Alcohol consumption and risk of type 2 diabetes mellitus among US male physicians

OBJECTIVE: To examine the association between low to moderate alcohol consumption and the incidence of type 2 diabetes mellitus (DM) in men. DESIGN: Prospective cohort study. SUBJECTS AND METHODS: Over an average period of 12.1 years, we evaluated 20 951 participants in the Physicians' Health Study between ages 40 and 84 years who were free of cardiovascular disease, cancer, and diabetes and provided data on alcohol consumption at baseline. MAIN OUTCOME MEASURE: Type 2 DM diagnosed after randomization. RESULTS: Among 20 951 physicians, 766 cases of incident DM were reported over an average follow-up period of 12.1 years. After adjustment for age, randomized treatment assignment, smoking, physical activity, and body mass index, the relative risk estimates and 95% confidence intervals for those reporting alcohol use of rarely/ never, 1 to 3 drinks per month, 1 drink per week, 2 to 4 drinks per week, 5 to 6 drinks per week, and 1 or more drinks per day were 1.00 (referent), 1.03 (0.80-1.33), 0.89 (0.70-1.14), 0.74 (0.59-0.93), 0.67 (0.51-0.89), and 0.57 (0.45-0.73), respectively (linear trend, P<.001). Additional adjustment for baseline history of hypertension, high cholesterol level, or parental history of myocardial infarction or family history of diabetes (data collected at 9 years) did not materially alter the results. These associations persisted in analyses stratified by age, smoking status, body mass index, physical activity, and family history of DM. CONCLUSION: These data indicate that apparently healthy men who self-select for light to moderate alcohol consumption have a decreased subsequent risk of type 2 DM.     

Insulin-dependent diabetes mellitus mortality. The risk of cigarette smoking

The relation between cigarette smoking and mortality was examined prospectively in a population of adult insulin-dependent diabetes mellitus (IDDM) patients. In 1981, information on smoking history and other health and lifestyle factors was obtained by questionnaire from 93% of the 723 patients included in the Children's Hospital of Pittsburgh IDDM registry who were diagnosed between 1950 and 1964. Vital status as of January 1, 1988 was ascertained for 98% of the 548 patients who participated in the baseline survey and were alive as of January 1, 1982. Fifty-four cases died during the 6-year follow-up (32 male, 22 female). Proportional hazards analysis revealed that heavy smoking was a significant independent predictor of all-cause mortality among females but not males. The excess mortality in female diabetics was explained primarily by a marked excess risk of coronary heart disease mortality in smokers. These data strongly suggest that cigarette smoking, especially among diabetic females, should be avoided in order to improve longevity.     

A prospective study of the effects of cigarette smoking and alcohol abuse on mortality

Objective:To compare the relative risks of alcohol abuse and cigarette smoking. Design:Cohort studies utilizing a 12-to-16-year follow-up of 47-to-52-year old men. Participants and setting:237 Caucasian college sophomores (COLLEGE sample) and 366 socially disadvantaged junior high school students (CORE-CITY sample) selected in 1940–43 for relative mental health and for interdisciplinary study. Main results:The presence of many risk factors for death, including alcohol abuse and smoking, had been assessed prior to age 47 (CORE-CITY sample) and age 52 (COLLEGE sample). Over the next 12 years (CORE-CITY sample) and the next 16 years (COLLEGE sample), the men’s mortality was monitored. Heavy use of cigarettes and alcohol abuse were highly correlated. When the effect of alcohol abuse was controlled, heavy smoking was associated with elevated mortality risks in both samples, although this was not statistically significant in the CORE-CITY sample. When smoking was controlled, the odds ratios for mortality from alcohol abuse were substantial in both samples. Conclusions:These results and a literature review suggest that insufficient alcohol abuse histories may lead clinicians to underestimate the mortality risk of alcohol abuse. Supported by research grants K05-MH00364, MH39799, and MH42248 from the National Institute of Mental Health.     

A prospective study of cigarette smoking and risk of incident hypertension in women.

