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Yusuf FM, San Sebastián M, Vaezghasemi M. Explaining gender inequalities in overweight people: a Blinder-Oaxaca decomposition analysis in northern Sweden. Int J Equity Health 2023; 22:159. [PMID: 37608286 PMCID: PMC10464412 DOI: 10.1186/s12939-023-01973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Being overweight and obesity are considered serious public health concerns worldwide. At the population level, factors contributing to overweight as well as the differences in overweight between men and women in terms of prevalence or associated factors are relatively well-known. What is less known is what explains the inequalities in overweight between men and women. In this study, we examined the contribution of material, behavioural, and psychosocial factors in explaining the gender differences in overweight among adults in northern Sweden. METHODS This study was based on the 2018 Swedish Health on Equal Terms survey, which was carried out in Sweden's four northernmost regions. The analytical sample consisted of 20,855 participants (47% men) aged 20-84 years. Overweight (including obesity) was the outcome, and the selected explanatory variables were grouped according to three theoretical perspectives: material, behavioural and psychosocial. Descriptive statistics and Blinder-Oaxaca decomposition were applied for analysing the data. RESULTS Our study showed that the prevalence of overweight was 64% and 52% among men and women, respectively. It, therefore, revealed a gender gap in overweight people of 11.7% points with explanatory factors accounting for 39% of that gap. This gender gap in overweight people was mostly explained by behavioural variables (19.3%), followed by the materialistic variables and age accounting for 16.2% and 3.1%, respectively. Specifically, having low education, being in the lowest income quintile, alcohol drinking and snus usage contributed to explain 8.4%, 8.9%, 2.8% and 6.3% of the gender difference, respectively. CONCLUSIONS We found a considerable gender inequality in overweight between men and women. The findings highlight that future overweight prevention initiatives would benefit from targeting the uncovered contributing factors to reduce gender inequalities in overweight people.
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Affiliation(s)
- Fethi Mohammed Yusuf
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE -901 87, Sweden.
| | - Miguel San Sebastián
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE -901 87, Sweden
| | - Masoud Vaezghasemi
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE -901 87, Sweden
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Titova OE, Baron JA, Fall T, Michaëlsson K, Larsson SC. Swedish Snuff (Snus), Cigarette Smoking, and Risk of Type 2 Diabetes. Am J Prev Med 2023:S0749-3797(23)00020-X. [PMID: 36754744 DOI: 10.1016/j.amepre.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Cigarette smoking is a known risk factor for Type 2 diabetes, but evidence regarding former smoking and moist snuff (snus) use and Type 2 diabetes risk is inconclusive. This study investigated the relationships of cigarette smoking and Swedish snus use with the risk of Type 2 diabetes in a cohort of middle-aged and elderly participants. METHODS Participants (N=36,742; age range=56-95 years) were followed for incident Type 2 diabetes and death between 2009 and 2017 through linkage to the Swedish National Patient, Prescribed Drug and Death Registers. Cox proportional hazards regression was used to obtain hazard ratios and 95% CIs adjusted for potential confounders, including physical activity, education, BMI, and alcohol intake. Analyses were conducted in 2021‒2022. RESULTS Former and current smoking was associated with an increased risk of Type 2 diabetes (hazard ratios [95% CI]=1.17 [1.07, 1.29] and 1.57 [1.36, 1.81], respectively). In those who stopped smoking, Type 2 diabetes risk remained elevated up to approximately 15 years after cessation. In participants who have never smoked, snus use was linked to a higher risk of Type 2 diabetes in the model adjusted for age and sex (hazard ratio [95% CI]=1.49 [1.04, 2.15]), but this was attenuated after multivariable adjustment (hazard ratio [95% Cl]=1.29 [0.89, 1.86]). CONCLUSIONS This study indicates that current and former smoking are associated with an increased risk of Type 2 diabetes in middle-aged and older individuals. There was less evidence of an association of snus use with the risk of Type 2 diabetes, suggesting that compounds other than nicotine may underlie the detrimental association of smoking with the risk of Type 2 diabetes.
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Affiliation(s)
- Olga E Titova
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - John A Baron
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Tove Fall
- Unit of Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Susanna C Larsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Walicka M, Russo C, Baxter M, John I, Caci G, Polosa R. Impact of stopping smoking on metabolic parameters in diabetes mellitus: A scoping review. World J Diabetes 2022; 13:422-433. [PMID: 35800409 PMCID: PMC9210544 DOI: 10.4239/wjd.v13.i6.422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/01/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
The purpose of this scoping review is to create a single narrative that describes the impact of smoking cessation on metabolic parameters in people with diabetes. It is generally well accepted that smoking enhances the harmful effects of elevated blood glucose levels, accelerating the vascular damage seen in patients with diabetes. Smoking cessation has clear benefits in terms of reducing cardiovascular morbidity and mortality. However, there is less evidence for the impact of smoking cessation on other diabetes-related complications. Studies in people with diabetes have shown improvement as well as temporary deterioration in glycemic control after ceasing smoking. Only a few studies have described the effect of quitting smoking on insulin resistance and lipid parameters, however, their results have been inconclusive. In this situation, healthcare professionals should not assume that cessation of smoking will improve metabolic parameters in patients with diabetes. It seems they should, first of all, emphasize the prevention of weight gain that may be associated with quitting smoking. The lack of data regarding the metabolic effects of smoking and smoking cessation in diabetes is very disappointing and this area needs to be addressed.
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Affiliation(s)
- Magdalena Walicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw 02-106, Poland
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Warsaw 02-507, Poland
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
| | - Cristina Russo
- Ashford and Saint Peter's Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, United Kingdom
| | - Michael Baxter
- Ashford and Saint Peter's Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, United Kingdom
| | - Isaac John
- Ashford and Saint Peter's Hospitals NHS Foundation Trust, Chertsey KT16 0PZ, United Kingdom
| | - Grazia Caci
- Department of Clinical and Experimental Medicine, University of Messina, Messina 98124, Italy
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania 95123, Italy
- Center of Excellence for The Acceleration of HArm Reduction (CoEHAR), University of Catania, Cataia 95123, Italy
- Centre for The Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico-V. Emanuele", Catania 95123, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania 95123, Italy
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Lee PN, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence relating smoking to type 2 diabetes. World J Meta-Anal 2020; 8:119-152. [DOI: 10.13105/wjma.v8.i2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence relating tobacco smoking to type 2 diabetes has accumulated rapidly in the last few years, rendering earlier reviews considerably incomplete.
AIM To review and meta-analyse evidence from prospective studies of the relationship between smoking and the onset of type 2 diabetes.
METHODS Prospective studies were selected if the population was free of type 2 diabetes at baseline and evidence was available relating smoking to onset of the disease. Papers were identified from previous reviews, searches on Medline and Embase and reference lists. Data were extracted on a range of study characteristics and relative risks (RRs) were extracted comparing current, ever or former smokers with never smokers, and current smokers with non-current smokers, as well as by amount currently smoked and duration of quitting. Fixed- and random-effects estimates summarized RRs for each index of smoking overall and by various subdivisions of the data: Sex; continent; publication year; method of diagnosis; nature of the baseline population (inclusion/exclusion of pre-diabetes); number of adjustment factors; cohort size; number of type 2 diabetes cases; age; length of follow-up; definition of smoking; and whether or not various factors were adjusted for. Tests of heterogeneity and publication bias were also conducted.
RESULTS The literature searches identified 157 relevant publications providing results from 145 studies. Fifty-three studies were conducted in Asia and 53 in Europe, with 32 in North America, and seven elsewhere. Twenty-four were in males, 10 in females and the rest in both sexes. Fifteen diagnosed type 2 diabetes from self-report by the individuals, 79 on medical records, and 51 on both. Studies varied widely in size of the cohort, number of cases, length of follow-up, and age. Overall, random-effects estimates of the RR were 1.33 [95% confidence interval (CI): 1.28-1.38] for current vs never smoking, 1.28 (95%CI: 1.24-1.32) for current vs non-smoking, 1.13 (95%CI: 1.11-1.16) for former vs never smoking, and 1.25 (95%CI: 1.21-1.28) for ever vs never smoking based on, respectively, 99, 156, 100 and 100 individual risk estimates. Risk estimates were generally elevated in each subdivision of the data by the various factors considered (exceptions being where numbers of estimates in the subsets were very low), though there was significant (P < 0.05) evidence of variation by level for some factors. Dose-response analysis showed a clear trend of increasing risk with increasing amount smoked by current smokers and of decreasing risk with increasing time quit. There was limited evidence of publication bias.
CONCLUSION The analyses confirmed earlier reports of a modest dose-related association of current smoking and a weaker dose-related association of former smoking with type 2 diabetes risk.
