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Studies in the general population show an improvement in mortality and morbidity from light to moderate ingestion of alcohol. This improved mortality was greatest amongst those individuals with the highest risk of ischaemic heart disease (1). The definition of light to moderate intake is, however, confusing and varies between researchers from one to three drinks per day, 3-4 units for men and 2-3 units for women per day, 0.5-1.0 g/kg body weight, or 'moderate drinking is the level below which overall net harmful effects are seen in population surveys, about three drinks per day. Thus less than three drinks per day is moderate or lighter drinking and heavy drinking is three or more drinks per day' (2).

Recommendations have generally been determined from epidemiological and retrospective data where the problem of evaluating thresholds is complicated by the underestimation of alcohol consumption. Drinking more frequently or larger measures than reported can lead to a lower apparent threshold of alcohol-related effects.

For people with diabetes, recommendations for alcohol intakes are complicated by the well-established risks of alcohol ingestion such as increasing blood pressure, increasing triglycerides and contributing to obesity versus the benefits of reducing the risk of ischaemic heart disease through increasing HDL cholesterol, increasing insulin sensitivity and the contribution of antioxidant nutrients. (The effect of alcohol ingestion on these individual risks and benefits is discussed later in this chapter.)

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