Department of Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.
Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan.
Front Public Health. 2024 Jun 4;12:1406524. doi: 10.3389/fpubh.2024.1406524. eCollection 2024.
Habitual substance use, i. e., alcohol, tobacco and betel nut, has been found with an increased risk of metabolic syndrome (MetS) in the general population, whereas the association remains unclear in physically fit military personnel. This study aimed to investigate the combination of these substances use and their associations with new-onset MetS in the military.
A total of 2,890 military men and women, aged 18-39 years, without MetS were obtained from the cardiorespiratory fitness and health in eastern armed forces study (CHIEF) in Taiwan and followed for incident MetS from baseline (2014) through the end of 2020. Incident MetS event was defined by the International Diabetes Federation guideline and confirmed in the annual health examinations. A self-report was used to assess the alcohol, tobacco and betel nut use status (active vs. former/never). Multivariable Cox regression model was performed to determine the association with adjustments for sex, age, body mass index and physical activity at baseline.
At baseline, there were 279 active betel nut chewers (9.7%), 991 active smokers (34.3%) and 1,159 active alcohol consumers (40.1%). During a mean follow-up of 6.0 years, 673 incident MetS (23.3%) were observed. As compared to no substance users, only one substance, and two and three substances users had a greater risk of incident MetS [hazard ratios (HRs) and 95% confidence intervals: 1.27 (1.06-1.54), 1.38 (1.12-1.69) and 1.78 (1.37-2.32), respectively]. In subgroup analyses, the risk of incident MetS in two and three substances users was significantly greater in those free of baseline low high-density lipoprotein [HRs: 1.54 (1.21-1.95) and 2.57 (1.92-3.46), respectively], as compared to their counterparts (both p for interactions <0.05).
A dose-response association of more substances use for new-onset MetS was noted in military personnel. This finding suggests that the combined alcohol, tobacco and betel nut use may play a role in the development of MetS. Further study is required to establish causation and to investigate the potential benefits of substance use cessation in reducing the risk of MetS.
习惯性物质使用，即酒精、烟草和槟榔，已被发现与普通人群中代谢综合征（MetS）的风险增加有关，而在身体健康的军人中，这种关联尚不清楚。本研究旨在调查这些物质使用的组合及其与军队中新发代谢综合征的关系。
共纳入 2890 名年龄在 18-39 岁之间、无代谢综合征的台湾东部武装部队心肺功能与健康研究（CHIEF）中的军人，并从基线（2014 年）开始通过 2020 年底对新发代谢综合征进行随访。新发代谢综合征事件按照国际糖尿病联合会指南定义，并在年度健康检查中得到证实。使用自我报告评估酒精、烟草和槟榔的使用状况（活跃与既往/从不）。多变量 Cox 回归模型用于确定与基线时的性别、年龄、体重指数和体力活动调整后的关联。
基线时，有 279 名活跃的槟榔咀嚼者（9.7%）、991 名活跃的吸烟者（34.3%）和 1159 名活跃的饮酒者（40.1%）。在平均 6.0 年的随访期间，观察到 673 例新发代谢综合征（23.3%）。与无物质使用者相比，只有一种物质和两种和三种物质使用者发生新发代谢综合征的风险更高[风险比（HRs）和 95%置信区间：1.27（1.06-1.54）、1.38（1.12-1.69）和 1.78（1.37-2.32）]。在亚组分析中，与基线时无低高密度脂蛋白的患者相比，两种和三种物质使用者新发代谢综合征的风险更高[HRs：1.54（1.21-1.95）和 2.57（1.92-3.46）]，差异具有统计学意义（均 P<0.05）。
在军人中，物质使用越多，新发代谢综合征的风险呈剂量反应关系。这一发现表明，酒精、烟草和槟榔的联合使用可能在代谢综合征的发生中起作用。需要进一步的研究来确定因果关系，并研究物质使用戒除对降低代谢综合征风险的潜在益处。
