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Eighteen-year alcohol consumption trajectories and their association with risk of type 2 diabetes and its related factors: the China Health and Nutrition Survey

  • Tianshu Han
  • Shuang Zhang
  • Wei Duan
  • Xinhui Ren
  • Chunbo Wei
  • Changhao SunEmail author
  • Ying LiEmail author



Alcohol consumption levels frequently fluctuate over the life course, but studies examining the association between alcohol consumption trajectories and type 2 diabetes are limited. This study aims to investigate the association of alcohol consumption trajectories with the risk of type 2 diabetes and its related factors.


Weighted longitudinal data were obtained for 12,186 adults who completed a questionnaire about alcohol consumption and diabetes status as part of the China Health and Nutrition Survey (1993–2011). Participants were designated into subgroups based on alcohol consumption trajectory, and subgroup analyses included 5436 individuals who were tested for specified diabetes-related factors. Light alcohol consumption was defined as fewer than seven standard drinks per week; moderate as 7–21 drinks per week; and heavy as more than 21 drinks per week. Latent class trajectory modelling was used to identify different alcohol consumption trajectories by sex. Multivariate Cox regression models and general linear regression models were used to assess association of trajectories with type 2 diabetes and its related factors.


Compared with stable abstainers (individuals who never drank alcohol), two trajectories in men showing reduction to moderate or light levels after heavy alcohol consumption during early adulthood were significantly associated with increased risk of type 2 diabetes (HR 1.66 [95% CI 1.18, 2.33]; HR 1.93 [95% CI 1.01, 3.70]), while no significant association between trajectories and risk of type 2 diabetes was observed in women (p for trend = 0.404). Triacylglycerol, HDL-cholesterol (HDL-C), uric acid and high sensitivity C-reactive protein were significantly higher in these two trajectories than other trajectories in men (all p < 0.05), while only HDL-C showed significant increasing trends in women. Trajectories showing light–stable, or increase to moderate, levels were not associated with reduced risk of type 2 diabetes.


This study indicated that heavy alcohol consumption in early adulthood is significantly associated with increased risk of type 2 diabetes and higher levels of its biomarkers throughout adulthood in men. Gradually reducing alcohol consumption to moderate levels may not make a difference, which demonstrates the importance of alcohol intervention strategies in early adulthood. Although association between alcohol consumption and increased HDL-C levels has been observed, the results of this study did not support the hypothesis regarding the protective effect of moderate alcohol consumption on risk of type 2 diabetes in the Asian population.

Data availability

Data from China Health and Nutrition Survey was used in this study, which can be downloaded at


Alcohol Risk factors Trajectory Type 2 diabetes mellitus 



China Health and Nutrition Survey




High sensitivity C-reactive protein


Latent class trajectory modelling


Metabolic equivalent


Physical activity level



We thank the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Carolina Population Center (P2C HD050924, T32 HD007168), the University of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350, R24 HD050924 and R01-HD38700) and the NIH Fogarty International Center (D43 TW009077, D43 TW007709) for financial support for the CHNS data collection and analysis files from 1989 to 2015 and future surveys, and the China-Japan Friendship Hospital, Ministry of Health for support for CHNS 2009, Chinese National Human Genome Center at Shanghai since 2009, and Beijing Municipal Center for Disease Prevention and Control since 2011.

Contribution statement

TH, CS and YL conceived the idea. TH and WD designed the study and wrote the original manuscript. TH and SZ wrote the revised manuscript. WD, XR and CW analysed and interpreted data. TH, SZ and WD performed the validation analyses. All authors critically assessed and reviewed the paper, and approved the version to be published. CS is the guarantor of this work.


TH was supported by the National Natural Science Foundation (81803227), CS by the National Key R&D Program of China (2017YFC1307401) and YL by the Open Research Fund for Top Disciplines of Public Health and Preventive Medicine at Ningxia Medical University (30181302).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2019_4851_MOESM1_ESM.pdf (439 kb)
ESM (PDF 438 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.National Key Discipline, Department of Nutrition and Food Hygiene, School of Public HealthHarbin Medical UniversityHarbinPeople’s Republic of China
  2. 2.Department of EndocrinologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinPeople’s Republic of China

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