OBJECTIVES: We undertook this study to prospectively evaluate whether cigarette smoking was associated with an increased risk of developing hypertension. BACKGROUND: Smoking is a well-recognized risk factor for cardiovascular disease. Few prospective cohort studies have examined the relationship between smoking and hypertension. METHODS: We conducted a prospective cohort study among 28,236 women in the Women's Health Study who were initially free of hypertension, cardiovascular disease, and cancer. Detailed risk factor information, including smoking status, was collected from self-reported questionnaires. We used Cox proportional hazards survival models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension (defined as either new diagnosis, the initiation of antihypertensive medication, systolic blood pressure > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg). RESULTS: At baseline, 51% of women were never smokers, 36% were former smokers, 5% smoked 1 to 14 cigarettes, and 8% smoked > or =15 cigarettes per day. During a median of 9.8 years, there were 8,571 (30.4%) cases of incident hypertension. The age-adjusted HRs of developing hypertension among never, former, and current smokers of 1 to 14 and > or =15 cigarettes per day were 1.00 (reference), 1.04 (95% CI 0.99 to 1.09), 1.00 (95% CI 0.90 to 1.10), and 1.10 (95% CI 1.01 to 1.19), respectively. In multivariable models further adjusting for lifestyle, clinical, and dietary variables, the corresponding HRs were 1.00 (reference), 1.03 (95% CI 0.98 to 1.08), 1.02 (95% CI 0.92 to 1.13), and 1.11 (95% CI 1.03 to 1.21), respectively. Among women who smoked > or =25 cigarettes per day, the multivariable HR was 1.21 (95% CI 1.06 to 1.39). CONCLUSIONS: In this large cohort of women, cigarette smoking was modestly associated with an increased risk of developing hypertension, with an effect that was strongest among women smoking at least 15 cigarettes per day.     

Impact of cigarette smoking on the incidence of Type 2 diabetes mellitus in middle-aged Japanese men: the Osaka Health Survey.

AIMS: To assess the impact of cigarette smoking on the incidence of Type 2 diabetes mellitus (DM) in middle-aged Japanese men. METHODS: The study enrolled 6250 men aged 35-60 years and free of diabetes, impaired fasting glucose and hypertension at entry. Type 2 DM was defined by a fasting plasma glucose level > or =7.0 mmol/l or physician-diagnosed Type 2DM. RESULTS: Four hundred and fifty cases of Type 2 DM were confirmed during the 60904 person-years follow-up. After adjustment for multiple covariates, including age, body mass index, alcohol consumption, physical activity, parental history of diabetes and the level of fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol and haematocrit, the relative risk of Type 2 DM among current smokers compared with non-smokers was 1.47 (95% confidence interval (CI) 1.14-1.92). Men who smoked >30 cigarettes/day had a multivariate-relative risk of 1.73 (95% CI 1.20-2.48) compared with non-smokers. The number of cigarettes smoked daily and the pack-year values were positively related to the development of Type 2 DM in a dose-dependent manner (P for trends = 0.0026 and 0.001, respectively). CONCLUSIONS: A cigarette smoking habit is an independent risk factor for Type 2 DM.     

Exocrine pancreatic cancer,cigarette smoking,and diabetes mellitus: a case-control study in northern Italy

The role of cigarette smoking and diabetes mellitus as risk factors for exocrine pancreatic cancer (PC) was investigated in a hospital based case-control study. Current smokers were at increased risk for PC (OR = 2.36, 95% CI 1.53-3.63): the magnitude of the risk was related to the lifetime amount of smoking (chi2(trend) = 17.00; P < 0.0001). Among former smokers, after 15 years from ceasing smoking, the risk for PC dropped to the level of a lifetime non-smoker, whichever the lifetime smoking amount. Diabetes was associated with a 2.89-fold increased risk for PC (95% CI 1.71-4.86): the risk was 4.76 (95% CI 1.99-11.53) for diabetes diagnosed up to 2 years before the diagnosis of PC and dropped to 2.07 (95% CI 1.02-4.20) for diabetes diagnosed more than 5 years before PC. The risk for PC was estimated according to the treatment used to control diabetes: it was 6.49 (95% CI 2.28-18.48) for insulin treated diabetes and 2.12 (95% CI 1.16-3.87) for diabetes treated with oral hypoglycemic drugs. The risk of PC for diabetes treated for more than 5 years before the diagnosis of PC was 6.21 (95% CI 1.61-23.96) for patients treated with insulin and 1.21 (95% CI 0.50-2.92) for those treated with oral hypoglycemic drugs: the type of treatment needed to control the disease may discriminate between the diabetes that represents a consequence of cancer from the diabetes that could represent an etiological co-factor. More studies are needed to clarify whether long-lasting insulin-treated diabetes is an etiological co-factor in PC.     

