Active or Passive Smoking May Be Linked to Glucose Intoleran

Active or Passive Smoking May Be Linked to Glucose Intolerance

Both active and passive smoking increase the risk of developing glucose
intolerance, according to the results of a prospective cohort study.



"Smoking has been linked to impaired response to glucose tolerance
tests and insulin resistance," write Thomas K. Houston, MD, from the
Birmingham Veterans Affairs Medical Center in Alabama, and colleagues.
"Although smoking cessation can result in modest weight gain, smoking
is related to a more unhealthy distribution of upper body weight and
greater waist:hip ratio. Smoking has also been associated with risk of
chronic pancreatitis and pancreatic cancer, suggesting that tobacco
smoke may be directly toxic to the pancreas."



The Coronary Artery Risk Development In young Adults (CARDIA) study
began in 1985 to 1986 with recruitment of black and white men and women
aged 18 to 30 years with no glucose intolerance at baseline.
Participants were 1386 current smokers, 621 previous smokers, 1452
never smokers with reported exposure to secondhand smoke and 1113 never
smokers with no exposure to secondhand smoke. The primary endpoint was
time to development of glucose intolerance (glucose, >/= 100 mg/dL
or taking antidiabetic drugs) during 15 years of follow-up.



At baseline, median age was 25 years, 55% of participants were women,
and 50% were African American. During follow-up, glucose intolerance
developed in 16.7% of participants. There was a graded association
between smoking exposure and the incidence of glucose intolerance
during the 15-year follow-up, which was 21.8% for smokers, 17.2% for
never smokers with passive smoke exposure, 14.4% for previous smokers,
and 11.5% for never smokers with no passive smoke exposure.

After adjustment for multiple baseline sociodemographic, biological,
and behavioral factors, risk was still higher in current smokers
(hazard ratio

---

, 1.65, 95% confidence interval [CI], 1.27 - 2.13)
and never smokers with passive smoke exposure (HR, 1.35; 95% CI, 1.06 -
1.71) than in never smokers without passive smoke exposure. However,
risk in previous smokers was similar to that in never smokers without
passive smoke exposure.



"We found that tobacco exposure is associated with the development of
glucose intolerance over a 15 year period, with a dose-response effect
apparent," the authors write. "These findings support a role of both
active and passive smoking in the development of glucose intolerance in
young adulthood."



"Importantly, we identified passive tobacco
exposure in never smokers as a new risk factor for glucose
intolerance," the authors conclude. "If confirmed by further research,
these findings provide further documentation of the deleterious effects
of tobacco smoking, and policy makers may use them as additional
justification to reduce exposure to passive smoke."