI was calculated as weight (kilograms) divided by height (meters) squared.
Laboratory Determinations
Blood samples were drawn and immediately placed in ice until separation. Glucose was determined by a hexokinase enzymatic assay using a Cobas Bio instrument (Roche Diagnostics, Indianapolis, IN) and reagents from Beckman Instruments (Carlsbad, CA). Insulin concentration was determined using a radioimmunoassay from Diagnostic Products (Los Angeles, CA).
Diabetes Evaluation
Blood samples were collected between 8:00 AM and 8:30 AM after an overnight fast, and assayed for serum glucose and insulin concentrations as part of a larger battery of tests. Unless the participant was on insulin and/or an oral hypoglycemic agent, or had a screening fasting glucose level >150 mg/dl (8.3 mmol/l), the individual was asked to ingest 75 grams of glucola during a 10-minute period, and a blood sample was obtained 2 hours later for serum insulin and glucose determinations.
Participants were placed in one of four categories based on World Health Organization recommendations recently modified by the American Diabetes Association's Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (15). Participants were considered to have diabetes if they were on insulin, and/or oral hypoglycemic agents. They also were considered to have diabetes if their fasting serum glucose was 7.0 mmol/l (126 mg/dl) or their 2-hour postglucola glucose was 11.1 mmol/l (200 mg/dl). Participants were considered to have impaired glucose tolerance if their fasting serum glucose was 6.1 mmol/l (110 mg/dl) but <7.0 mmol/l or their 2-hour glucose was 7.8 mmol/l (140 mg/dl) but <11.1 mmol/l. Participants were considered to have a normal glucose tolerance if their fasting serum glucose was <6.1 mmol/l and the 2-hour glucose was <7.8 mmol/l. The remaining participants were listed as indeterminate, generally because permission was not obtained for blood sampling, or the participant arrived not fasting.
Statistical Methods
Descriptive statistics include mean ± standard deviation (SD) and frequency rates (%). In making comparisons between groups on continuous variables, and where normal distribution of the measure held, Student's t test was used. A logarithmic transformation of skewed variables (glucose, insulin), followed by a t test, was used when approximate normal distribution could be obtained. Linear regression models were constructed to show the associations between serum insulin and glucose concentrations as predictors and age and ethnicity as covariates, and serum insulin and BMI as predictors and serum glucose, ethnicity, and age as covariates for men and women. All analyses were conducted using SAS software (16).
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RESULTS |
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Table 1 shows the mean ± SD fasting serum glucose and insulin levels and BMIs comparing daily drinkers with abstainers for all men and all women, then stratifying them by diabetic status (diabetes, impaired glucose tolerance, normal glucose tolerance). When stratified by diabetic status, the mean fasting blood glucose concentrations in men and women are more comparable between daily drinkers and nondrinkers in each comparison group. Whereas more abstainers are diabetic than daily drinkers, the mean fasting glucose concentrations are higher when all participants of each gender are grouped together.
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Body mass indices were observed to be lower in daily drinkers than abstainers. Numerous studies have found a positive association between fasting serum insulin level and fat distribution or BMI (17,18), raising the question of whether or not the higher insulin levels in the abstainers compared with the daily drinkers could be explained by the greater total body obesity observed in the former. A linear regression model showing the association between the fasting serum insulin concentrations and the body mass indices, adjusting for differences in fasting serum glucose concentrations, age, gender, and ethnicity for all participants, shows that, at any level of BMI, abstainers still had significantly higher fasting serum insulin levels compared with daily drinkers (p = 0.003) (Figure 1).
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DISCUSSION |
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Besides the implications for diabetes risk, the finding of an inverse correlation between alcohol intake and serum insulin concentration may reflect an additional independent mechanism, other than its effect on raising serum high-density lipoprotein (HDL) cholesterol concentrations (12,19), that would explain how daily alcohol ingestion lowers the risk for coronary heart disease (CHD). Hyperinsulinemia is independently associated with decreased serum HDL cholesterol and increased triglyceride concentrations, obesity, and an increased risk for type 2 diabetes mellitus and CHD (20,21).
Our study population is unique in that all participants were Medicare recipients, therefore aged 65 years or older, with a mean age of 74.1 years. Most previous studies have examined younger subjects. Furthermore, nearly equal numbers of Hispanics and NHWs were studied, the former having a much higher prevalence of diabetes. All volunteers lived in New Mexico with its Southwestern culture and dietary habits. Additional studies in other populations will be necessary before concluding that our findings can be applied to all populations. Nevertheless, our findings appear to confirm previous reports.
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Acknowledgments |
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Address correspondence to Robert D. Lindeman, MD, Aging and Genetic Epidemiology Program, University of New Mexico, Surge Building, Rm. 215, 2701 Frontier Place NE, Albuquerque, NM 87131-5666. E-mail: rlindeman{at}salud.unm.edu or Richard N. Baumgartner, PhD, Aging and Genetic Epidemiology Program, University of New Mexico, Surge Building, Rm. 215, 2701 Frontier Place NE, Albuquerque, NM 87131-5666. E-mail: rbaumgartner{at}salud.unm.edu
Received November 11, 2002
Accepted December 20, 2002
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