Abstract
Active smoking is a risk factor for type 2 diabetes (T2DM), but it is unclear whether exposure to environmental tobacco smoke (ETS) is also associated with T2DM. The effect of passive and active smoking on the 7-year T2DM incidence was investigated in a population-based cohort in Southern Germany (KORA S4/F4; 1,223 subjects aged 55–74 years at baseline in 1999–2001, 887 subjects at follow-up). Incident diabetes was identified by oral glucose tolerance tests or by validated physician diagnoses. Among never smokers, subjects exposed to ETS had an increased diabetes risk in the total sample (odds ratio (OR) = 2.5; 95% confidence interval (CI): 1.1, 5.6) and in a subgroup of subjects having prediabetes at baseline (OR = 4.4; 95% CI: 1.5, 13.4) after adjusting for age, sex, parental diabetes, socioeconomic status, and lifestyle factors. Active smoking also had a statistically significant effect on diabetes incidence in the total sample (OR = 2.8; 95% CI: 1.3, 6.1) and in prediabetic subjects (OR = 7.8; 95% CI: 2.4, 25.7). Additional adjustment for components of the metabolic syndrome including waist circumference did not attenuate any of these associations. This study provides evidence that both passive and active smoking is associated with T2DM.
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Abbreviations
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- ETS:
-
Environmental tobacco smoke
- HOMA-IR:
-
Homeostatis model assessment of insulin resistance
- HR:
-
Hazard ratio
- IFG:
-
Impaired fasting glucose
- IGT:
-
Impaired glucose tolerance
- OGTT:
-
Oral glucose tolerance test
- OR:
-
Odds ratio
- RR:
-
Relative risk
- SES:
-
Socioeconomic status
- T2DM:
-
Type 2 diabetes mellitus
References
Houston TK, Person SD, Pletcher MJ, et al. Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study. BMJ. 2006;332(7549):1064–9.
Hayashino Y, Fukuhara S, Okamura T, et al. A prospective study of passive smoking and risk of diabetes in a cohort of workers: the high-risk and population strategy for occupational health promotion (HIPOP-OHP) study. Diabetes Care. 2008;31(4):732–4.
Willi C, Bodenmann P, Ghali WA, et al. Active smoking and the risk of type 2 diabetes. A systematic review and meta-analysis. JAMA. 2007;298(22):2654–64.
Keen H, Jarrett RJ, McCartney P. The ten-year follow-up of the Bedford Survey (1962–1972): glucose tolerance and diabetes. Diabetologia. 1982;22(2):73–8.
Wilson PWF, Anderson KM, Kannel WB. Epidemiology of diabetes mellitus in the elderly. The Framingham study. Am J Med. 1986;80(suppl 5A):3–9.
Feskens EJM, Kromhout D. Cardiovascular risk factors and the 25-year incidence of diabetes mellitus in middle-aged men. Am J Epidemiol. 1989;130(6):1101–8.
Hur NW, Kim HC, Nam CM, et al. Smoking cessation and risk of type 2 diabetes mellitus: Korea Medical Insurance Corporation Study. Eur J Cardiovasc Prev Rehabil. 2007;14(2):244–9.
Park CH, Ga H, Leem JH, et al. The effects of smoking status upon occurrence of impaired fasting glucose or type 2 diabetes in Korean men (Korean). J Prev Med Public Health. 2008;41(4):249–54.
Onat A, Özhan H, Metin Esen A, et al. Prospective epidemiologic evidence of a “protective” effect of smoking on metabolic syndrome and diabetes among Turkish women—without associated overall health benefit. Atherosclerosis. 2007;193(2):380–8.
Nagaya T, Yoshida H, Takahashi H, et al. Heavy smoking raises risk for type 2 diabetes mellitus in obese men; but, light smoking reduces the risk in lean men: a follow-up study in Japan. Ann Epidemiol. 2008;18(2):113–8.
Rathmann W, Haastert B, Icks A, et al. High prevalence of undiagnosed diabetes mellitus in Southern Germany: target populations for efficient screening. The KORA survey 2000. Diabetologia. 2003;46(2):182–9.
Alberti KGMM, Zimmet PZ, For the WHO Organization. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.
Forouhi NG, Balkau B, Borch-Johnsen K, et al. The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group. Diabetologia. 2006;49(5):822–7.
Rathmann W, Haastert B, Icks A, et al. Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA survey 2000. Eur J Public Health. 2005;15(6):627–33.
Winkler G, Döring A. Validation of a short qualitative food frequency list used in several German large scale surveys. Z Ernaehrungswiss. 1998;37(3):234–41.
Zhang J, Yu KF. What′s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280(19):1690–1.
Foy CG, Bell RA, Farmer DF, et al. Smoking and incidence of diabetes among US adults: findings from the Insulin Resistance Atherosclerosis Study. Diabetes Care. 2005;28(10):2501–7.
