The mediating effect of quality of life on alcohol consumption and the 10-year type 2 diabetes mellitus risk score in adult Korean men

Background: The rate of high-risk drinking, a major cause of type 2 diabetes mellitus (T2DM), is increasing among Korean men. This study descriptive survey whether quality of life (QoL) mediates the relationship between drinking and 10-year T2DM risk scores in adult Korean men. Methods: We further analyzed data from the 7th Korea National Health and Nutrition Examination Survey 7th (KNHANES VII) from 2016 to 2018, selecting 4134 men aged 40–69 years who were not diagnosed with T2DM. The data were analyzed using complex sample regression; after analyzing the mediation. Results: In step 1 of the regression, the drinking rate significantly predicted QoL (β = 0.08, p < 0.001), and in step 2, the drinking rate significantly predicted the 10-year T2DM risk score (β = 0.08, p < 0.001). In step 3, the drinking rate (β = 0.08, p < 0.001) and QoL (β = –0.09, p < 0.001) were found to significantly predict the 10-year T2DM risk score, confirming that QoL partially mediates the 10-year T2DM risk score (z = –3.62, p < 0.001). QoL was found to mediate the relationship between the drinking rate and 10-year T2DM risk score. Conclusions: Sex-specific risk factors must be considered to reduce the incidence of T2DM, and measures to promote healthy drinking habits need to be implemented to reduce the incidence of T2DM in men. Furthermore, these findings highlight the need to develop and actively implement various practical intervention strategies to enhance QoL.

diabetes mellitus; alcohol consumption; quality of life; mediation analyses; men

[1] International Diabetes Federation. IDF Diabetes atlas 9th edi-tion 2019. 2019. Available at: https://www.diabetesatlas.org/en /sections/worldwide-toll-of-diabetes.html (Accessed: 23 April 2021).

[2] Korean Diabetes Association. Diabetes Fact Sheet in Korea 2020. 2020. Available at: https://www.diabetes.or.kr/pro/news/admin.php?category=A&code=admin&number=1992&mode =view (Accessed: 23 April 2021).

[3] Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Dif-ferences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocrine Reviews. 2016; 37: 278–316.

[4] Witkiewitz K, Kranzler HR, Hallgren KA, O’Malley SS, Falk DE, Litten RZ, et al. Drinking Risk Level Reductions Asso-ciated with Improvements in Physical Health and Quality of Life among Individuals with Alcohol Use Disorder. Alcoholism: Clinical and Experimental Research. 2018; 42: 2453–2465.

[5] Diabetes in men versus women. 2019. Available at: https://www.news-medical.net/health/Diabetes-in-Men-v ersus-Women.aspx (Accessed: 26 February 2019).

[6] Volaco A. Alcohol Consumption and its Relationship to Diabetes Mellitus: Friend or Foe. Endocrinology and Metabolism Inter-national Journal. 2018; 6: 00150.

[7] Spracklen CN, Horikoshi M, Kim YJ, et al. Identification of type 2 diabetes loci in 433,540 East Asian individuals. Nature. 2020; 582: 240–245.

[8] Korea Centers for Disease Control and Prevention. 2019 Na-tional Health Statistics. Drinking and smoking status. Available at: https://www.kdca.go.kr/upload_comm/syview/doc.html?f n=157615244957000.pdf&rs=/upload_comm/docu/0034/ (Ac-cessed: 4 April 2021).

[9] Korean Statistical Information Service. Trend of high-risk drinking rate. Available at: https://kosis.kr/statHtml/statHt

ml. doorgId=177&tblId=DT_11702_N018&vw_cd=&list_id =&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id= &conn_path=E1&docId=0243534434&markType=S&itmNm (Accessed: 24 April 2021).

[10] World Health Organization. Global status report on alcohol and health 2018. 2018. Available at: https://www.who.int/health-top ics/alcohol#tab=tab_1 (Accessed: 30 June 2021).

[11] Jekarl J, Kim KK, Lee JT. Structural relationship between drinker’s characteristics, work environment, and alcohol prob-lems among employee. Health and Social Science. 2010; 28: 5–31.

[12] Park JH, Lee MK, Jang YE. A study on the effect of job stress of employees to depression: moderating effect of quantities and frequencies of dringking. Journal of Korean Alcohol Science. 2010; 11: 1–14.

[13] Ha Y, Jung M. Factors associated with Problem Drinking in Ko-rean Male Employees for Drinking Motivation, Job Stress, and Drinking Refusal Self-efficacy. Korean Journal of Occupational Health Nursing. 2015; 24: 48–56.

[14] Bloomfield KIM, Grittner U, Kramer S, et al. Social inequali-ties in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action ‘Gender, Culture and Alcohol Problems: a Multi-national Study’. Alcohol and Alco-holism. 2006; 41: i26–i36.

[15] Cha B. A Path Analysis of Factors Influencing Health-related Quality of Life among Male Adults. Journal of Korean Academy of Community Health Nursing. 2016; 27: 399–409.

[16] Kim KH, Kim JS. The association between alcohol consumption patterns and health-related quality of life in a nationally repre-sentative sample of South Korean adults. PLoS ONE. 2015; 10: e0119245.

[17] Gebremedhin T, Workicho A, Angaw DA. Health-related qual-ity of life and its associated factors among adult patients with type II diabetes attending Mizan Tepi University Teaching Hos-pital, Southwest Ethiopia. BMJ Open Diabetes Research and Care. 2019; 7: e000577.