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Affiliation(s)
- Peter N Lee
- Department of Statistics, P.N. Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
| | - Katharine J Coombs
- Department of Statistics, P.N. Lee Statistics and Computing Ltd., Sutton SM2 5DA, Surrey, United Kingdom
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Malovichko MV, Zeller I, Krivokhizhina TV, Xie Z, Lorkiewicz P, Agarwal A, Wickramasinghe N, Sithu SD, Shah J, O'Toole T, Rai SN, Bhatnagar A, Conklin DJ, Srivastava S. Systemic Toxicity of Smokeless Tobacco Products in Mice. Nicotine Tob Res 2020; 21:101-110. [PMID: 30085294 DOI: 10.1093/ntr/ntx230] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/02/2017] [Indexed: 02/05/2023]
Abstract
Introduction Smokeless tobacco products such as snuff and snus are used worldwide. However, little is known about the systemic and cardiovascular toxicity of smokeless tobacco exposure. Methods Biomarkers of endothelial activation and injury, immune functions, platelet activation and insulin resistance were measured in 8-week old male C57BL/6 mice exposed to commercial snuff, CRP-2 reference snuff, commercial snus, CRP-1 reference snus, and nicotine in drinking water (100 µg/mL) for 4, 12, and 24 weeks. Results Twenty-four weeks of exposure to smokeless tobacco products or nicotine significantly decreased the levels of circulating Flk+/Sca+ endothelial progenitor cells. Twelve and 24 weeks of exposure to all the smokeless tobacco products and nicotine significantly decreased the levels of circulating CD19+ B cells, CD4+ T cells, CD8+ T cells, and CD11b+ monocytes, whereas 4 weeks of exposure to Camel snus and Copenhagen snuff significantly depleted the levels of peripheral blood CD19+ B cells and CD11b+ monocytes. Twenty-four weeks of exposure to smokeless tobacco products or nicotine significantly decreased plasma IFNγ levels. However, plasma TNFα levels were significantly increased in mice exposed to Copenhagen snuff or nicotine for 24 weeks. This was accompanied by a five to sevenfold increase in the hepatic expression of TNFα. Neither smokeless products nor nicotine affected plasma lipoproteins, platelet activation, or systemic insulin sensitivity. Conclusions Chronic exposure to snuff and snus suppresses circulating levels of EPCs, endothelial microparticles and immune cells, but increases plasma TNF-α levels. These effects of smokeless tobacco products are attributable, at least in part, to nicotine. Implications Exposure to smokeless tobacco products results in the depletion of endothelial progenitor cells, which may impair the endothelium repair. Suppression of the circulating levels of immune cells upon exposure to smokeless tobacco products may increase the susceptibility to secondary infection. Increased formation of proinflammatory cytokines such as TNFα by nicotine or Copenhagen snuff may lead to vascular inflammation and thereby exacerbate atherogenesis.
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Affiliation(s)
- Marina V Malovichko
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Iris Zeller
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Tatiana V Krivokhizhina
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Zhengzhi Xie
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Pawel Lorkiewicz
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Abhinav Agarwal
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Nalinie Wickramasinghe
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Srinivas D Sithu
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Jasmit Shah
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Timothy O'Toole
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Shesh N Rai
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Aruni Bhatnagar
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Daniel J Conklin
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
| | - Sanjay Srivastava
- American Heart Association-Tobacco Regulation and Addiction Center, Institute of Molecular Cardiology, and Diabetes and Obesity Center, University of Louisville, Louisville, KY
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Clarke E, Thompson K, Weaver S, Thompson J, O’Connell G. Snus: a compelling harm reduction alternative to cigarettes. Harm Reduct J 2019; 16:62. [PMID: 31775744 PMCID: PMC6882181 DOI: 10.1186/s12954-019-0335-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022] Open
Abstract
Snus is an oral smokeless tobacco product which is usually placed behind the upper lip, either in a loose form or in portioned sachets, and is primarily used in Sweden and Norway. The purpose of this review is to examine the reported effects of snus use in relation to specified health effects, namely lung cancer, cardiovascular disease, pancreatic cancer, diabetes, oral cancer and non-neoplastic oral disease. The review also examines the harm reduction potential of snus as an alternative to cigarettes by comparing the prevalence of snus use and cigarette smoking, and the reported incidence of tobacco-related diseases across European Union countries. The scientific literature generally indicates that the use of snus is not a significant risk factor for developing lung cancer, cardiovascular disease, pancreatic cancer or oral cancer. Studies investigating snus use and diabetes have reported that high consumption of snus (estimated as being four or more cans per week) may be associated with a higher risk of developing diabetes or components of metabolic syndrome; however, overall results are not conclusive. Snus use is associated with the presence of non-neoplastic oral mucosal lesions which are reported to heal rapidly once use has stopped. The most recent Eurobarometer data from 2017 reported that Sweden had the lowest prevalence of daily cigarette use in the European Union at 5% whilst daily "oral tobacco" use was reported to be 20%. European data published by the World Health Organisation in 2018 indicated that Sweden had the lowest rate of tobacco-related mortality and the lowest incidence of male lung cancer. Overall, prevalence statistics and epidemiological data indicate that the use of snus confers a significant harm reduction benefit which is reflected in the comparatively low levels of tobacco-related disease in Sweden when compared with the rest of Europe. The available scientific data, including long-term population studies conducted by independent bodies, demonstrates that the health risks associated with snus are considerably lower than those associated with cigarette smoking.
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Affiliation(s)
| | - Keith Thompson
- Elucid8 Holdings Ltd, Ballymena Business Centre, 62 Fenaghy Road, Ballymena, BT42 1FL UK
| | - Sarah Weaver
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Joseph Thompson
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Grant O’Connell
- Imperial Brands Plc, 121 Winterstoke Road, Bristol, BS3 2LL UK
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Choudhary AK, Qudeer A. Smokeless tobacco: Risk factor for cardiovascular and breathing in young Indian adolescent. HIPERTENSION Y RIESGO VASCULAR 2019; 36:176-183. [PMID: 31401090 DOI: 10.1016/j.hipert.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Teenagers are the foremost susceptible population to smokeless tobacco usage and limited studies have surveyed the influence of smokeless tobacco on cardiac and respiratory response. OBJECTIVE This study aims to measure consequence (cardiovascular and breathing) of smokeless tobacco usage (gutkha and chewing tobacco) among young Indian men. METHOD On random basis, the applicants were divided into Group I (n=50) - healthy control group, Group II (n=50) - smokeless tobacco users. Anthropometric measurements and recording of blood pressure (BP), pulse wave analysis (PWV), heart rate variability (HRV) and pulmonary function test (PFT) was performed. RESULT We observed that altogether anthropometric variables were comparable among all individuals. In blood pressure variable, except DBP, other variables for example SBP, PP and MAP were significantly increased in Group II individuals, once compare to Group I. Pulse wave analysis, (such as, AP, AIx, and SEVR), was comparable in individuals of both groups. As compare to Group I, HR was significantly increased in Group II. In HRV investigation, NN, VLF, LF, LF(nu), LF/HF were increased significantly and TSP, HF, HF(nu) were decreased significantly in Group II with compare to Group I. In PFT analysis, FVC was comparable among individuals of both the group and conversely, significant decrease in FEV1, FEV1/FVC, FEF25-75 and PEFR in Group II when compare with Group I. CONCLUSION This study illustrate that smokeless tobacco practice has increasing adverse effects on cardiovascular as well as breathing system and become an important public health problem.
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Affiliation(s)
- A K Choudhary
- Department of Physiology, Government Medical College, Shivpuri, MP, India.
| | - A Qudeer
- Department of Physiology, L.N. Medical College and J.K. Hospital, Bhopal, India
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Ryman TK, Boyer BB, Hopkins SE, Philip J, Thompson B, Beresford SAA, Thummel KE, Austin MA. Association between iq'mik smokeless tobacco use and cardiometabolic risk profile among Yup'ik Alaska Native people. ETHNICITY & HEALTH 2018; 23:488-502. [PMID: 28116909 PMCID: PMC5796859 DOI: 10.1080/13557858.2017.1280136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The traditional lifestyle of Yup'ik Alaska Native people, including a diet abundant in marine-based foods and physical activity, may be cardio-protective. However, iq'mik, a traditional form of smokeless tobacco used by >50% of Yup'ik adults, could increase cardiometabolic (CM) risk. Our objective was to characterize the associations between iq'mik use and biomarkers of CM status (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], systolic blood pressure [SBP] and diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], fasting blood glucose [FBG], waist circumference [WC], and body mass index [BMI]). DESIGN We assessed these associations using data from a cross-sectional sample of Yup'ik adults (n = 874). Current iq'mik use, demographic, and lifestyle data were collected through interviews. Fasting blood samples were collected to measure LDL-C, HDL-C, TG, HbA1c, and FBG. SBP, DBP, WC, and BMI were obtained by physical examination. We characterized the association between current iq'mik use and continuous biomarkers of CM status using multiple approaches, including adjustment for measures of Yup'ik lifestyle and a propensity score. RESULTS Based on either adjustment method, current iq'mik use was significantly and positively associated with at least 5% higher HDL-C, and significantly associated but in an inverse direction with multiple biomarkers of CM status including 7% lower TG, 0.05% lower HbA1c, 2% lower FBG, 4% lower WC, and 4% lower BMI. Observed associations for LDL-C, SBP, and DBP varied by adjustment method. CONCLUSIONS This inverse association between iq'mik use and cardiometabolic risk status has not been previously reported. Additional research is needed to replicate these findings and explore physiological mechanisms and/or confounding factors.
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Affiliation(s)
- Tove K Ryman
- a Department of Epidemiology, School of Public Health , University of Washington , Seattle , WA , USA
| | - Bert B Boyer
- b Center for Alaska Native Health Research , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Scarlett E Hopkins
- b Center for Alaska Native Health Research , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Jacques Philip
- b Center for Alaska Native Health Research , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Beti Thompson
- c Department of Health Services , University of Washington , Seattle , WA , USA
| | - Shirley A A Beresford
- a Department of Epidemiology, School of Public Health , University of Washington , Seattle , WA , USA
| | - Kenneth E Thummel
- d Department of Pharmaceutics , University of Washington , Seattle , WA , USA
| | - Melissa A Austin
- a Department of Epidemiology, School of Public Health , University of Washington , Seattle , WA , USA
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Lee PN, Thornton AJ. The relationship of snus use to diabetes and allied conditions. Regul Toxicol Pharmacol 2017; 91:86-92. [PMID: 29061372 DOI: 10.1016/j.yrtph.2017.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/20/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022]
Abstract
A recent meta-analysis reported smoking to be associated with a 37% higher risk of type 2 diabetes in current smokers, rising to a 57% increase in heavy smokers, which declines on quitting. If the increase results from nicotine exposure, it is possible that using Swedish moist snuff ("snus"), which provides at least equivalent nicotine doses, might also increase diabetes risk. Following a recent publication reporting pooled results from five cohorts, we present a detailed meta-analysis of data from 18 studies. Based on covariate-adjusted estimates, no significant increased risk was seen in never smokers with RRs (95% CIs) of 1.08 (0.86-1.34), 0.93 (0.79-1.11) and 1.05 (0.94-1.18) for current, former and ever snus users. Significant increases were also not seen in the whole population, the corresponding RR estimates being 1.18 (0.94-1.48), 0.69 (0.49-0.96) and 0.95 (0.81-1.11). Nor was there an association of snus use with related endpoints, such as impaired glucose tolerance. However, dose-response analyses showed a relationship, with the highest levels of snus exposure associated with a diabetes RR of 1.65 (1.25-2.18) in never smokers. The evidence relating snus to type 2 diabetes is somewhat limited, requiring further studies to confirm any possible relationship.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, United Kingdom.
