| Non-communicable chronic diseases(NCDs)have become the leading cause of global deaths,deaths from cardiovascular diseases accounted for 70% of all deaths worldwide.Cardiovascular diseases(CVD),cancer,chronic respiratory disease and diabetes are the main types of NCDs and CVD were the leading cause of NCDs deaths.According to the date of Global Burden of Disease Study 2013,8.14 million deaths were caused by coronary heart disease(CHD).According to the estimated statistical data,an estimated 415 million people were diagnosed with diabetes mellitus(DM)worldwide in 2015 and an estimated 642 million individuals would be diagnosed with DM in 2040 [the type 2 diabetes mellitus(T2DM)accounts for 90%].Unhealthy behaviors and lifestyle were closely related to NCDs incidence and mortality.For instance,7.2 million deaths had been attributed to tobacco use and insufficient physical activity accounted for 1.6 million deaths according to the date reported by World Health Organization(WHO).The China Kadoorie Biobank study(CKB)study reported that 67.9% of CHD event could be attributed to modifiable unhealthy behaviors including smoking,inadequate physical activity,unhealthy diet,heavy drinking,and obesity in China.Alcohol consumption was considered as an important part of lifestyle and the association between drinking and incident risk of NCDs has been widely concerned.The health consequences of alcohol consumption on NCDs are complex and controversial.On the one hand,alcohol consumption was considered as an important risk factor for incident NCD s and injury and an estimated of 3.8% of global deaths and 9.0% of global burden from cardiovascular diseases were attributed to alcohol consumption.On the other hand,epidemiological studies have found that moderate alcohol consumption could regulate lipid metabolism,improve metabolic disorders and increase the insulin sensitivity.And moderate alcohol consumption was associated with a decreased risk of CHD incidence,especially among individuals with diabetes.The association between moderate alcohol consumption with risk of T2 DM still remained uncertain and heavy drinking has been identified a risk factor of T2 DM.Although the conclusion still remains inconsistent,most of epidemiologic studies have found that moderate alcohol consumption was associated with a lower incident risk of NCDs.In addition,drinking pattern might play an important role in the alcohol-NCDs relationship and daily or weekly ethanol consumption alone was not adequate to estimate the relationship between alcohol consumption and incident risk of NCDs.Therefore,our study aimed to investigate the association between alcohol consumption and incident risk of CHD and T2 DM among the middle-aged and elderly Chinese men and to explore the effect of drinking pattern on the alcohol-diseases relationship and a favorable drinking pattern.Part 1 Association of drinking pattern with incident risk of coronary heart disease in the middle-aged and elderly Chinese menObjective: Epidemiologic studies have found that moderate alcohol consumption was associated with a decreased risk of CHD incident.Nevertheless,whether the drinking pattern is associated with incident risk of CHD still remains inconclusive.Therefore,our study aimed at to investigate the association between drinking pattern and CHD incident and explore a health drinking pattern.Methods: We included 8,469 Chinese men who were free of CHD,stroke,or cancer at baseline from Dongfeng-Tongji cohort.A semi-structured questionnaire was used to collect information on alcohol consumption and other covariates.Cox proportional hazard regression model was applied to estimate the multivariable-adjusted hazard ratios(HRs)and 95% confidence intervals(95% CIs).Results: During an average of 4.36 years of follow-up,we identified 959 incident CHD events.Compared with non-drinkers,the multivariable-adjusted HR(95% CI)of CHD incidence was 0.84(0.71-0.98)in current drinkers.The adjusted HRs(95% CI)of CHD incidence were 0.80(0.65,0.99),1.02(0.84,1.22),and 0.75(0.59-0.96)in subjects who consumed 0.01-10,10.01-30,and > 30 grams ethanol per day,respectively.Individuals who consumed 20.01-40 grams ethanol once a time had a 24% lower risk of incident CHD(HR=0.76,95% CI=0.62,0.94)compared with non-drinkers.We observed no statistically significant association between type and frequency of alcohol consumption and CHD incidence.With respect to drinking pattern,participants who consumed 20.01-40 grams ethanol per time with less than 5 times per week had the lowest incident risk of CHD(HR=0.73,95% CI=0.52,0.96).Conclusions: Moderate alcohol consumption was associated with a lower incident risk of CHD in middle-aged and elderly Chinese men and drinking pattern may modify the relationship between alcohol consumption and incident CHD.Part 2 Association of drinking pattern with incident risk of type 2 diabetes mellitus in the middle-aged and elderly Chinese menObjective: To investigate the association between drinking pattern and incident risk of T2 DM in the middle-aged and elderly Chinese men and to explore a healthy lifestyle for the middle-aged and elderly person.Methods: We examined the association between drinking pattern and risk of incident T2 DM among 7,445 male participants from Dongfeng-Tongji cohort who were free of diabetes,CHD,stroke,or cancer at baseline.Cox proportional hazard regression model was used to estimate the adjusted hazard ratios(HRs)and 95% confidence intervals(95% CIs).Diabetes was defined as individuals with current use of oral hypoglycemic medication or insulin,fasting glucose level ? 7.0 mmol/L,or heamoglobin A1c(Hb A1c)? 6.5%.Results: During an average of 4.47 years of follow-up,we identified 597 incident T2 DM events.Compared with non-drinkers,men who consumed 20.01-30 grams per day had a significantly increased incident risk of T2DM(HR=1.53,95% CI=1.16,2.02)after the adjustment for age,education level,smoking,BMI,central obesity,family history of diabetes and physical activity.HR(95% CI)of T2 DM incidence was 1.38(1.03-1.84)in the subjects who consumed alcoholic beverages more than 7 times per week.Among men who consumed alcoholic beverages more than 7 times/week,HRs(95% CI)of T2 DM incidence in the subjects who consumed 0.01 to 40 grams and more than 40 grams ethanol once a time were 1.48(1.05-2.09)and 1.27(0.80-2.10),respectively.Among participants with overweight,obesity,current smoking,or insufficient physical activity,participants who consumed more than 20 grams/day had a higher risk of T2 DM incidence.Conclusions: Heavy drinking,especially higher frequency drinking was associated with an increased incident risk of T2 DM for middle-aged and elderly Chinese men.The joint effects between unhealthy behaviors including overweight,obesity,smoking,or insufficient physical activity and heavy drinking were associated with increased risk of T2 DM incidence. |
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