Manson JE, Ajani UA, Liu S, et al. A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. Am J Med. 2000;109(7):538–42.
Rimm EB, Chan J, Stampfer MJ, et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995;310(6979):555–9.
Nakanishi N, Nakamura K, Matsuo Y, et al. Cigarette smoking and risk for impaired fasting glucose and type 2 diabetes in middle-aged Japanese men. Ann Intern Med. 2000;133(3):183–91.
Rimm EB, Manson JE, Stampfer MJ, et al. Cigarette smoking and the risk of diabetes in women. Am J Public Health. 1993;83(2):211–4.
Will JC, Galuska DA, Ford ES, et al. Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Int J Epidemiol. 2001;30(3):540–6.
Kawakami N, Takatsuka N, Shimizu H, et al. Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus. Am J Epidemiol. 1997;145(2):103–9.
Sairenchi T, Iso H, Nishimura A, et al. Cigarette smoking and risk of type 2 diabetes mellitus among middle-aged and elderly Japanese men and women. Am J Epidemiol. 2004;160(2):158–62.
Wannamethee SG, Shaper AG, Perry IJ. Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men. Diabetes Care. 2001;24(9):1590–5.
US Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke. A Report of the Surgeon General. Rockville, MD, USA, 2006.
California Environmental Protection Agency. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Sacramento: California Environmental Protection Agency, Office of Environmental Health Hazard Assessment, 2005.
Attvall S, Fowelin J, Lager I, et al. Smoking induces insulin resistance—A potential link with the insulin resistance syndrome. J Intern Med. 1993;233(4):327–32.
Facchini FS, Hollenbeck CB, Jeppesen J, et al. Insulin resistance and cigarette smoking. Lancet. 1992;339(8802):1128–30.
Eliasson B, Mero N, Taskinen MR, et al. The insulin resistance syndrome and postprandial lipid intolerance in smokers. Atherosclerosis. 1997;129(1):79–88.
Nilsson PM, Lind L, Pollare T, et al. Increased level of hemoglobin A1c, but not impaired insulin sensitivity, found in hypertensive and normotensive smokers. Metabolism. 1995;44(5):557–61.
Henkin L, Zaccaro D, Haffner S, et al. Cigarette smoking, environmental tobacco smoke exposure and insulin sensitivity. Ann Epidemiol. 1999;9(5):290–6.
Sonmez A, Dogru T, Yilmaz MI, et al. Adiponectin and insulin resistance in young and healthy smokers. Endocr J. 2006;53(6):729–34.
Shimokata H, Muller DC, Andres R. Studies in the distribution of body fat. III. Effects of cigarette smoking. JAMA. 1989;261(8):1169–73.
Albanes D, Jones Y, Micozzi MS, et al. Associations between smoking and body weight in the US population: analysis of NHANES II. Am J Public Health. 1987;77(4):439–44.
Troisi RJ, Heinold JW, Vokonas PS, et al. Cigarette smoking, dietary intake, and physical activity: effects on body fat distribution—The Normative Aging Study. Am J Clin Nutr. 1991;53(5):1104–11.
Freemantle N, Holmes J, Hockey A, et al. How strong is the association between abdominal obesity and the incidence of type 2 diabetes? Int J Clin Pract. 2008;62(9):1391–6.
Chowdhury P, MacLeod S, Udupa KB, et al. Pathophysiological effects of nicotine on the pancreas: an update. Exp Biol Med. 2002;227(7):445–54.
Gallicchio L, Kouzis A, Genkinger JM, et al. Active cigarette smoking, household passive smoke exposure, and the risk of developing pancreatic cancer. Prev Med. 2006;42(3):200–5.
Bazzano LA, He J, Muntner P, et al. Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States. Ann Intern Med. 2003;138(11):891–7.
Wannamethee SG, Lowe GDO, Shaper AG, et al. Associations between cigarette smoking, pipe/cigar smoking, and smoking cessation, and haemostatic and inflammatory markers for cardiovascular disease. Eur Heart J. 2005;26(17):1765–73.
Burke A, FitzGerald GA. Oxidative stress and smoking-induced vascular injury. Prog Cardiovasc Dis. 2003;46(1):79–90.
Berlin I. Smoking-induced metabolic disorders: a review. Diabetes Metab. 2008;34(4):307–14.
Hays NP, Galassetti PR, Coker RH. Prevention and treatment of type 2 diabetes: current role of lifestyle, natural product, and pharmacological interventions. Pharmacol Ther. 2008;118(2):181–91.
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Kowall, B., Rathmann, W., Strassburger, K. et al. Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: the KORA S4/F4 cohort study. Eur J Epidemiol 25, 393–402 (2010). https://doi.org/10.1007/s10654-010-9452-6
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DOI: https://doi.org/10.1007/s10654-010-9452-6