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Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes. Transl Res 2017; 184:101-107. [PMID: 28336465 PMCID: PMC5429867 DOI: 10.1016/j.trsl.2017.02.004] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/19/2017] [Accepted: 02/25/2017] [Indexed: 01/18/2023]
Abstract
Despite accumulating evidence demonstrating strong epidemiologic and mechanistic associations between cigarette smoking, hyperglycemia, and the development of type 2 diabetes, tobacco abuse has not been uniformly recognized as a modifiable risk factor in diabetes prevention or screening strategies. In this review, we highlight population-based studies that have linked cigarette smoking with an increased risk of type 2 diabetes and summarize clinical and preclinical studies offering insight into mechanisms through which cigarette smoking and nicotine exposure impact body composition, insulin sensitivity, and pancreatic β cell function. Key questions for future studies are identified and strategies for smoking cessation as a means to decrease diabetes risk are discussed.
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Affiliation(s)
- Judith Maddatu
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind
| | | | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Ind; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Ind; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Ind; Roudebush VA Medical Center, Indianapolis, Ind.
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11
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Carlsson S, Andersson T, Araghi M, Galanti R, Lager A, Lundberg M, Nilsson P, Norberg M, Pedersen NL, Trolle-Lagerros Y, Magnusson C. Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts. J Intern Med 2017; 281:398-406. [PMID: 28164394 DOI: 10.1111/joim.12592] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Swedish smokeless tobacco (snus) is high in nicotine, and its use is prevalent in Scandinavian countries, but few studies have investigated snus use in relation to diabetes risk. OBJECTIVE To explore the association between snus use and risk of type 2 diabetes using pooled data from five cohorts. METHODS Analyses were based on prospective studies conducted between 1990 and 2013 including 54 531 never-smoking men and 2441 incident cases of type 2 diabetes identified through screening, self-reporting and hospital and prescription registries. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed and adjusted for age, body mass index, educational level, alcohol consumption and physical activity. RESULTS Compared to never users, the HR of type 2 diabetes was 1.15 (95% CI: 1.00-1.32) in current users of snus. In individuals consuming 5-6 boxes per week, the HR was 1.42 (95% CI: 1.07-1.87); in those consuming ≥7 boxes per week, the HR was 1.68 (95% CI: 1.17-2.41). Each additional box of snus consumed per week yielded an HR of 1.08 (95% CI: 1.01-1.16). CONCLUSION Our findings indicate that high consumption of snus is a risk factor for type 2 diabetes. The risk was similar to that in smokers, implying that smokers will not reduce their risk of type 2 diabetes by changing to snus use. The results also support the notion that nicotine increases the risk of type 2 diabetes.
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Affiliation(s)
- S Carlsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - M Araghi
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - R Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - A Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - M Lundberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - P Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - M Norberg
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - N L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - C Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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12
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Rasouli B, Andersson T, Carlsson PO, Grill V, Groop L, Martinell M, Midthjell K, Storm P, Tuomi T, Carlsson S. Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA). Diabet Med 2017; 34:514-521. [PMID: 27353226 DOI: 10.1111/dme.13179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
Abstract
AIMS It has been suggested that moist snuff (snus), a smokeless tobacco product that is high in nicotine and widespread in Scandinavia, increases the risk of Type 2 diabetes. Previous studies are however few, contradictory and, with regard to autoimmune diabetes, lacking. Our aim was to study the association between snus use and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA). METHOD Analyses were based on incident cases (Type 2 diabetes, n = 724; LADA, n = 200) and population-based controls (n = 699) from a Swedish case-control study. Additional analyses were performed on cross-sectional data from the Norwegian HUNT study (n = 21 473) with 829 prevalent cases of Type 2 diabetes. Odds ratios (OR) were estimated adjusted for age, BMI family history of diabetes and smoking. Only men were included. RESULTS No association between snus use and Type 2 diabetes or LADA was seen in the Swedish data. For Type 2 diabetes, the OR for > 10 box-years was 1.00 [95% confidence interval (CI), 0.47 to 2.11] and for LADA 1.01 (95% CI, 0.45 to 2.29). Similarly, in HUNT, the OR for Type 2 diabetes in ever-users was estimated at 0.91 (95% CI, 0.75 to 1.10) and in heavy users at 0.92 (95% CI, 0.46 to 1.83). CONCLUSION The risk of Type 2 diabetes and LADA is unrelated to the use of snus, despite its high nicotine content. This opens the possibility of the increased risk of Type 2 diabetes seen in smokers may not be attributed to nicotine, but to other substances in tobacco smoke.
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Affiliation(s)
- B Rasouli
- Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T Andersson
- Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - P-O Carlsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - V Grill
- NTNU Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Trondheim University Hospital, Trondheim, Norway
| | - L Groop
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - M Martinell
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - K Midthjell
- HUNT Research Centre, Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Levanger, Norway
| | - P Storm
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - T Tuomi
- Department of Medicine, Helsinki University Central Hospital and Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - S Carlsson
- Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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13
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Affiliation(s)
- Mats Eliasson
- Sunderby Hospital, Luleå and Department of Public Health and Clinical Medicine, Umeå University, Sweden.
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14
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Mahapatra T, Chakraborty K, Mahapatra S, Mahapatra U, Pandey N, Thomson PL, Musk AW, Mitra RN. Burden and Socio-Behavioral Correlates of Uncontrolled Abnormal Glucose Metabolism in an Urban Population of India. PLoS One 2016; 11:e0163891. [PMID: 27755543 PMCID: PMC5068776 DOI: 10.1371/journal.pone.0163891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 09/18/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Progressive burden of diabetes mellitus is a major concern in India. Data on the predictors of poor glycemic control among diabetics are scanty. A population-based cross-sectional study nested in an urban cohort was thus conducted in West Bengal, India to determine the burden and correlates of total and uncontrolled abnormalities in glucose metabolism (AGM) in a representative population. METHODS From 9046 adult cohort-members, 269 randomly selected consenting subjects (non-response = 7.24%) were interviewed, examined [blood pressure (BP), anthropometry], tested for fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1C). Those having pre-diagnosed diabetes or FPG ≥126 or HbA1c≥6.5 were defined as diabetic. Among non-diabetics, subjects with FPG (mg/dl) = 100-125 or HbA1C(%) = 5.7-6.4 were defined as pre-diabetic. Pre-diagnosed cases with current FPG ≥126 were defined as uncontrolled AGM. Descriptive and regression analyses were conducted using SAS-9.3.2. RESULTS Among participants, 28.62% [95% Confidence Interval (95%CI) = 23.19-34.06)] were overweight [body mass index(BMI) = (25-29.99)kg/meter2], 7.81% (4.58-11.03) were obese(BMI≥30kg/meter2), 20.82% (15.93-25.70) were current smokers, 12.64% (8.64-16.64) were current alcohol-drinkers and 46.32% of responders (39.16-53.47) had family history of diabetes. 17.84% (13.24-22.45) had stage-I [140≤average systolic BP (AvSBP in mm of mercury)<160 or 90≤average diastolic BP (AvDBP)<100] and 12.64% (8.64-16.64) had stage-II (AvSBP≥160 or AvDBP≥160) hypertension. Based on FPG and HbA1c, 10.41% (6.74-14.08) were diabetic and 27.88% (22.49-33.27) were pre-diabetic. Overall prevalence of diabetes was 15.61% (11.25-19.98). Among pre-diagnosed cases, 46.43% (26.74-66.12) had uncontrolled AGM. With one year increase in age [Odds Ratio(OR) = 1.05(1.03-1.07)], retired subjects [OR = 9.14(1.72-48.66)], overweight[OR = 2.78(1.37-5.64)], ex-drinkers [OR = 4.66(1.35-16.12)] and hypertensives [ORStage I = 3.75(1.42-9.94); ORStage II = 4.69(1.67-13.17)] had higher odds of diabetes. Relatively older subjects [OR = 1.06(1.02-1.10)], unemployed [OR = 19.68(18.64-20.78)], business-owners [OR = 25.53(24.91-16.18)], retired [OR = 46.53(45.38-47.72)], ex-smokers [OR = 4.75(1.09-20.78)], ex-drinkers [OR = 22.43(4.62-108.81)] and hypertensives [ORStage II = 13.17(1.29-134.03)] were more likely to have uncontrolled AGM. CONCLUSIONS Burden of uncontrolled AGM was high among participants. Efforts to curb the diabetes epidemic in urban India should include interventions targeting appropriate diabetic control among relatively older persons, unemployed, business-owners, retired, ex-smokers, ex-drinkers and hypertensives.
