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Original Article
Dose-response Association Between Alcohol Consumption and Kidney Cancer Risk Differs According to Glycemic Status: A Nationwide Cohort Study of 9.4 Million Individuals
Joo-Hyun Park1,2orcid , Jung Yong Hong2,3,4orcid , Kyungdo Han5, Jay J. Shen2, Se Hoon Park3

DOI: https://doi.org/10.4143/crt.2024.996 [Accepted]
Published online: January 31, 2025
1Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
2Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, USA
3Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
5Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
Corresponding author:  Jung Yong Hong
Tel: 82-2-3410-1211 Email: hongjungyong@naver.com
Received: 15 October 2024   • Accepted: 30 January 2025
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Purpose
Previous studies suggested an association between alcohol consumption and reduced kidney cancer risk. Given a potential interaction between alcohol's insulin-sensitizing effect and hyperglycemia-related insulin resistance, we aimed to assess whether the dose-response association between alcohol intake and kidney cancer risk varies based on glycemic status.
Materials and Methods
This nationwide cohort study analyzed data from 9,492,331 adults who underwent a national health screening program in 2009 and were followed until 2018. Multivariable-adjusted Cox regression models were applied to estimate the hazard ratios (aHRs) and 95% confidence intervals (CIs).
Results
Over a median follow-up period of 8.3 years, 12,381 participants were diagnosed with kidney cancer. A U-shaped relationship between alcohol consumption and kidney cancer risk was observed among individuals with normoglycemia (light-to-moderate; HR, 0.94; 95% CI, 0.89–0.99 and heavy; HR, 1.00; 95% CI, 0.91–1.09, respectively). In prediabetic individuals, alcohol consumption was not significantly associated with kidney cancer risk. In individuals with diabetes, a dose-dependent increase in kidney cancer risk was noted with higher alcohol consumption (light-to-moderate consumption: HR, 1.12; 95% CI, 1.03–1.22; heavy consumption: HR, 1.24; 95% CI, 1.09–1.42; P for trend <0.01).
Conclusion
A modest U-shaped dose-response association between alcohol consumption and kidney cancer risk was observed exclusively in individuals with normoglycemia. Individuals with diabetes demonstrated a dose-dependent increased risk of kidney cancer with higher alcohol consumption. Tailored patient education and personalized risk assessments regarding alcohol consumption and kidney cancer risk should be emphasized over a generalized 'one-size-fits-all' approach.

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