Smoking Status and Metabolic Syndrome in the Multi-Ethnic Study of Atherosclerosis. A cross-sectional study.
ABSTRACT BACKGROUND: Current smoking is associated with type 2 diabetes mellitus and impaired glucose tolerance but its association with the metabolic syndrome (metS), particularly with sufficiently sampled African American representation, has not been clearly established. OBJECTIVE: To assess whether a) metS is associated with smoking; b) any increased risk of metS among smokers is independent of body mass index (BMI) compared with non-smokers; c) smoking status is differentially associated with the metS and its components across different ethnic groups. METHODS: Cross sectional analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) a community population-based sample free of cardiovascular disease. RESULTS: Current smokers (N=769) had higher risk of metS (odds ratio [OR, 95 % confidence interval]: 1.4, 1.1-1.7) versus never (reference, N=2981) and former smokers (1.0, 0.8-1.1, N=2163) and for metS components: high waist circumference (WC) (OR:1.9, 1.2-2.1), low high density lipoprotein cholesterol (HDL-C) (1.5, 1.3-1.8), elevated plasma triglycerides (TG) (OR:1.4, 1.2-1.7) as well as high C-reactive protein (CRP, an inflammatory marker) concentration (OR: 1.6,1.3-2.0) compared to never and former smokers after adjustment for BMI. A smoking status by ethnicity interaction occurred such that African American current and former smokers had greater likelihood of low HDL-C than White counterparts. CONCLUSIONS: This study found that smoking is associated with the metS and despite the lower BMI of current smokers the prevalence of low HDL-C, elevated TG and CRP is higher among them than among non-smokers. African American individuals generally have higher HDL-C than Whites but smoking wipes out this advantage.
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ABSTRACT: To test the hypothesis that smokers have a higher frequency of the metabolic syndrome, and a syndrome with different characteristics than non-smokers. The 2,569 men and 2,637 women included in the D.E.S.I.R. study, aged 30-64 years, volunteers from ten French Social Security Health Examination Centres, were studied. The World Health Organization definition of the metabolic syndrome was adapted for this analysis, and insulin resistance was defined by a concentration above the 75(th) centile of the sex-specific distribution of fasting insulin. 28.1% of men and 15.1% of women were current smokers. The metabolic syndrome was twice as frequent in men than in women (22.8% vs 11.0%). Smokers and never-smokers were compared in age stratified samples. In men, the frequencies of hyperglycaemia or hypoglycaemic treatment, dyslipidaemia, microalbuminuria, and central obesity were significantly higher in smokers and 22.5% of smokers and 15.3% of non-smokers had this syndrome (p=0.001). In women, only dyslipidaemia was more frequent in smokers; in contrast smokers had lower insulin concentrations and hence a lower frequency of hyperinsulinemia. The frequency of the syndrome did not differ between women who smoked and those who did not (6.3% vs 6.0%). In men, the metabolic syndrome was more frequent in smokers than in non-smokers; in contrast, there was no difference for women. For both sexes, syndrome abnormalities tended to be more frequent in smokers than in non-smokers.Diabetes & Metabolism 07/2003; 29(3):226-34. · 2.41 Impact Factor
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ABSTRACT: No previous studies have explored weight concerns in relation to smoking habits, or investigated how weight concerns affect smoking cessation in a general population. Inter99 is a population-based lifestyle interventional study, conducted in 1999-2001 in Copenhagen, Denmark, comprising 30-60 year old men and women. All daily smokers (N=2408) were offered help to quit. The baseline investigation (N=6784) was used for analysing associations of smoking status with weight concerns (cross-sectional design). To analyse how weight concerns affected smoking cessation we included the 1387 daily smokers attending 1-year follow-up; 221 of these were verified quitters (longitudinal design). Daily smoking men and women had a significantly lower body mass index than never smokers (men: 3%, women 5%) but reported to be significantly less concerned of their weight (men: OR=0.64, 95%CI=0.4-0.9), women: 0.78(0.6-1.0)). Ex-smoking normal weight women were significantly more likely to be frequently concerned of their weight than never smoking normal weight women (OR=2.06, 95CI%=1.6-2.7). Fifty-two percent of the women and 32% of the men with a previous quit attempt reported that weight gain was a reason for relapse. Neither weight concerns nor eating patterns were predictive of point abstinence at 1-year follow-up. Smokers are believed to be very concerned of their weight but in this population-based study, daily smokers more frequently ate what they wanted, had a lower BMI and were significantly less concerned of their weight than never smokers. Weight concerns and eating patterns did not predict abstinence at 1-year follow-up. It seems that weight gain and weight concerns are independent factors.Preventive Medicine 05/2007; 44(4):283-9. · 3.22 Impact Factor
Article: African American-White Differences in Lipids, Lipoproteins, and Apolipoproteins, by Educational Attainment, among Middle-aged Adults: The Atherosclerosis Risk in Communities Study[show abstract] [hide abstract]
ABSTRACT: Measures of socioeconomic status have been shown to be related positively to levels of high density lipoprotein (HDL) cholesterol in white men and women and negatively in African American men. However, there is little information regarding the association between educational attainment and HDL fractions or apolipoproteins. The authors examined these associations in 9,407 white and 2,664 African American men and women aged 45–64 years who participated in the Atherosclerosis Risk in Communities Study baseline survey, and they found racial differences. A positive association for HDL cholesterol, its fractions HDL 2 and HDL 3 cholesterol, and its associated apolipoprotein A-l was found in white men and white women, but a negative association was found in African American men, and there was no association in African American women. In whites, there was also an inverse association of low density lipoprotein (LDL) cholesterol and apolipoprotein B with educational attainment. With the exception of African American men, advanced education was associated with a more favorable cardiovascular lipid profile, which was strongest in white women. Racial differences in total cholesterol (women only), plasma triglycerides, LDL cholesterol, apolipoprotein B (women only), HDL cholesterol, HDL 2 and HDL 3 cholesterol, and apolipoprotein A-l were reduced at higher levels of educational attainment. Apart from triglycerides in men and HDL 3 cholesterol in women, these African American-white lipid differences associated with educational attainment remained statistically significant after multivariable adjustment for lifestyle factors. Lipoprotein(a) showed no association with educational attainment. These findings confirm African American-white differences in lipids, lipoproteins, and apolipoproteins across levels of educational attainment that were not explained by conventional nondietary lifestyle variables. Understanding these differences associated with educational attainment will assist in identifying measures aimed at prevention of cardiovascular disease. Am J Epidemiol 1998; 148:750–60.American Journal of Epidemiology 11/1998; · 5.22 Impact Factor