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Affiliation(s)
- Tanmay Mahapatra
- Barrackpore Population Health Research Foundation, Kolkata, 700123, India
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, 700010, India
| | | | - Sanchita Mahapatra
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, 700010, India
| | - Umakanta Mahapatra
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical, Education and Research, Kolkata, 700020, India
| | - Naren Pandey
- Mediland Diagnostic Institute, Kolkata, Kolkata, 700014, India
| | - Peter L. Thomson
- Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia
| | - Arthur W. Musk
- Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia
- School of Population Health, University of Western Australia, Perth, 6009, Australia
| | - Ramendra N. Mitra
- Barrackpore Population Health Research Foundation, Kolkata, 700123, India
- Sir Charles Gairdner Hospital, University of Western Australia, Nedlands, 6009, Australia
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Jena SS, Kabi S, Panda BN, Kameswari BC, Payal, Behera IC, Tripathy SK, Mahanta S. Smokeless Tobacco and Stroke - A Clinico-epidemiological Follow-up Study in A Tertiary Care Hospital. J Clin Diagn Res 2016; 10:OC40-OC43. [PMID: 27891376 DOI: 10.7860/jcdr/2016/21763.8756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/15/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Among the modifiable risk factors for stroke, tobacco smoking is well recognized. In some studies the use of Smokeless Tobacco (ST) has also been contributed as a risk factor for ischemic stroke. Use of ST is very common in South-East Asia. The form of ST varies according to the geographical and cultural variation. AIM To study the various clinical symptoms and radiological findings of stroke due to different types of ST. MATERIALS AND METHODS This was a prospective hospital based study carried out over a period of 2 years. All the cases within age group of 16 - 60 years and with a clinical and radiological diagnosis of acute stroke were included in the study. The Fagerström Test for Nicotine Dependence for ST of more than 6 was taken as the inclusion criteria. Patients having other addictions like smoked tobacco, alcohol, etc., and with important risk factors like hypertension, diabetes, dyslipidemia were excluded. The cases were extensively investigated and followed up for at least 6 months. Analysis was done using the Statistical Package for Social Sciences (SPSS- version 16.0). Descriptive statistics like percentage, mean were used wherever appropriate. RESULTS During a period of 2 years, a total of 54 patients were studied. Forty two (77.7%) were males and 12(22.3%) were females. The mean age at presentation was 42.72(± 8.6) years and among all 96.3% patients were diagnosed as ischemic stroke. Among ST, pan was most commonly used in 21(38.9%) patients with an average of 14.6(±3.27) years of addiction. Hemiplegia was the predominant symptom on presentation (46, 85.2%). According to Oxfordshire Stroke Classification, partial anterior circulation infarct was most common in 20(38.4%). The mean Modified Rankin scale after 5 days of hospital stay was 3.83(±1.03) and after 6 months of follow-up was 2.1(±0.8). Patients were counseled for deaddiction and after 6 months follow-up 48(88.8%) patients had quit ST. CONCLUSION ST is an important etiological factor for young ischemic stroke. This is the first study depicting clinical symptomatology of ST addicted ischemic stroke patients from India. Considering the increasing prevalence of ST use in south-east Asia, further long term studies are needed from this region.
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Affiliation(s)
- Subhransu Sekhar Jena
- Associate Professor, Department of Neurology, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Shobhitendu Kabi
- Associate Professor, Department of Medicine, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Baikuntha Nath Panda
- Professor, Department of Medicine, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - B C Kameswari
- Student, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Payal
- Student, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Ishwar Chandra Behera
- Associate Professor, Department of Emergency and Critical Care, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Subrat Kumar Tripathy
- Assistant Professor, Department of Biochemistry, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Seemanchana Mahanta
- Junior Resident, Department of Neurology, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India
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16
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Norberg M, Stenlund H, Lindahl B, Boman K, Weinehall L. Contribution of Swedish moist snuff to the metabolic syndrome: A wolf in sheep's clothing? Scand J Public Health 2016; 34:576-83. [PMID: 17132590 DOI: 10.1080/14034940600665143] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between several lifestyle factors and MetSy, with a focus on the possible role of smokeless tobacco in the form of Swedish moist snuff (snus). Methods: A population-based longitudinal cohort study within the Västerbotten Intervention Programme in Northern Sweden. All inhabitants at the ages of 30, 40, 50, and 60 are invited to participate in a health survey that includes a questionnaire on psychosocial conditions and lifestyle and measurement of biological variables. Individuals examined in 1990—94 (n=24,230) and who also returned for follow-up after 10 years were included (total of 16,492 individuals: 46.6% men and 53.4% women). Regression analyses were performed. MetSy was the outcome and analyses were adjusted for age, sex, alcohol abuse, and family history of CVD and diabetes. Results: Ten-year development of MetSy was associated with high-dose consumption of snus at baseline (OR 1.6 [95% CI 1.26—2.15]), low education (2.2 [1.92—2.63]), physical inactivity (1.5 [1.22—1.73]) and former smoking (1.2 [1.06—1.38]). Snus was associated with separate components of MetSy, including triglycerides (1.6, 1.30—1.95), obesity (1.7 [1.36—2.18]) but not hypertension, dysglycemia and low HDL cholesterol. Conclusions: MetSy is independently associated with high consumption of snus, even when controlling for smoking status. The finding is of public health interest in societies with widespread use of snus. More research is needed to better understand the mechanisms underlying this effect.
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Affiliation(s)
- Margareta Norberg
- Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
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17
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Falcone C, Emanuele E, Buzzi M, Ballerini L, Repetto A, Canosi U, Mazzucchelli I, Schirinzi S, Sbarsi I, Boiocchi C, Cuccia M. The-374T/A Variant of the Rage Gene Promoter is Associated with Clinical Restenosis after Coronary Stent Placement. Int J Immunopathol Pharmacol 2016; 20:771-7. [DOI: 10.1177/039463200702000413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Upregulation of the receptor for advanced glycation end products (RAGE) may play a crucial role in neointimal formation upon vessel injury. The −374T/A variant of the RAGE gene promoter, which has been associated with an altered expression of the cell-surface receptor, could exert a protective effect toward the development of vascular disease. The aim of this study is to determine the impact of this common genetic variant in the occurrence of clinical in-stent restenosis after coronary stent implantation. The −374T/A polymorphism of the RAGE gene promoter was evaluated by PCR-RFLPs in 267 patients with coronary artery disease who underwent coronary stent implantation and a subsequent coronary angiography 6–9 months later for suspected restenosis. In-stent restenosis was assessed by means of quantitative angiography. Carriers of the-374AA genotype showed a significantly reduced risk of developing restenosis after percutaneous transluminal intervention than non-carriers. To determine whether the protective effect of the homozygous AA genotype toward clinical restenosis was independent of potential confounders, we performed multivariable logistic regression analysis. After allowance for clinical and biochemical risk factors and stent length, the AA genotype remained significantly associated with a reduced prevalence of in-stent restenosis. No relation was evident between the RAGE genotype and established cardiovascular risk factors. In conclusion, the −374AA genotype of the RAGE gene promoter could be associated with a reduced risk of in-stent restenosis after coronary stent implantation.
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Affiliation(s)
- C. Falcone
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - E. Emanuele
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - M.P. Buzzi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - L. Ballerini
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - A. Repetto
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - U. Canosi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - I. Mazzucchelli
- Interdepartmental Center for Research in Prevention of Cardiovascular and Metabolic Diseases (CIRMC), University of Pavia, Pavia, Italy
| | - S. Schirinzi
- Department of Cardiology, University Hospital Foundation IRCCS San Matteo, Pavia
| | - I. Sbarsi
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
| | - C. Boiocchi
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
| | - M. Cuccia
- Department of Genetics and Microbiology, University of Pavia, Pavia, Italy
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19
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Gupta R, Gupta N, Khedar RS. Smokeless tobacco and cardiovascular disease in low and middle income countries. Indian Heart J 2013; 65:369-77. [PMID: 23992997 DOI: 10.1016/j.ihj.2013.06.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/19/2013] [Indexed: 01/30/2023] Open
Abstract
Smoking is an important cardiovascular risk factor, however, use of smokeless tobacco has not been well studied. Smokeless tobacco use is high in countries of South and Southeast Asia, Africa and Northern Europe. Meta-analyses of prospective studies of smokeless tobacco users in Europe reported a relative risk for fatal coronary heart disease of 1.13 (confidence intervals 1.06-1.21) and fatal stroke of 1.40 (1.28-1.54) while in Asian countries it was 1.26 (1.12-1.40). Case-control studies reported significantly greater risk for acute coronary events in smokeless tobacco users (odds ratio 2.23, 1.41-3.52), which was lower than smokers (2.89, 2.11-3.96), and subjects who both chewed and smoked, had the greatest risk (4.09, 2.98-5.61). There is a greater prevalence of hypertension and metabolic syndrome in users of smokeless tobacco. Smokeless tobacco use leads to accelerated atherothrombosis similar to smoking. There is an urgent need for public health and clinical interventions to reduce smokeless tobacco addiction.
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Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, JLN Marg, Jaipur 302017, India.
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20
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Östenson CG, Hilding A, Grill V, Efendic S. High consumption of smokeless tobacco ("snus") predicts increased risk of type 2 diabetes in a 10-year prospective study of middle-aged Swedish men. Scand J Public Health 2012; 40:730-7. [PMID: 23117209 DOI: 10.1177/1403494812459814] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Cigarette smoking increases the risk of type 2 diabetes (T2D). In Sweden and the US, people shift from smoking cigarettes to smokeless tobacco, i.e. oral moist snuff, "snus", to attain harm-reduction. There are limited and conflicting data as to whether snus increases the risk of T2D. The present study investigated if snus use predicts the risk of T2D incidence. METHODS This is a prospective population-based study where middle-aged Swedish men (n=2,383), without previously diagnosed T2D, were investigated with oral glucose tolerance test (OGTT) at baseline in 1992-94 and at follow-up 10 years later. Odds ratios (ORs) for newly diagnosed T2D at follow-up were assessed among those using snus, or cigarettes, at both baseline and follow-up, adjusted for major confounders. RESULTS The OR for T2D was not significantly increased in the whole group of snus users. However, the risk of diabetes increased with increasing weekly snus consumption; ORs (CIs) for >four boxes of snus/week were 2.1 (CI 0.9-4.9), and for >five boxes/week 3.3 (CI 1.4-8.1). For comparison, men smoking at baseline and still smoking at follow-up had an increased risk of diabetes compared with never smokers, OR 1.5 (CI 0.8-3.0), most evident for those smoking >15 cigarettes per day, OR 2.4 (CI 1.0-5.8). Tobacco use was associated with estimations of low insulin response (OGTT), but not low insulin sensitivity (HOMA). CONCLUSIONS High consumption of snus, like smoking, predicts risk of developing T2D. This should be considered when seeking harm-reduction by changing from use of cigarettes to snus. T2D risk from tobacco use may be mediated by effects on beta-cell function.
