Rasouli B, Andersson T, Carlsson P-O, Grill V, Groop L, Martinell M, Midthjell K, Storm P, Tuomi T, Carlsson S
Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
Diabet Med. 2017 Apr;34(4):514-521. doi: 10.1111/dme.13179. Epub 2016 Jul 31.
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).
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.
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).
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.
有人提出，湿鼻烟（小鼻烟）是一种尼古丁含量高且在斯堪的纳维亚广泛使用的无烟烟草产品，会增加2型糖尿病的风险。然而，以往的研究较少，结果相互矛盾，且对于自身免疫性糖尿病的研究尚属空白。我们的目的是研究使用湿鼻烟与2型糖尿病及成人隐匿性自身免疫性糖尿病（LADA）风险之间的关联。
分析基于瑞典一项病例对照研究中的新发病例（2型糖尿病，n = 724；LADA，n = 200）和基于人群的对照（n = 699）。对挪威HUNT研究（n = 21473）中的横断面数据进行了额外分析，其中有829例2型糖尿病现患病例。对年龄、体重指数、糖尿病家族史和吸烟情况进行校正后估计比值比（OR）。仅纳入男性。
在瑞典的数据中，未发现使用湿鼻烟与2型糖尿病或LADA之间存在关联。对于2型糖尿病，使用超过10盒年的OR为1.00 [95%置信区间（CI），0.47至2.11]，对于LADA为1.01（95% CI，0.45至2.29）。同样，在HUNT研究中，曾经使用者患2型糖尿病的OR估计为0.91（95% CI，0.75至1.10），重度使用者为0.92（95% CI，0.46至1.83）。
尽管湿鼻烟尼古丁含量高，但2型糖尿病和LADA的风险与使用湿鼻烟无关。这表明吸烟者中2型糖尿病风险增加可能并非归因于尼古丁，而是烟草烟雾中的其他物质。
