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The Relation of Light-to-Moderate Alcohol Consumption to Glucose Metabolism and Insulin Resistance in Nondiabetic Adults: the Moderating Effects of Depressive Symptom Severity, Adiposity, and Sex

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Abstract

Purpose

We examined the relation of alcohol consumption to glucose metabolism and insulin resistance (IR) as a function of depressive symptoms, adiposity, and sex.

Method

Healthy adults (aged 18–65 years) provided fasting blood samples and information on lifestyle factors. Alcohol intake was categorized as never, infrequent (1–3 drinks/month), occasional (1–7 drinks/week), and regular (≥2 drinks/day) drinkers. The Beck Depression Inventory (BDI) was used to assess symptom severity. Primary outcomes were fasting insulin, glucose, and IR assessed by the homeostasis model assessment (HOMA).

Results

In univariate analysis, alcohol consumption was negatively associated with HOMA-IR (p = 0.03), insulin (p = 0.007), and body mass index (BMI) (p = 0.04), but not with glucose or BDI. Adjusting for potential confounders including BMI, alcohol consumption was associated with HOMA-IR (p = 0.01) and insulin (p = 0.009) as a function of BDI and sex. For women with minimal depressive symptoms, light-to-moderate alcohol consumption was associated with lower HOMA-IR and insulin. Alcohol consumption was not associated with metabolic markers in women with higher depressive symptoms and in men. In analysis using BMI as a continuous moderator, alcohol consumption was only associated with insulin (p = 0.004). Post-hoc comparisons between BMI groups (<25 vs ≥25 kg/m2) revealed that light-to-moderate alcohol consumption was associated with lower insulin but only in subjects with BMI ≥ 25 kg/m2.

Conclusions

The benefits of light-to-moderate alcohol consumption on fasting insulin and IR are sex dimorphic and appear to be independently moderated by adiposity and depressive symptom severity.

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Notes

  1. Due to the small number of regular drinkers (7.6%, n = 16 out of 213), we combined the occasional and regular drinking categories to form one category representative of light-to-moderate drinking. Before establishing this combined category, we examined whether the two categories, occasional and regular, differed on demographics, anthropomorphics, and depressive symptom severity. As expected, occasional drinkers (n = 70) reported fewer drinks per week (median = 0.43, IQR 0.15–1.0) relative to regular (n = 16) drinkers (median = 1.43, IQR 0.86–2.14). No subject in the regular consumption group reported drinking more than 3 drinks/day; thus, heavy drinkers (≥5 drinks/day) were no represented in this sample. Comparisons between occasional and regular drinkers did not reveal significant differences in age (F = 2.86, ns), BMI (F = 1.15, ns), educational status (F = 0.49, ns), and BDI (F = 0.14, ns). In addition, the distribution of men and women did not differ by alcohol group χ 2(1) = 0.46, ns. Using the same set of covariates as in the primary analysis (e.g., age, BMI, race, sex, educational status, and physical activity), we examined differences between occasional and regular drinkers on log(HOMA-IR), insulin, and glucose. Results showed no group differences for log(HOMA-IR) (F = 0.32, ns), insulin (F = 0.21, ns), and glucose (F = 2.29, ns).

  2. For women, we also examined whether the BDI total score was positively associated with log (HOMA-IR) and insulin within each alcohol group. Previous studies have suggested that increases in BDI are associated with increases in insulin resistance and, to a lesser extent, increases in fasting insulin in nondiabetic adults [34, 58]. Results of analysis revealed that increasing log(HOMA-IR) was significantly associated with increasing BDI (b = 0.30, t = 2.56, p = 0.02) for nondrinkers, but not for infrequent (b = −0.70, t = −0.99, ns) and regular/occasional (b = 0.14, t = 1.38, ns) drinkers. Similarly, insulin values were significantly associated with total BDI score (b = 5.20, t = 2.46, p = 0.02) for nondrinkers, but not for infrequent (b = −0.15, t = −0.19, ns) or regular/occasional (b = 0.92, t = 0.86, ns) drinkers. Lastly, when alcohol group was used as a covariate, results of multivariate liner regression revealed positive associations between log(HOMA-IR) and BDI (b = 0.12, t = 1.93, p = 0.057) and between insulin and BDI (b = 1.85, t = 2.19, p = 0.03) for never drinkers. In drinkers, no associations between BDI and either log(HOMA-IR) or fasting insulin were observed. Combined, these findings suggest that higher levels of depressive symptom severity are associated with greater IR and fasting insulin and that these associations are significant only in women who abstain from alcohol. While we do not recommend that woman with elevated symptoms of depression begin drinking alcohol, the findings underscore the complex nature of the relationship among sex, alcohol consumption, glucose metabolism, IR, and depressive symptom severity.

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Authors and Affiliations

  1. Duke University Medical Center, PO Box 3327, Durham, NC, 27701, USA

    Edward C. Suarez, Jean C. Beckham & Kimberly T. Green

  2. Department of Veterans Affairs Medical Center, Durham, NC, USA

    Jean C. Beckham

  3. VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA

    Jean C. Beckham

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  1. Edward C. Suarez
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Correspondence to Edward C. Suarez.

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Funding

This work was supported by a grant from National Heart, Lung, and Blood Institute (NHLBI) HL67459 to Dr. Suarez and by a Clinical Sciences Research and Development (CSR&D) Research Career Scientist Award (#11S-RCS-009) to Dr. Beckham.

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All authors declare that they have no conflict of interests.

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All procedures performed in this study were conducted in accordance with the ethical standards of the Duke University Health System Institutional Review Board (IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All participants gave written consent prior to study participation and data collection. The Duke University Health System Institutional Review Board (IRB) approved the consent process. We thank those who kindly volunteered to participate in this study.

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Suarez, E.C., Beckham, J.C. & Green, K.T. The Relation of Light-to-Moderate Alcohol Consumption to Glucose Metabolism and Insulin Resistance in Nondiabetic Adults: the Moderating Effects of Depressive Symptom Severity, Adiposity, and Sex. Int.J. Behav. Med. 24, 927–936 (2017). https://doi.org/10.1007/s12529-017-9652-5

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