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Affiliation(s)
- Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Stockholm, Sweden.
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Saeed AA. Association of tobacco products use and diabetes mellitus-results of a national survey among adults in saudi arabia. Balkan Med J 2012; 29:247-51. [PMID: 25207009 DOI: 10.5152/balkanmedj.2012.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 05/08/2012] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To compare the tobacco products use patterns of known diabetics and non diabetics. MATERIAL AND METHODS A community-based cross-sectional study using STEPwise approach among adults using a multistage, stratified, cluster random sample. Data was collected using a questionnaire which included sociodemographics; tobacco products use habits, history of diabetes, biochemical and anthropometric measurements. RESULTS Of the total of 4654 subjects who participated in the study, 1016 (21.8%) were ever smoked tobacco products users and 65 (1.4%) were ever smokeless tobacco products users. Known Diabetes prevalence was 15.3% (712 known diabetics). There were no significant differences in diabetic status and smokeless tobacco products use for both ever and current use. For smoked products diabetics are fewer in current smokers and more in ex smokers. Diabetics started smoking significantly older, smoked for longer duration and higher intensity than non diabetics. CONCLUSION Diabetes appears to be associated with smoked but not smokeless tobacco products use.
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Guven A, Tolun F. Effects of smokeless tobacco "Maras powder" use on nitric oxide and cardiovascular risk parameters. Int J Med Sci 2012; 9:786-92. [PMID: 23136542 PMCID: PMC3491438 DOI: 10.7150/ijms.4563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/15/2012] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Smokeless tobacco use is common in various parts of the world. In Turkey a type of smokeless tobacco called "Maras powder" is widely used in southeastern region. Smoking is known to have an adverse effect on nitric oxide and cardiovascular risk factors. The aim of this study was to evaluate whether there is difference between the effects of Maras powder and cigarette smoking on the cardiovascular risk factors and nitric oxide levels. METHODS In the study, participants were 48 Maras powder users, 50 cigarette smokers and 45 nontobacco user subjects. Blood samples were collected and hematological parameters and lipid parameters were measured. Plasma Nitric oxide level was also detected by using the Griess method. RESULTS Plasma total cholesterol, LDL-cholesterol, triglyceride levels were significantly higher in Maras powder and cigarette smokers group than in the nontobacco user group (p<0.001). Plasma HDL-cholesterol levels were significantly lower in Maras powder and cigarette smokers group than in the nontobacco user group (p<0.001). Plasma Nitric oxide levels were found significantly lower in Maras powder and cigarette smokers group compared to the nontobacco user group (4.9±0.9 µmol/l, 4.8±1 µmol/l, 9.4±3.4 µmol/l, respectively, p<0.001) whereas there was no significant difference between the Maras powder and cigarette smokers group. In multivariate logistic regression model, cigarette smoking (Odds ratio=17.832, p<0.001), Maras powder usage (Odds ratio=12.311, p=0.002) and mean platelet volume (Odds ratio=1.425, p=0.030) remained independently associated with lower Nitric oxide levels. CONCLUSION We conclude that Maras powder has similar adverse effects on nitric oxide level and cardiovascular risk parameters and thereby it appears to be harmful as cigarette smoking.
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Affiliation(s)
- Aytekin Guven
- Baskent University School of Medicine, Department of Cardiology, Konya, Turkey
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Nyrén O, Lambe M, Ye W, Adami HO. Are cohort data on smokeless tobacco use and pancreatic cancer confounded by alcohol use? Ann Oncol 2011; 22:1930-1; author reply 1931-2. [PMID: 21690234 DOI: 10.1093/annonc/mdr302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Hansson J, Galanti MR, Magnusson C, Hergens MP. Weight gain and incident obesity among male snus users. BMC Public Health 2011; 11:371. [PMID: 21605406 PMCID: PMC3118245 DOI: 10.1186/1471-2458-11-371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 05/23/2011] [Indexed: 12/31/2022] Open
Abstract
Background Snus is a moist smokeless tobacco product which has recently reached beyond its original market of Scandinavia. Snus is now being increasingly used in both the United States and South Africa. The effect of snus use on weight is unknown. This study has therefore investigated the relationship between the use of snus, weight gain (≥5%) and the incidence of obesity (body mass index ≥30 kg/m2). Methods The study participants (n = 9,954 males living in Stockholm County, Sweden) were recruited in 2002 and reassessed in 2007. Tobacco use was categorized according to information obtained in both the baseline and follow-up surveys. Outcomes were assessed by comparing self-reported weight and body mass index between the baseline and follow-up surveys. Results Stable current snus use (according to both surveys), compared to never having used any kind of tobacco, seemed to be associated with both weight gain (odds ratio = 1.31, 95% confidence interval: 1.04-1.65) and incident obesity (odds ratio = 1.93, 95% confidence interval: 1.13-3.30) after adjustment for age, baseline weight, alcohol consumption, physical activity, education, consumption of fruit and berries, and the frequency of having breakfast. No associations with incident obesity or weight gain were seen for stable former users of snus (according to both surveys) or among men who quit or began using snus during follow-up. Conclusions These data suggest that the use of snus is moderately associated with weight gain and incident obesity among men.
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Affiliation(s)
- Jenny Hansson
- Department of Public Health Sciences, Karolinska Institutet, 171 76 Stockholm, Sweden
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Lunell E, Curvall M. Nicotine delivery and subjective effects of Swedish portion snus compared with 4 mg nicotine polacrilex chewing gum. Nicotine Tob Res 2011; 13:573-8. [PMID: 21454913 DOI: 10.1093/ntr/ntr044] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Snus availability has been claimed to have contributed to the low rates of smoking among Swedish men and made possible the transfer to a less harmful form of nicotine dependence. METHODS Fourteen cigarette smokers were randomly assigned to 2 types of 1 g Swedish portion snus and 4 mg nicotine polacrilex (NP) chewing gum in open-label, single-dose crossover study. Nicotine delivery and pharmacokinetics were estimated, and self-reports of subjective effects were obtained using Visual Analogue Scales (VASs). RESULTS Extracted dose from the NP gum averaged 2.56 mg compared with 2.12 and 2.18 mg, respectively, for Swedish portion snus. This resulted in a slightly larger area under the curve (AUC) for the NP chewing gum. The rise of the nicotine plasma concentration was faster for Swedish snus. Median T(max) was shorter, 30 min for snus compared with 45 min for the NP gum. The lower C(max) of NP gum compared with the snus products in spite of larger AUC may be explained by slower absorption from the chewing gum. The faster absorption of nicotine from Swedish portion snus was mirrored in a higher VAS score for "head rush." Craving/urges to smoke decreased similarly for all treatments. Salivation and throat burn were rated higher for the 4 mg NP gum compared with both types of snus. CONCLUSIONS Swedish snus produced higher maximum blood nicotine concentration in shorter time and with a quicker onset of "head rush" compared with 4 mg NP chewing gum in spite of a smaller extracted dose. The quicker onset of "head rush" and supposedly higher satisfaction from snus may partly explain the widespread use of snus for stopping smoking in Sweden.
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Klesges RC, Ebbert JO, Morgan GD, Sherrill-Mittleman D, Asfar T, Talcott WG, Debon M. Impact of differing definitions of dual tobacco use: implications for studying dual use and a call for operational definitions. Nicotine Tob Res 2011; 13:523-31. [PMID: 21436298 DOI: 10.1093/ntr/ntr032] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Concomitant use of two forms of tobacco is an increasing public health concern, yet there is little consensus regarding a consistent definition of so-called "dual use." We defined dual use as cigarette and smokeless tobacco (ST) consumption with either product used daily or nondaily. METHODS We analyzed a cohort of 36,013 Air Force recruits. We categorized dual tobacco use across 2 dimensions, type of tobacco products (cigarettes, ST, or others), and the frequency of use (daily vs. nondaily). We determined how varying the definition impacted the prevalence estimates and evaluated the prevalence estimate based on our recommended definition of dual use. Multivariate logistic regression analysis was used to evaluate the risk profile of dual users of ST and cigarettes versus mono users of ST and mono users of cigarettes. RESULTS Varying definitions of dual use vary prevalence estimates 50-fold (0.5%-25.3%). Including only ST and cigarettes narrows the prevalence estimate to less than 4-fold (2.0%-9.7%). Dual users are more likely to be young Caucasian males, with lower education, and from families with relatively higher incomes. Compared with mono users, dual users of cigarettes and ST have a distinct pattern of risk profiles. CONCLUSIONS Depending on the definition of dual use, markedly different prevalence and risk profiles are observed. Dual users of ST and cigarettes are a unique group of tobacco users. We propose a common definition of dual use to advance our understanding of this unique group.
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Affiliation(s)
- Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline, Memphis, TN 38105, USA.
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Lee PN. Summary of the epidemiological evidence relating snus to health. Regul Toxicol Pharmacol 2010; 59:197-214. [PMID: 21163315 DOI: 10.1016/j.yrtph.2010.12.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/06/2010] [Accepted: 12/06/2010] [Indexed: 02/06/2023]
Abstract
Interest in snus (Swedish-type moist snuff) as a smoking alternative has increased. This wide-ranging review summarizes evidence relating snus to health and to initiation and cessation of smoking. Meta-analyses are included. After smoking adjustment, snus is unassociated with cancer of the oropharynx (meta-analysis RR 0.97, 95% CI 0.68-1.37), oesophagus (1.10, 0.92-1.33), stomach (0.98, 0.82-1.17), pancreas (1.20, 0.66-2.20), lung (0.71, 0.66-0.76) or other sites, or with heart disease (1.01, 0.91-1.12) or stroke (1.05, 0.95-1.15). No clear associations are evident in never smokers, any possible risk from snus being much less than from smoking. "Snuff-dipper's lesion" does not predict oral cancer. Snus users have increased weight, but diabetes and chronic hypertension seem unaffected. Notwithstanding unconfirmed reports of associations with reduced birthweight, and some other conditions, the evidence provides scant support for any major adverse health effect of snus. Although some claims that snus reduces initiation or encourages quitting are unsoundly based, snus seems not to increase initiation, as indicated by few smokers using snus before starting and current snus use being unassociated with smoking in adults (the association in children probably being due to uncontrolled confounding), and there are no reports that snus discourages quitting.
