No interaction of body mass index and smoking on diabetes mellitus risk in elderly women

Nicotine Dependence Center, Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Preventive Medicine (Impact Factor: 3.09). 10/2008; 48(1):74-8. DOI: 10.1016/j.ypmed.2008.10.008
Source: PubMed


We sought to assess the interaction of smoking and body mass index (BMI) on diabetes risk.
We analyzed data from a community-based prospective cohort of 41,836 women from Iowa who completed a baseline survey in 1986 and five subsequent surveys through 2004. The final analysis included 36,839 participants.
At baseline (1986), there were 66% never smokers, 20% former smokers, and 14% current smokers. Subjects represented 40% normal weight, 38% overweight, and 22% obese individuals. Compared to normal weight women, the hazard ratio (HR) for diabetes was increased in overweight (HR 1.96; 95% CI 1.75-2.19) and obese subjects (HR 3.58; 95% CI 3.19-4.02). The hazard ratio for diabetes increased in a dose-dependent manner with smoking intensity. Compared to never smokers, former smokers had a higher risk for diabetes (HR 1.22; 95% CI 1.11-1.34). Among current smokers, the hazard ratio for diabetes was 1.21 (95% CI 0.95-1.53) for 1-19 pack-year smokers, 1.33 (95% CI 1.12-1.57) for 20-39 pack-year smokers, and 1.45 (95% CI 1.23-1.71) for > or =40 pack-year smokers. Similar trends were observed when the results were stratified by BMI. A test of interaction between BMI and smoking on diabetes risk was not statistically significant.
Our findings suggest that smoking increases diabetes risk through a BMI-independent mechanism.

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    • "Nicotine acts on nicotinic (cholinergic) receptors in sympathetic ganglia, activating postganglionic neurons and stimulating the secretion of catecholamines from their terminals [16]. Smoking is associated with insulin resistance [17], dyslipidaemia [18] and an increased propensity for type 2 diabetes [19, 20] through a body mass index-independent mechanism [21]. Contrary to what one might expect, stopping smoking does not reduce these metabolic abnormalities but, by mechanisms not well understood, is often accompanied by increased weight and a further increase in the risk of diabetes [22, 23]. "
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