It has been suggested that the inverse association between alcohol and type 2 diabetes could be explained by moderate drinkers’ healthier lifestyles.
We studied whether moderate alcohol consumption is associated with a lower risk of type 2 diabetes in adults with combined low-risk lifestyle behaviors.
We prospectively examined 35,625 adults of the Dutch European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort aged 20–70 y, who were free of diabetes, cardiovascular disease, and cancer at baseline (1993–1997).
30 min of physical activity/d), current nonsmoker, and a healthy diet [upper 2 quintiles of the Dietary Approaches to Stop Hypertension (DASH) diet]. During a median of 10.3 y, we identified 796 incident cases of type 2 diabetes. Compared with teetotalers, hazard ratios of moderate alcohol consumers for risk of type 2 diabetes in low-risk lifestyle strata after multivariable adjustments were 0.35 (95% CI: 0.17, 0.72) when of a normal weight, 0.65 (95% CI: 0.46, 0.91) when physically active, 0.54 (95% CI: 0.41, 0.71) when nonsmoking, and 0.57 (95% CI: 0.39, 0.84) when consuming a healthy diet. When 3 low-risk lifestyle behaviors were combined, the hazard ratio for incidence of type 2 diabetes in moderate alcohol consumers after multivariable adjustments was 0.56 (95% CI: 0.32, 1.00).
In subjects already at lower risk of type 2 diabetes on the basis of multiple low-risk lifestyle behaviors, moderate alcohol consumption was associated with an 
40% lower risk compared with abstention.
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