ArticleDiabetologia2026
Baseline and longitudinal joint associations of alcohol consumption and obesity with diabetes risk: evaluating multiplicative and additive interactions.
Article in Diabetologia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aims/hypothesisThe aim of this study was to examine whether the independent and joint effects of obesity and alcohol consumption on diabetes risk differ when exposures are assessed at baseline or as time-varying variables, and whether interaction patterns vary across multiplicative and additive scales in a Asian prospective cohort.
methodsIn total, 7817 participants aged ≥40 years without diabetes at baseline (2001-2002) were followed until 2017-2018, and the associations of obesity and alcohol consumption with incident diabetes and their interactions were assessed using Cox proportional hazards and Aalen's additive hazards models.
resultsObesity and high alcohol consumption (≥30 g/day) were consistently associated with incident diabetes across all analyses, with stronger associations observed in the time-varying models. Obesity (HR 1.91; 95% CI 1.75, 2.09; 21.9 additional cases per 1000 person-years; 95% CI 20.0, 23.8) and high alcohol consumption (HR 1.23; 95% CI 1.05, 1.44; 14.6 additional cases per 1000 person-years; 95% CI 11.1, 18.1) were both associated with increased diabetes risk. Associations for low-to-moderate alcohol consumption were weaker, and were statistically significant only on the additive scale. No significant multiplicative interactions were observed for the effect of baseline or time-varying obesity, current alcohol consumption or daily alcohol consumption on the risk of diabetes. However, significant antagonistic additive interactions were observed between baseline or time-varying obesity and current alcohol consumption: drinking <10 g/day with 12.8 fewer cases/1000 person-years (95% CI -17.4, -8.2), 10-29.9 g/day with 15.9 fewer cases (95% CI -22.1, -9.8), and ≥30 g/day with 14.6 fewer cases (95% CI -22.0, -7.2), with a p CONCLUSIONS/
interpretationObesity and high alcohol consumption were consistently associated with incident diabetes, and an antagonistic additive interaction was observed between obesity and all alcohol consumption levels. These findings highlight the importance of exposure modelling and scale choice, and support prioritising weight management and reducing high alcohol consumption in diabetes prevention.
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