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Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd., Sutton, Surrey, UK.
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Engström K, Magnusson C, Galanti MR. Socio-demographic, lifestyle and health characteristics among snus users and dual tobacco users in Stockholm County, Sweden. BMC Public Health 2010; 10:619. [PMID: 20955584 PMCID: PMC2976748 DOI: 10.1186/1471-2458-10-619] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 10/18/2010] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Socio-demographic and lifestyle characteristics of snus users have not been systematically described. Such knowledge is pivotal for tobacco control efforts and for the assessment of health effects of snus use. METHODS A cross-sectional study was conducted, based on the Stockholm Public Health Survey, including a population-based sample of 34,707 men and women aged 18-84 years. We examined how socio-demographic, lifestyle and health-related characteristics were associated with the prevalence of current daily snus use, smoking and dual tobacco use. Logistic regression was used to calculate odds ratios of prevalence (ORs) and 95% confidence intervals (CIs). RESULTS Low educational level (OR = 1.60, CI = 1.41-1.81 and OR = 1.49, CI = 1.17-1.89, for men and women respectively), as well as occupational class and low income were associated with snus use. Some unfavourable lifestyle characteristics, including risky alcohol consumption (males: OR = 1.81, CI = 1.63-2.02; females: OR = 1.79, CI = 1.45-2.20), binge drinking and low consumption of fruit and vegetables were also associated with snus use. In contrast, physical inactivity and overweight/obesity were not, nor was perceived health. The prevalence of smoking followed steeper gradients for social as well as lifestyle characteristics. Overweight and obese men were however less often smokers. Perceived poor general health and psychological distress were highly related to smoking. Social disadvantage, as well as unhealthy lifestyle and self-reported poor health were strongly associated with dual use. There were limited differences between men and women. CONCLUSIONS The social, lifestyle and health profiles of exclusive snus users in Stockholm County are less favourable than those of non-users of tobacco, but more advantageous than those of exclusive smokers. This knowledge should guide tobacco control measures as well as the interpretation of health risks linked to snus use.
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Affiliation(s)
- Karin Engström
- Department of Public Health Sciences, Division of Public Health Epidemiology, S-171 76 Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Division of Public Health Epidemiology, S-171 76 Stockholm, Sweden
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Division of Public Health Epidemiology, S-171 76 Stockholm, Sweden
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Piano MR, Benowitz NL, Fitzgerald GA, Corbridge S, Heath J, Hahn E, Pechacek TF, Howard G. Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation 2010; 122:1520-44. [PMID: 20837898 DOI: 10.1161/cir.0b013e3181f432c3] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Colilla SA. An epidemiologic review of smokeless tobacco health effects and harm reduction potential. Regul Toxicol Pharmacol 2010; 56:197-211. [DOI: 10.1016/j.yrtph.2009.09.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/22/2009] [Accepted: 09/24/2009] [Indexed: 01/11/2023]
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Schipf S, Schmidt CO, Alte D, Werner A, Scheidt-Nave C, John U, Steveling A, Wallaschofski H, Völzke H. Smoking prevalence in Type 2 diabetes: results of the Study of Health in Pomerania (SHIP) and the German National Health Interview and Examination Survey (GNHIES). Diabet Med 2009; 26:791-7. [PMID: 19709149 DOI: 10.1111/j.1464-5491.2009.02784.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS Smoking contributes to the development of diabetes and diabetes-related complications. Currently, data on smoking prevalence in subjects with diabetes in Germany are lacking. The aim of our analysis was to determine smoking prevalence in adults with Type 2 diabetes mellitus using data from the two population-based studies in Germany. METHODS From the Study of Health in Pomerania (SHIP) (n = 4283) and the 1998 German National Health Interview and Examination Survey (GNHIES 98) (n = 6663) subjects aged 20-79 years were investigated. Descriptive statistics on smoking prevalence and behaviours were calculated for Type 2 diabetes mellitus and compared with the general population using weightings reflecting the European adult population. RESULTS Overall, the prevalence of current smokers was lower among persons with than without Type 2 diabetes mellitus in SHIP (17.3% vs. 38.0%) and in GNHIES 98 (24.7% vs. 32.1%). Only in men, there were more former smokers in Type 2 diabetic patients than in subjects without diabetes in both studies. Among current and former smokers, the number of cigarettes smoked was higher among persons with than without Type 2 diabetes mellitus. For men, this finding was consistent in SHIP and GNHIES 98, while in women, this difference was only observed in GNHIES 98. CONCLUSIONS The associations between smoking and Type 2 diabetes mellitus are likely to reflect behavioural changes secondary to illness or medical counselling. The high proportion of current smokers among Type 2 diabetic patients, particularly men, should be monitored in repeated surveys following the introduction of disease management programmes.
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Affiliation(s)
- S Schipf
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, Ernst Moritz Arndt University, Greifswald, Germany.
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Tonstad S. Cigarette smoking, smoking cessation, and diabetes. Diabetes Res Clin Pract 2009; 85:4-13. [PMID: 19427049 DOI: 10.1016/j.diabres.2009.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 03/27/2009] [Accepted: 04/09/2009] [Indexed: 01/19/2023]
Abstract
There is evidence for increased risk of developing type 2 diabetes among cigarette smokers. In addition, smoking-associated health risks can exacerbate major conditions that precede or accompany diabetes, such as cardiovascular and kidney diseases. Smoking cessation can result in weight gain and a short-term worsening of some diabetic symptoms that may deter smokers with diabetes from attempting to quit. Additionally, there is limited evidence regarding the efficacy/safety of smoking cessation pharmacotherapies in this population and the general effects of smoking cessation, particularly for type 1 diabetes. Smoking cessation in diabetes therefore remains a highly relevant subject for further research.
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Janzon E, Hedblad B. Swedish snuff and incidence of cardiovascular disease. A population-based cohort study. BMC Cardiovasc Disord 2009; 9:21. [PMID: 19473535 PMCID: PMC2695419 DOI: 10.1186/1471-2261-9-21] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 05/27/2009] [Indexed: 01/13/2023] Open
Abstract
Background The relationship between smoking and an increased incidence of cardiovascular diseases is well known. Whether smokeless tobacco (snuff) is related to myocardial infarction (MI) or stroke is still controversial. Aim of this study was to explore whether snuff users have an increased incidence of MI or stroke. Methods A total of 16 754 women and 10 473 men (aged 45–73 years), without history of cardiovascular disease (CVD), belonging to the population-based "Malmö Diet and Cancer" study were examined. Incidence of MI and stroke were monitored over 10.3 years. Results Snuff was used by 737 (7.0%) men and 75 (0.4%) women, respectively. Among men, snuff was significantly associated with low occupation level, single civil status, high BMI and with current and former smoking. In women, snuff was associated with lower systolic blood pressure. A total of 964 individuals (3.5%), i.e.544 men (5.3%) and 420 (2.5%) women suffered a MI during the follow-up period. The corresponding numbers of incident stroke cases were 1048, i.e. 553 men (5.3%) and 495 (3.0%) women, respectively. Snuff was not associated with any statistically significant increased risk of MI or stroke in men or women. The relative risks (RR) in male snuff users compared to non-users were 1.05 (95% confidence interval (CI): 0.8–1.4, p = 0.740) for incident MI and 0.97 (0.7–1.4, p = 0.878) for stroke, after taking age and potential confounders into account. In women none of the 420 (2.5%) women who were snuff users had a MI and only one suffered a stroke during the follow-up. Conclusion Several life-style risk factors were more prevalent in snuff-users than in non-users. However, the present study does not support any relationship between snuff and incidence of cardiovascular disease in men.
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Affiliation(s)
- Ellis Janzon
- Department of Health and Society, Malmö University, Malmö, Sweden.
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Sundbeck M, Grahn M, Lönngren V, Månsson NO, Råstam L, Lindblad U. Snuff use associated with abdominal obesity in former smokers. Scand J Public Health 2009; 37:487-93. [DOI: 10.1177/1403494809105546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aim: To describe the consumption of snuff in a rural male population and to explore associations between snuff use and obesity. Participants and Methods: Tobacco use was explored in 834 men aged 30—75 years old who participated in a cross-sectional population survey in the municipality of Vara (participation rate was 81%). Self-reported questionnaires assessed the habits of smoking and snuff use. Anthropometric measures were obtained during a health examination. Results: Of these men 21% (n = 179) were snuff users, 13% (n = 109) current smokers, and 65% (n = 546) were non-users. Of all snuff users 65% (n = 116) were former smokers, and 35% (n = 63) were exclusive snuff users (current users who never smoked). Among non-users 65% (n = 357) were never users and 35% (n = 189) had quit smoking without nicotine substitution. These men were characterized by abdominal obesity; OR 1.84 (1.08—3.12) (p = 0.002) (WHR 41.0) and OR 1.71 (1.08—2.72) (p = 0.022) (waist circumference 4102 cm). One can/week use of snuff among ex-smokers was associated with a 1.21 cm wider (0.05—2.36) (p = 0.041) waist circumference and 0.01 (0.00—0.02) units higher (p = 0.021) WHR. There were statistically significant associations between former smoking without current nicotine substitute and both general and abdominal obesity. No similar association with abdominal obesity was seen among exclusive snuff users. Conclusions: Abdominal obesity in current snuff users is limited to former smokers. The remaining effect of previous smoking has to be considered in future studies on obesity and related disorders in snuff users. Counselling among people who substitute snuff for smoking should include measures to prevent weight gain.