[18] Trikkalinou A, Papazafiropoulou AK, Melidonis A. Type 2 di-abetes and quality of life. World Journal of Diabetes. 2017; 8: 120.

[19] Li X, Yu F, Zhou Y, He J. Association between alcohol con-sumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis. The American Journal of Clinical Nutrition. 2016; 103: 818–829.

[20] HEALTH NEWS. Drinking less might be tied to higher quality of life. 2019. Available at: https://www.reuters.com/news/hea lth/article/us-health-alcohol-qol/drinking-less-might-be-tied-to- higher-quality-of-life-idUSKCN1U32KO (Accessed: 9 July 2019).

[21] Jia AH, Xu SY, Ming J, et al. The optimal cutoff value of waist-to-height ratio in Chinese: based on cardiovascular risk and metabolic disease. Zhonghua nei ke za zhi. 2017; 56: 822–826.(In Chinese)

[22] Korea Centers for Disease Control and Prevention. 2018 Korean National Health and Nutrition Examination Survey. 2018. Avail-able at: https://knhanes.kdca.go.kr/knhanes/sub03/sub03_01.do (Accessed: 29 September 2021).

[23] Ha KH, Lee Y, Song SO, Lee J, Kim DW, Cho K, et al. De-velopment and Validation of the Korean Diabetes Risk Score: a 10- Year National Cohort Study. Diabetes and Metabolism Jour-nal. 2018; 42: 402–414.

[24] Nam HS, Kim KY, Kwon SS, et al. EQ-5D Korean valuation study using time trade off method. Seoul: Korea Centers for Dis-ease Control and Prevention. 2007.

[25] Seong SC, Kim Y, Park SK, Khang YH, Kim HC, Park JH, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open. 2017; 7: e016640.

[26] World Health Organization. The Asia Pacific perspective: re-defining obesity and its treatment. Sydney: Health Communica-tions. 2000; 15–21.

[27] Baron RM, Kenny DA. The moderator–mediator variable dis-tinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of personality and social psychology. 1986; 51: 1173.

[28] Holst C, Becker U, Jørgensen ME, Grønbæk M, Tolstrup JS. Alcohol drinking patterns and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population. Diabetologia. 2017; 60: 1941–1950.

[29] Wu X, Liu X, Liao W, Kang N, Dong X, Abdulai T, et al. Preva-lence and characteristics of alcohol consumption and risk of type 2 diabetes mellitus in rural China. BMC Public Health. 2021; 21: 1–10.

[30] Cho B, Sohn A, Kim M, Yang J, Son S. Determinants of Drink-ing and Harmful Drinking Experience among Korean Adults. Journal of Korean Alcohol Science. 2018; 19: 1–14.

[31] Myong JP, Kim HR, Choi WS, Jo SE, Lee B, Koo JW, et al. The Relation between Employees’ Lifestyle and their Health Status in an Electronics Research and Development Company. Korean Journal of Occupational and Environmental Medicine. 2009; 21: 1–9.

[32] Chung IB, Chang NS. Effects of alcohol drinking frequency and foods consumed along with alcohol on anthropometry, serum lipid levels, and blood pressure in male patients with type 2 dia-betes mellitus. Journal of Nutrition and Health. 2008; 41: 317–326.

[33] van de Wiel A. Diabetes mellitus and alcohol. Dia-betes/Metabolism Research and Reviews. 2004; 20: 263–267.

[34] Baliunas DO, Taylor BJ, Irving H, Roerecke M, Patra J, Moha-patra S, et al. Alcohol as a Risk Factor for Type 2 Diabetes: a systematic review and meta-analysis. Diabetes Care. 2009; 32: 2123–2132.

[35] Food Information Statistics System. 2019 Liquor Market Trend Report. Available at: https://www.atfis.or.kr/article/M001040000/view.do?articleId=3543&page=&searchKey=&s earchString=&searchCategory= (Accessed: 20 June 2021).

[36] Chan AM, von Mühlen D, Kritz-Silverstein D, Barrett-Connor E. Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: the Rancho Bernardo Study. Maturitas. 2009; 62: 294–300.

[37] Salonsalmi A, Rahkonen O, Lahelma E, Laaksonen M. The as-sociation between alcohol drinking and self-reported mental and physical functioning: a prospective cohort study among City of Helsinki employees. BMJ Open. 2017; 7: e014368.

[38] Yao XI, Ni MY, Cheung F, Wu JT, Schooling CM, Leung GM, et al. Change in moderate alcohol consumption and quality of life: evidence from 2 population-based cohorts. Canadian Med-ical Association Journal. 2019; 191: E753–E760.

[39] Feng X, Astell-Burt T. Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a longitu-dinal study. BMJ Open Diabetes Research and Care. 2017; 5: e000198.

[40] Lu Y, Wang N, Chen Y, Nie X, Li Q, Han B, et al. Health-related quality of life in type-2 diabetes patients: a cross-sectional study in East China. BMC Endocrine Disorders. 2017; 17: 1–7.

[41] Centers for Disease Control and Prevention. Alcohol and pub-lic health. Available at: https://www.cdc.gov/alcohol/fact-sheet s/moderate-drinking.htm (Accessed: 29 December 2020).

[42] Aschalew AY, Yitayal M, Minyihun A. Health-related quality of life and associated factors among patients with diabetes mellitus at the University of Gondar referral hospital. Health and Quality of Life Outcomes. 2020; 18: 1–8.