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Investigating the relationship between alcohol consumption and type 2 diabetes: A longitudinal analysis of the Whitehall II cohort, 1985-2013

Knott, CS; (2016) Investigating the relationship between alcohol consumption and type 2 diabetes: A longitudinal analysis of the Whitehall II cohort, 1985-2013. Doctoral thesis , UCL (University College London). Green open access

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Abstract

BACKGROUND: Although previous studies have reported a J-shaped association between the volume of alcohol consumption and incidence of type 2 diabetes (T2DM), a number of limitations weaken the validity of such findings. This thesis aims to systematically explore the effect of key methodological shortcomings. METHODS: Analyses were undertaken using Whitehall II data from 1985-2013. To examine the degree to which conventional survival analyses might be subject to misclassification error due to the use of a single baseline measure of drinking status, mixed effects models were used to plot the trajectory of alcohol intake according to baseline categories of consumption. Mixed effects models were also stratified by diagnosis status to shed light upon whether increases or decreases in risk are likely to accrue gradually over the life course or occur as a consequence of differences in intake specific to periods of heightened biological sensitivity. Finally, given changes in alcohol consumption across the life course, increasingly complex survival models were used to explore the relationship between different dimensions of the longitudinal trajectory and T2DM risk. RESULTS: Alcohol consumption within categories of baseline drinking converged over the adult life course toward moderate volumes, with moderate drinkers increasingly contaminated by participants defined at baseline as heavy or infrequent drinkers. Men who developed T2DM were found to increase their consumption up to their date of diagnosis, while drinking among women remained relatively stable up to diagnosis. Marked decreases in consumption were evident among both sexes following diagnosis. Reductions in the risk of T2DM were specific to or most pronounced among female current drinkers in middle age, with drinking in later life associated with an increased risk regardless of sex, after adjustment for prior consumption. CONCLUSIONS: Variations in alcohol consumption across the adult life course highlight the importance of considering drinking histories when defining alcohol consumption categories, with the risk of misclassification error appearing to increase with age. Although reductions in the risk of T2DM were most pronounced among middle-aged women, evidence concerning the determinants of such a sex-specific disparity is lacking. That risks are heightened in older age suggest that any benefits from drinking earlier in the life course may be countered by age-related deteriorations to the alcohol metabolism.

Type: Thesis (Doctoral)
Title: Investigating the relationship between alcohol consumption and type 2 diabetes: A longitudinal analysis of the Whitehall II cohort, 1985-2013
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
Keywords: Diabetes, alcohol, drinking, trajectories, joint models
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
URI: https://discovery.ucl.ac.uk/id/eprint/1528656
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