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Affiliation(s)
| | - Mathias Grahn
- Department of Social and Preventive Medicine, Malmö University Hospital, Malmö, Sweden
| | | | | | - Lennart Råstam
- Department of Clinical Sciences, Malmö, Lund University, Sweden
| | - Ulf Lindblad
- Department of Clinical Sciences, Malmö, Lund University, Sweden, , Skaraborg Institute, Skövde, Sweden, Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy at Göteborg University, Sweden
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Furberg H, Lichtenstein P, Pedersen NL, Thornton L, Bulik CM, Lerman C, Sullivan PF. The STAGE cohort: a prospective study of tobacco use among Swedish twins. Nicotine Tob Res 2009; 10:1727-35. [PMID: 18988069 DOI: 10.1080/14622200802443551] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We investigated patterns of cigarette smoking and Swedish snus (oral smokeless tobacco) use in a population-based sample of 19,073 Swedish twins 20-47 years old who participated in the baseline assessment of a prospective study of tobacco use and cessation in 2005-2006. Age-adjusted prevalence odds ratios (POR) and 95% confidence intervals (CI ) describe the association between tobacco use and sex, after adjustment for non-independence of twin pairs. Kaplan-Meier survival methods produced cumulative incidence curves of age at initiation of tobacco use. Slightly more than half of the baseline population was female (55.2%); the mean age at interview was 33.3 (+/-7.2) years and did not differ by sex. Having ever smoked daily was less common among males than females (11.9% vs. 15.3%; POR = 0.70 [0.64-0.77]), while having ever used snus daily was more common among males than females (31.1% vs. 4.8%; POR 11.7 [95% CI = 10.6-13.1]). The median age at initiation of smoking was 15 years for both sexes; median age at onset of snus use was 15 years for males and 18 years for females. Nicotine dependence scores were higher for males than females, and for current than former smokers. Findings from this study are in contrast to our previously published report on tobacco use among 32,123 Swedish twins 42-64 years old who completed a similar survey, and reported lower rates of snus use at later ages. Patterns of tobacco use may be changing in Sweden; snus use appears to be increasing, while daily smoking appears to be decreasing in popularity among the younger Swedish twins.
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Affiliation(s)
- Helena Furberg
- Department of Genetics, University of North Carolina at Chapel Hill, NC 27599, USA.
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Hellqvist L, Rolandsson M, Birkhed D, Hugoson A. Tobacco use in relation to socioeconomic factors and dental care habits among Swedish individuals 15-70 years of age, 1983-2003. Int J Dent Hyg 2009; 7:62-70. [DOI: 10.1111/j.1601-5037.2008.00339.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Arabi Z. How smokeless tobacco differs from smoking and nicotine replacement therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2008. [DOI: 10.1007/s12170-008-0078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Furberg H, Lichtenstein P, Pedersen NL, Bulik CM, Lerman C, Sullivan PF. Snus use and other correlates of smoking cessation in the Swedish Twin Registry. Psychol Med 2008; 38:1299-308. [PMID: 18680625 PMCID: PMC2914546 DOI: 10.1017/s0033291707002346] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND We investigated 12 variables and their interactions as correlates of smoking cessation among regular smokers in the population-based Swedish Twin Registry (STR). METHOD Detailed information on tobacco use and personal characteristics were available from 14 715 male and female twins aged 42-64 years who participated in a screening of the population-based STR and reported being regular smokers in their lifetime. A two-stage analytic design was used to examine correlates of smoking cessation. The sample was split at random and significant main effects and interactions identified in the testing set were examined in the validation set. Hazard ratios (HRs) and 95% confidence intervals (CIs) describe the association between correlates and smoking cessation. RESULTS Twelve main effects were significantly associated with smoking cessation in the testing set; eight were confirmed in the validation set. Of the nine interactions identified in the testing set, none remained significant when evaluated in the validation set after Bonferroni correction. HRs were highest for Swedish oral smokeless tobacco (snus) use (HR 2.70, 95% CI 2.30-3.20), >11 years of education (HR 1.57, 95% CI 1.43-1.73) and being married or cohabitating (HR 1.51, 95% CI 1.39-1.63). Although not statistically significant after Bonferroni correction, snus use also appeared important in the context of interactions, where lower nicotine dependence score, higher socio-economic status (SES) and greater body size were associated with smoking cessation only among participants who never used snus. CONCLUSIONS Snus use was the strongest independent correlate of smoking cessation. Further studies should investigate the mechanism of this association.
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Affiliation(s)
- H Furberg
- Department of Genetics, University of North Carolina at Chapel Hill, NC 27599-7264, USA.
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Smoking-induced metabolic disorders: a review. DIABETES & METABOLISM 2008; 34:307-14. [PMID: 18468932 DOI: 10.1016/j.diabet.2008.01.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 01/21/2008] [Accepted: 01/25/2008] [Indexed: 12/17/2022]
Abstract
Smoking is the leading avoidable cause of cardiovascular mortality worldwide. The aim of this report is to briefly review the existing evidence regarding smoking and cardiovascular risk, and to analyze in greater detail the links between tobacco use and metabolic disorders. The evidence so far shows that smoking dose-dependently increases the risk of impaired glucose tolerance, the incidence of type 2 diabetes mellitus and abdominal-type obesity. Although smokers have a lower body mass index than do nonsmokers, recent data show that they have higher waist-to-hip ratios and waist circumferences, established risk factors for cardiovascular disorders-in particular, for coronary heart disease. We propose that smoking may lead not only directly, but also indirectly via these metabolic risk factors, to cardiovascular disorders. As both weight and waist circumference may increase on stopping smoking, further studies are needed to assess whether the post-smoking weight increase and potential changes in waist-to-hip ratio (or waist circumference) have consequences that may reduce the benefits of smoking cessation.
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Association between metabolic effects and tobacco use in 60-year-old Swedish men. Eur J Epidemiol 2008; 23:431-4. [DOI: 10.1007/s10654-008-9260-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 04/25/2008] [Indexed: 12/18/2022]
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Wennberg P, Eliasson M, Hallmans G, Johansson L, Boman K, Jansson JH. The risk of myocardial infarction and sudden cardiac death amongst snuff users with or without a previous history of smoking. J Intern Med 2007; 262:360-7. [PMID: 17697157 DOI: 10.1111/j.1365-2796.2007.01813.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To investigate the risk of a first myocardial infarction (MI) and sudden cardiac death (SCD) amongst male snuff users. DESIGN We used a prospective incident case-referent study design nested in the population-based Västerbotten Intervention Program and the Northern Sweden MONICA study. SUBJECTS Tobacco habits and cardiovascular risk factors were assessed at baseline screening and compared in 525 male MI cases (including 93 SCD cases) and 1798 matched referents. RESULTS Myocardial infarction occurred on average 4 years and 2 months after the baseline screening. No increased risk for MI was found amongst snuff users without a previous history of smoking compared with nontobacco users after adjustments for body mass index, leisure time physical activity, educational level and cholesterol level (OR 0.82; 95% CI, 0.46-1.43). For snuff users with a previous history of smoking, the adjusted OR was 1.25 (95% CI, 0.80-1.96). Significantly increased risk for MI was found in current smokers with or without current snuff use. For SCD cases with survival time<24 h, the adjusted OR for snuff users without previous history of smoking was 1.18 (95% CI, 0.38-3.70) and for cases with survival time<1 h the OR was 0.38 (95% CI, 0.08-1.89). CONCLUSIONS We found no increased risk for MI amongst snuff users without a previous history of smoking. Amongst snuff users with a previous history of smoking, the tendency towards an increased risk for MI may reflect the residual risk from former smoking. This study does not support the hypothesis that the risk for SCD is increased amongst snuff users.
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Affiliation(s)
- P Wennberg
- Bureå Health Centre, Department of Medicine-Geriatric, Skellefteå County Hospital, Skellefteå, and Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden.
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Arabi Z. An Epidemic that Deserves More Attention: Epidemiology, Prevention, and Treatment of Smokeless Tobacco. South Med J 2007; 100:890-4. [PMID: 17902289 DOI: 10.1097/smj.0b013e3180f631ad] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Smokeless tobacco (ST) use is common, especially in southern and rural areas. It is expected to become more popular with the recent move to sell more ST in areas where indoor smoking is banned. ST use usually starts in adolescence, which places this group at high risk. Nicotine dependence occurs almost exclusively in people who start using ST in their adolescent years, so it is crucial to prevent the introduction of ST to this age group. The debate over whether ST is a gateway to smoking or a bridge to quitting has not been fully answered. ST should not replace smoking where indoor smoking is banned. ST is less harmful than smoking, but nicotine replacement therapy (NRT) is much safer than ST. NRT and bupropion are helpful in the treatment of ST dependence by decreasing withdrawal symptoms and preventing weight gain after cessation.
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Affiliation(s)
- Ziad Arabi
- Department of General Internal Medicine, Geriatrics, and Health Policy Research at University of Louisville, Louisville, KY 40202, USA.
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van Gool CH, Kempen GIJM, Penninx BWJH, Deeg DJH, van Eijk JTM. Chronic disease and lifestyle transitions: results from the Longitudinal Aging Study Amsterdam. J Aging Health 2007; 19:416-38. [PMID: 17496242 DOI: 10.1177/0898264307300189] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article addresses the association between course of chronic disease and lifestyle. METHOD We examined differences in unhealthy lifestyles--smoking, excessive alcohol use, being sedentary--and transitions herein after 6 years in prevalent and incident chronic disease categories--lung and cardiovascular disease, diabetes, and osteoarthritis and/or rheumatic arthritis--among 2,184 respondents aged 55 years and older from the Netherlands. We also examined if transitions in lifestyle co-occurred with changes in disease-related symptomatology. RESULTS Proportions of respondents who smoked decreased over time, whereas proportions of respondents who were sedentary increased. Respondents with incident cardiovascular disease demonstrated more lifestyle transitions than respondents from other disease categories. Respondents demonstrating healthy lifestyle transitions did not differ from those persisting in unhealthy lifestyles in change in disease-related symptoms. DISCUSSION Health promotion may benefit from these findings in a way that patient groups at risk for not initiating healthy lifestyles might be identified sooner.
