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Research Summary

Is the Inverse Association between Moderate Drinking and Type 2 Diabetes the Result of Other Healthy Lifestyle Habits?

To determine whether the association between moderate alcohol consumption and the reduced risk of type 2 diabetes might be the result of a combination of lifestyle behaviors, researchers in the Dutch European Prospective Investigation into Cancer and Nutrition (EPIC-NL) prospectively analyzed data from 35,625 participants aged 20–70 years who were free of diabetes, cardiovascular disease, and cancer at baseline (1993–1997) and categorized them into groups based on the following low-risk lifestyle factors: moderate alcohol consumption, optimal weight, regular physical activity, nonsmoking, and healthy diet.* Scores ranged from 0 (no low-risk behaviors) to 4 (all low-risk behaviors).

  • Over a median follow-up of 10.3 years, 796 incident cases of type 2 diabetes occurred.
  • Compared with nondrinkers, hazard ratios (HRs) for risk of type 2 diabetes among moderate alcohol consumers, after multivariable adjustments, were as follows:

    • 0.35 for participants of normal weight,
    • 0.65 for people who were physically active,
    • 0.54 for nonsmokers,
    • 0.57 for people eating a healthy diet, and
    • 0.56 for people with 3 or more low-risk lifestyle behaviors combined.
*Moderate alcohol consumption = 5.0–14.9 g alcohol per day for women and 5.0–29.9 g per day for men; optimal weight = BMI <25; being physically active = ≥30 minutes of activity per day; and healthy diet = general adherence to Dietary Approaches to Stop Hypertension [DASH] guidelines.


In this study, compared with abstaining, moderate alcohol consumption was associated with an approximately 40% lower risk for type 2 diabetes in subjects already at low risk due to multiple low-risk lifestyle behaviors. Whether the lower risk in moderate drinkers is due to the alcohol itself or to other lifestyle factors is a continuing question for epidemiologists; however, these results indicate that the association is not likely to be explained solely by the healthier lifestyle of moderate drinkers. R. Curtis Ellison, MD


Joosten MM, Grobbee DE, van der A DL, et al. Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. Am J Clin Nutr. 2010;91 (6):1777–83.