Alcohol Consumption and Micronutrient Intake in Japanese Adults with Type 2 Diabetes: Age and Sex-Specific Associations

A recent cross-sectional study, published in Clinical Nutrition ESPEN, delved into the complex relationship between alcohol consumption and micronutrient intake among Japanese adults living with type 2 diabetes (T2D). The research aimed to illuminate how alcohol consumption patterns relate to dietary intake and specific micronutrient levels, with a particular focus on differences across age and sex groups.

The study aimed to clarify how alcohol consumption relates to dietary patterns and micronutrient intakes, considering age and sex differences.

Study Design and Participants

The investigation included 1,565 T2D outpatients from various Japanese clinics, with data collected between December 2014 and December 2019. Participants provided self-reported information on weight and height, completed a detailed lifestyle questionnaire, and underwent dietary assessment using a Food Frequency Questionnaire (FFQ) that captured intake over the preceding one to two months.

Alcohol intake was estimated based on daily drinks, though without specific stratification by beverage type. Physical activity levels were assessed using the Japanese short version of the International Physical Activity Questionnaire. For analysis, participants were meticulously categorized into four distinct age-sex groups:

• Younger males (< 65 years)
• Older males (≥ 65 years)
• Younger females (< 65 years)
• Older females (≥ 65 years)

Within these groups, alcohol intake was further segmented into nondrinkers, < median intake, and ≥ median intake, allowing for detailed comparisons.

Key Findings

The study uncovered several significant associations between alcohol consumption and various dietary and health indicators.

Energy Intake and BMI

Higher alcohol intake was correlated with increased energy intake across all participant groups, with the notable exception of older females. Younger males who reported higher alcohol consumption also exhibited a lower Body Mass Index (BMI). In older females, drinkers had a significantly lower BMI compared to nondrinkers, although this relationship did not show a linear progression with intake levels.

Micronutrient Associations

The findings revealed distinct patterns across different demographic groups:

• Younger males with higher alcohol intake showed significant reductions in potassium, calcium, vitamin A, and vitamin C. Potassium demonstrated the strongest association among these micronutrients. Iron intake, however, did not show a significant association in this group.
• Older males exhibited a negative association between alcohol intake and vitamin C only.
• Crucially, no significant associations were observed between alcohol consumption and micronutrient intakes in either younger or older female groups.

Food Group Correlations

Specific food group correlations with alcohol intake were identified:

• Younger males: Positive correlations with fish/seafood, soybean/soy products, seaweed, seeds and nuts, sugar, pickles, and spices; and negative correlations with confectionery and milk.
• Older males: Positive correlation with fish/seafood; and negative correlations with sugar-sweetened beverages, bread, rice, fruits, and confectionery.
• Younger females: Positive correlations with confectionery and soybean/soy products.
• Older females: Positive correlations with vegetables, mushrooms, soybean/soy products, and seaweed.

Dietary Patterns

Principal component analysis helped identify three overarching dietary patterns: healthy, sweet, and savory. Alcohol intake was found to be significantly associated with the savory foods pattern, a dietary style characterized by high intakes of rice, meat, sugar-sweetened beverages, fish, and various seasonings.

Conclusions

The study concluded that alcohol intake is negatively associated with several micronutrients, particularly potassium, calcium, vitamin A, and vitamin C, in younger males. Older males showed a negative association with vitamin C only, while females across both age groups exhibited no significant associations between alcohol and micronutrient intakes.

The researchers suggested that lower intake of dairy products and associated lifestyle factors, such as smoking, might contribute to the observed reduced micronutrient intake in younger men with higher alcohol consumption.

These findings underscore age- and sex-specific associations of alcohol with micronutrient intake and highlight a pressing need to improve nutrient intake among younger male alcohol consumers.

Study Limitation

The cross-sectional design of the study indicates associations rather than causal relationships between alcohol consumption and nutrient intake. This means that while links were identified, the study cannot definitively prove that alcohol consumption directly causes changes in nutrient levels.