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Affiliation(s)
- Coen H van Gool
- Center for Public Health Forecasting, National Institute for Public Health and the Environment, Universiteit Maastricht Care and Public Health Research Institute, P.O. Box 1, NL 3720 BA, Bilthoven, the Netherlands
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Lee PN. Circulatory disease and smokeless tobacco in Western populations: a review of the evidence. Int J Epidemiol 2007; 36:789-804. [PMID: 17591642 DOI: 10.1093/ije/dym039] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Use of oral snuff or 'snus' has risen in Sweden. Sales of snuff in the US have also risen, overtaking sales of chewing tobacco. There is some evidence that nicotine contributes to circulatory disease (CID) from smoking. We therefore reviewed the evidence relating smokeless tobacco (ST) to CID and related risk factors. METHODS Publications that described relevant cohort, case-control and cross-sectional studies were identified from in-house files, a Medline search in December 2005 and reference lists. Relative risks (RRs) and odds ratios (ORs) for ischaemic heart disease, stroke and all CID for ST use, stratified by smoking habit, were estimated and combined by meta-analysis to provide an overall RR estimate. For diabetes, increased blood pressure, and other risk factors, evidence was qualitatively reviewed, with results from clinical studies also considered. RESULTS ST use in non-smokers was associated with an increased risk of heart disease (RR 1.12, 95% CI 0.99-1.27, n = 8), stroke (1.42, 1.29-1.57, n = 5) and CID (1.25, 1.14-1.37, n = 3). The increases mainly derived from two large US studies. The Swedish studies provided little evidence of an increase for heart disease (1.06, 0.83-1.37, n = 5) or stroke (1.17, 0.80-1.70, n = 2), although the estimates by country are not notably heterogeneous, even for stroke (P = 0.29). No dose-response was evident. No increase was seen in former users of ST, or in ST users who also smoked. No clear relationship to diabetes was seen. In the US, an acute blood pressure rise following ST use was consistently reported, and isolated reports linked specific risk factors to ST. In Sweden, though one study reported that snuff acutely increased blood pressure, and two linked snuff to Raynaud-type symptoms, the overall evidence for an effect was inconclusive. Swedish studies generally showed no chronic effect of snuff on blood pressure or various risk factors. CONCLUSIONS Any CID risk from ST appears to be substantially less than from smoking, and no clear risk from Swedish snuff is seen. However, the overall evidence is limited.
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Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
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Duval S, Vazquez G, Baker WL, Jacobs DR. The Collaborative Study of Obesity and Diabetes in Adults (CODA) project: meta-analysis design and description of participating studies. Obes Rev 2007; 8:263-76. [PMID: 17444967 DOI: 10.1111/j.1467-789x.2006.00263.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The Collaborative Study of Obesity and Diabetes in Adults (CODA) project was formed to establish an international database of studies of abdominal obesity and type 2 diabetes mellitus (T2DM), and to provide analyses of these associations using individual participant data (IPD) meta-analytic techniques. The collaboration involves obtaining raw data from existing studies. The main objectives of the collaboration are to assess which simple anthropometric indices most closely predict the risk of T2DM in adults, and to investigate ethnicity and other factors that potentially modify that prediction. A second task related to primary prevention of diabetes subsequently evolved, the CODA-2 project, and is concerned with population-based methods to identify people most likely to benefit from diabetes interventions. This article describes the meta-analysis design and the studies involved. The collaboration currently has 37 studies enrolled, providing data on 260,000 participants. The proposed IPD meta-analyses will help resolve several outstanding issues in diabetes.
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Affiliation(s)
- S Duval
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015, USA.
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Rodu B, Godshall WT. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers. Harm Reduct J 2006; 3:37. [PMID: 17184539 PMCID: PMC1779270 DOI: 10.1186/1477-7517-3-37] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 12/21/2006] [Indexed: 02/07/2023] Open
Abstract
According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable--or at least unwilling--to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.
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Affiliation(s)
- Brad Rodu
- Professor of Medicine and Endowed Chair, Tobacco Harm Reduction Research, School of Medicine, University of Louisville, KY, USA
| | - William T Godshall
- Founder and Executive Director, Smokefree Pennsylvania, Pittsburgh, PA, USA
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Abstract
The nation's largest cigarette companies are selling more smokeless tobacco (ST) products as more cities and states pass smoke-free laws. ST use is already common and is expected to get more popular as a result of these recent changes. Unfortunately, the medical and public knowledge of its risks is inadequate. The literature on the cardiovascular side effects of ST is scant, and there are many controversies associated with its use, for various reasons. Study findings show that ST may modestly increase cardiovascular mortality and produces transient changes in heart rate and blood pressure; however, it does not increase the risk of atherosclerosis or myocardial infarction. The association between ST and diabetes, lipoproteins, and stroke is less clear. Quitting ST causes weight gain, but less so than smoking. Although ST appears to be associated with less cardiovascular risk than smoking, nicotine replacement therapy is a safer and more controlled substitute for smoking than ST; however, ST can be considered in high-risk smokers in whom medicinal nicotine replacement therapy has failed.
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Affiliation(s)
- Ziad Arabi
- Department of General Internal Medicine, Geriatrics and Health Policy Research, University of Louisville, Louisville, KY 41729, USA.
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Nilsson R. De minimus non curat lex--virtual thresholds for cancer initiation by tobacco specific nitrosamines--prospects for harm reduction by smokeless tobacco. Int J Occup Med Environ Health 2006; 19:6-35. [PMID: 16881596 DOI: 10.2478/v10001-006-0004-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Whereas the impact of tobacco specific nitrosamines in smokers is obscured by the presence of numerous other carcinogens and promoters, for smokeless tobacco virtually all the carcinogenic potential is associated with 4-(nitrosomethylamino)-1-(3-pyridyl)-1-butanone (NNK) and N'-nitrosonornicotine (NNN). In some countries exposure to smokeless tobacco with extremely high nitrosamine concentrations have been found to induce cancers in the head-neck region, whereas three recent large epidemiological studies failed to detect any such risk with respect to Swedish low-nitrosamine snuff. This review deals with quantitative aspects of DNA adduct formation from NNN and NNK in relation to the background levels ubiquitously found in healthy humans without known exposures to either tobacco or alkylating agents. The lack of significant increases of pro-mutagenic O6-methylations and DNA pyridyloxobutylations seen in smokers, as well as the negative outcome of the Swedish epidemiological studies, can be expected on basis of extrapolation of the dose response relationships found in rodents to actual exposures to NNK and NNN in Swedish snuff or from smoking. Sweden has the lowest prevalence of male smokers and smoking related diseases in the Western World, which has been ascribed to the fact that more than 20% of the grown up male population uses snuff. Smokeless tobacco represents an inexpensive and effective alternative to nicotine delivering products like nicotine patch, spray or gum. Considering that all other tobacco products are freely marketed, the ban on low-nitrosamine snuff in all countries in EU except Sweden is difficult to defend on either medical or ethical grounds.
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Affiliation(s)
- Robert Nilsson
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, Lódź, Poland.
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Stegmayr B, Eliasson M, Rodu B. The decline of smoking in northern Sweden. Scand J Public Health 2005; 33:321-4; discussion 243. [PMID: 16087495 DOI: 10.1080/14034940510032301] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
For decades men in Sweden have smoked at far lower rates than those in comparable countries. Previous studies showed that snus use played a major role in low smoking rates among men in northern Sweden; daily smoking declined from 19% (95% CI 16-22%) in 1986 to 11% (CI 8.9-14%) in 1999. The prevalence of smoking among all men is now 9% (CI 7.0-11%) and only 3% (CI 0.1-5.4%) among men age 25-34 years; the prevalence of exclusive snus use is 27% (CI 24-30%) and 34% (CI 27-42%) respectively. Combined smoking and snus use, an unstable and transient category, was under 5% in all surveys and was 2.2% (CI 1.4-3.4%) by 2004. For the first time snus use is also associated with a decrease in smoking prevalence among women. These patterns of tobacco use have implications for all smoking-dominated societies.
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Affiliation(s)
- Birgitta Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Abstract
Although it is widely believed that type 2 diabetes mellitus is the result of a complex interplay between genetic and environmental factors, compelling evidence from epidemiologic studies indicates that the current worldwide diabetes epidemic is largely due to changes in diet and lifestyle. Prospective cohort studies and randomized clinical trials have demonstrated that type 2 diabetes can be prevented largely through moderate diet and lifestyle modifications. Excess adiposity is the most important risk factor for diabetes, and thus, maintaining a healthy body weight and avoiding weight gain during adulthood is the cornerstone of diabetes prevention. Increasing physical activity and reducing sedentary behaviors such as prolonged TV watching are important both for maintaining body weight and improving insulin sensitivity. There is increasing evidence that the quality of fat and carbohydrate plays a more important role than does the quantity, and thus, public health strategies should emphasize replacing saturated and trans fats with unsaturated fats and replacing refined grain products with whole grains. Recent studies have also suggested a potential role for coffee, dairy, nuts, magnesium, and calcium in preventing diabetes. Overall, a healthy diet, together with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption, and avoidance of sedentary behaviors and smoking, could nearly eliminate type 2 diabetes. However, there is still a wide gap between what we know and what we practice in the field of public health; how to narrow that gap remains a major public health challenge.
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Affiliation(s)
- Matthias B Schulze
- Department of Nutrition and Epidemiology, Boston, Massachusetts 02115, USA.
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