Background: Diabetes mellitus is a major public health issue. Alcohol abuse is a factor that has been suggested to be relevant for the risk of diabetes. Purpose: To estimate the aggregate level of beverage-specific effect of alcohol on diabetes mellitus mortality rate. Method: Trends in gender-specific coefficients of diabetes mortality rate from 1981 to 2001 in Belarus were analyzed in relation to trends in the level of different types of alcoholic beverages consumption per capita, employing the time series analysis. Results: The analysis demonstrated a positive and statistically significant effect of changes in strong spirits per capita (vodka) consumption on diabetes mortality rate. The analysis suggested that a 1% increase in spirits consumption per capita results in 1.1% increase in males and females diabetes mortality rates. Conclusion: This paper presents new epidemiological evidence of aggregate level relation between trends in per capita consumption of strong spirits and diabetes mortality rate.
Key words: Alcohol consumption; Diabetes mortality; Time series analysis, Belarus, 1981-2001.
Diabetes mellitus is a major public health issue, and its prevalence has been raised in recent decades world wide.1 Between 2000 and 2030, a 37% increase in the world wide prevalence of diabetes 2 (non-insulin-dependent) is expected.9 Aside from obesity, reduced physical activity, and cigarette smoking, there are few other lifestyle risk factors for type 2 diabetes. Alcohol is a lifestyle factor that also has been suggested to be relevant for the risk of type 2 diabetes.8,12 The diabetogenic effects of alcohol include obesity as a result of excess caloric intake, disturbance of carbohydrate metabolism, increased insulin resistance, decreased glucose tolerance and insulin secretion, induction of pancreatitis and liver cirrhosis.2,6,10,13 Alcohol abuse increases the risk for medical complications, such as ketoacidosis, peripheral vascular disease, neuropathy, heart disease, and cerebrovascular disease.6,15 Recently, Turner et al. reported that the evening consumption of alcohol increases the risk of hypoglycemia the next morning in patients with type 1 diabetes.14 Studies of the relationship between alcohol consumption and the risk for type 2 diabetes that have been published during the last few years have reported conflicting results.1,3,4,7 In the prospective Rancho Bernardo Study, the upper tertile of male drinkers consumed > 25 g alcohol/day had a significantly higher risk of developing type 2 diabetes compared with the lighter drinkers.7 The results of another study suggested that, after the adjustment for potential confounders, middle-aged men who consumed > 21 drinks/week were 50% more likely to develop type 2 diabetes compared to the men who drank < 1 drink/week. The risk of diabetes among the middle-aged men who drank > 14 drink of spirits per week was about 80% higher than the risk of those who did not drink spirits.9 Thus, the increased risk of diabetes among men was predominantly related to spirits consumption. On the other hand, several large-scale prospective studies have suggested an U - or J - shaped association, with the lowest incidence of type 2 diabetes in subjects with moderate alcohol consumption.3,11,15,16 Howard at al. reported a nonlinear relation between alcohol consumption and risk for the development of type 2 diabetes even after the adjustment for potential confounder factors. Compared with non-drinkers, the moderate drinkers (those who consume one to 3 drinks daily) have 33% to 56% lower risk for diabetes. Persons who consume more than 3 drinks daily have up to 43% greater risk for diabetes.8 In a recent study, Nakanichi et al. reported that the risk for the development of diabetes decreased progressively up to the level of moderate drinking (23.0-45.9 g ethanol/day) and increased in heavy drinkers (> 69.0 g ethanol/day).11 Several studies that addressed the role of drinking pattern in relation to the risk of type 2 diabetes suggested that binge drinking substantially increased the risk.5 In this paper, we focused on the aggregate level beverage-specific effect of alcohol on diabetes mortality rate.
MATERIALS AND METHODS
Trends in gender-specific coefficients of diabetes (type 1 and type 2) mortality rate from 1981 to 2001 in Belarus were analyzed in relation to trends in the level of different types of alcoholic beverages consumption per capita, employing the time series analyses. All data provided in the article were taken from the Ministry of Statistics of Belarus annual report from 1981 to 2001. The levels of mortality are presented as 1 to 100.000 of population. The consumption of alcohol per capita (in litres of pure alcohol) is estimated on the basis of total alcohol consumption as determined by sales statistics, divided by the total population. The time series analysis has been used in the assessment of population level association between alcohol and total mortality. Linear regression was also used for the analysis with the level of spirits' consumption as independent and the level of mortality as dependent variable. The logarhytmic model has been used in present study as well. The diagnostic test choser for the residual correlation was the Box-Ljung Q-test, which indicates whether the model has been adequately fitted.
According to the official statistics, the diabetes mortality rate has increased 3.3 fold (from 1.5 to 4.9 per 100.000 of population) among males and 3,4-fold (from 2.4 to 8.2 per 100.000 of population) among females in the period from 1981 to 2001. The trends in male and female diabetes mortality rate and level of spirits consumption per capita are displayed in Figure land 2.
As we can see, there is a marked-upward trend in diabetes mortality until the beginning of the 1990s, followed by a period of stabilization. The graphical evidence suggests quite a strong association between the trends of male and female diabetes mortality and trend of spirits consumption per capita. The results of correlation analysis suggest a strong relationship between the level of spirits consumption per capita and diabetes mortality rate (Table 1).
So, the outcome our study suggests that diabetes mortality tends to be more responsive to changes in strong spirits consumption per capita than to changes in total level of alcohol consumption in the countries with prevalently intoxicationoriented drinking pattern. This study also supports the idea that binge drinking is a risk factor for diabetes mortality at the population level.
POVEZANOST ZAJEDNlCKlH VREMENSKIH SERIJA KONZUMACIJE ALKOHOLA I MORTALITETA ZBOG DIJABETESA
Pozadina problema: Diabetes mellitus je jedan od glavnih javnozdravstvenih problema. Zlouporaba alkohola je Cimbenik za kojega je sugerirano da bi mogao biti znaCajan za rizik od dijabetesa. CiIj: Procijeniti povezanost o-vrsti-piea-ovisnih uCinaka alkohola sa stopom mortaliteta od dijabetesa. Metoda: Trendovi u o-spolu-ovisnim koeficijentima slope mortaliteta od dijabetesa u Bjelorusiji u razdoblju od 1981. - 2001, analizirani su u vezi s trendovima u razinama konzumacije razlioitih tipova alkoholnih pica, metodom analize vremenskih serija. Rezultati: Analiza je demonstrirala pozitivnu i statistical znaCajnu povezanost promjena u konzumaciji zestokih alkoholnih pica (votka) po glavi stanovnika i stope mortaliteta od dijabetesa. Analiza sugerira da 1% porast konzumacije zestokog alkohola po glavi stanovnika rezultira u 1.1%-nim porastom stopa mortaliteta od dijabetesa u muSkoj i u zenskoj populaciji. Zakljufak: Ovaj rad predstavlja novi epidemioloSki dokaz povezanosti konzumacije alkohola po glavi stanovnika i mortaliteta uslijed dijabetesa.
Kljucne rijeci: Konzumacija alkohola; Mortalitet zbog dijabetesa; Analiza vremenskih serija; Bjelorusija 1981. - 2001.
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Received March 3, 2006, accepted after revision May 18, 2006
Yury E. Razvodovsky
Grodno, State Medical University, Grodno, Belarus
Correspondence to: Yury E. Razvodovsky, M.D.,Ph.D, Grodno State Medical University, Belarus;
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