Wareham N J, Ness E M, Byrne C D, Cox B D, Day N E, Hales C N
Department of Community Medicine, University of Cambridge, Addenbrooke's Hospital, UK.
Metabolism. 1996 Dec;45(12):1551-6. doi: 10.1016/s0026-0495(96)90187-0.
Previous reports of a relationship between cigarette smoking and hyperinsulinemia and insulin resistance provide an important possible mechanism by which smoking could be associated with the metabolic cardiovascular syndrome and hence with ischemic heart disease. However, few previous studies have been able to adjust for all the possible confounding factors related both to smoking and to insulin resistance. Therefore, we examined this association in a population-based cohort study of 1,122 individuals aged 40 to 65 years who underwent a 75-g oral glucose tolerance test with specific measurement of insulin, 32,33-split proinsulin, and intact proinsulin concentrations. Physical activity was quantified using the Paffenbarger questionnaire, and smoking status and alcohol consumption were determined using the Health and Lifestyle Survey questionnaire; 17.4% of the population were current smokers and 32.4% were ex-smokers. Current smoking was associated with reduced overall obesity as indicated by the body mass index (BMI) but an increase in central adiposity as measured by the waist to hip ratio (WHR). There were also significant associations between cigarette smoking and the pattern of alcohol intake and physical inactivity. In unadjusted analyses, current smoking was associated with lower fasting and 120-minute insulin and also 120-minute glucose compared with levels in nonsmokers. Adjustment for confounding by age and BMI reduced these differences, but they were increased by adjustment for central obesity. We conclude from this study that a causal relationship between cigarette smoking and insulin resistance is unlikely.
先前有关吸烟与高胰岛素血症及胰岛素抵抗之间关系的报告提出了一种重要的可能机制，通过该机制，吸烟可能与代谢性心血管综合征相关，进而与缺血性心脏病相关。然而，先前很少有研究能够对与吸烟和胰岛素抵抗相关的所有可能混杂因素进行校正。因此，我们在一项基于人群的队列研究中对这一关联进行了研究，该研究纳入了1122名年龄在40至65岁之间的个体，他们接受了75克口服葡萄糖耐量试验，并对胰岛素、32,33 - 裂解胰岛素原和完整胰岛素原浓度进行了特定测量。使用帕芬巴格问卷对身体活动进行量化，使用健康与生活方式调查问卷确定吸烟状况和饮酒情况；17.4%的人群为当前吸烟者，32.4%为既往吸烟者。如体重指数（BMI）所示，当前吸烟与总体肥胖程度降低相关，但以腰臀比（WHR）衡量的中心性肥胖增加。吸烟与饮酒模式和身体不活动之间也存在显著关联。在未校正分析中，与不吸烟者相比，当前吸烟与较低的空腹和120分钟胰岛素水平以及120分钟血糖水平相关。对年龄和BMI进行混杂因素校正后，这些差异有所减小，但对中心性肥胖进行校正后差异增大。我们从这项研究得出结论，吸烟与胰岛素抵抗之间不太可能存在因果关系。