Diabetes and all-cause and coronary heart disease mortality among US male physicians

BACKGROUND: While diabetes has long been associated with increased risk of coronary heart disease (CHD), the magnitude of risk of diabetes-related CHD is uncertain. OBJECTIVE: To evaluate the impact of diabetes and prior CHD on all-cause and CHD mortality. METHODS: In a prospective cohort study of 91 285 US male physicians aged 40 to 84 years, participants were divided into 4 groups: (1) a reference group of 82 247 men free of both diabetes and CHD (previous myocardial infarction and/or angina) at baseline, (2) 2317 men with a history of diabetes but not CHD, (3) 5906 men with a history of CHD but not diabetes, and (4) 815 men with a history of both diabetes and CHD. Rates of all-cause and CHD mortality were compared in these groups. RESULTS: Over 5 years (49 7952 person-years of follow-up), 3627 deaths from all causes were documented, including 1242 deaths from CHD. Compared with men with no diabetes or CHD, the age-adjusted relative risk of death from any cause was 2.3 (95% confidence interval [CI], 2.0-2.6) among men with diabetes and without CHD, 2.2 (95% CI, 2.0-2.4) among men with CHD and without diabetes, and 4.7 (95% CI, 4.0-5.4) among men with both diabetes and CHD. The relative risk of CHD death was 3.3 (95% CI, 2.6-4.1) among men with diabetes and without CHD, 5.6 (95% CI, 4.9-6.3) among men with CHD and without diabetes, and 12.0 (95% CI, 9.9-14.6) among men with both diabetes and CHD. Multivariate adjustment for body mass index, smoking status, alcohol intake, and physical activity as well as stratification by these variables did not materially alter these associations. CONCLUSIONS: These prospective data indicate that diabetes is associated with a substantial increase in all-cause and CHD mortality. For all-cause mortality, the magnitude of excess risk conferred by diabetes is similar to that conferred by a history of CHD; for mortality from CHD, a history of CHD is a more potent predictor of death. The presence of both diabetes and CHD, however, identifies a particularly high-risk group.     

Abnormal effect of cigarette smoking on pituitary hormone secretions in insulin-dependent diabetes mellitus

OBJECTIVE We observed the effect of smoking two cigarettes on GH, AVP and cortisol secretion in patients with diabetes and normal subjects. DESIGN AND PATIENTS We tested 10 male smokers with insulin-dependent diabetes mellitus (IDDM) and 10 normal smokers. On a different occasion, normal and diabetic smokers were tested with an insulin (0.15 U/kg body weight) tolerance test (ITT). MEASUREMENTS Hypoglycaemia-induced hormonal responses in smokers were compared with those observed in 10 diabetic and 10 normal non smokers. RESULTS All subjects showed similar basal GH, cortisol and AVP levels. In the normal subjects, cigarette smoking induced a significant increase in circulating GH, AVP and cortisol levels, with mean peaks 3.3, 3 and 1.58 times higher than baseline, respectively. Smoking-induced hormonal responses were significantly higher in diabetics (mean peak was 5.2 times higher than baseline for GH, 4.0 for AVP and 1.83 for cortisol). Insulin induced a similar hypoglycaemic nadir in all subjects at 30 minutes, even though the diabetic subjects had a delayed recovery in blood glucose levels. GH and AVP responses to hypoglycaemia were significantly higher in diabetic (mean peaks 11.5 and 3.2 times higher than baseline, respectively) than in normal (mean peaks 7.3 and 1.9) non-smokers, whereas these groups showed similar cortisol responses (mean peak 2.3 times higher than baseline). Smoking did not change any hypoglycaemia-induced hormonal rise in the normal controls, whereas it significantly enhanced GH, AVP and cortisol levels (mean peaks 14.5, 4 and 3.8 times higher than baseline, respectively) in diabetics. CONCLUSIONS In patients with IDDM, cigarette smoking not only elicits higher GH, AVP and cortisol responses than in normal subjects, but also enhances the counter-regulatory hormone responses to insulin-induced hypoglycaemia. These findings suggest interactions between nicotine inhaled with cigarette smoking and diabetes-induced neuroendocrine alterations.     

A prospective study of nutritional factors and hypertension among US women

The relation of various nutritional factors with hypertension was examined prospectively among 58,218 predominantly white US female registered nurses, aged 34-59 years. In 1980, all women completed an independently validated dietary questionnaire. During 4 years of follow-up, 3,275 women reported a diagnosis of hypertension; the validity of the self-report was shown in a subsample. Age, relative weight, and alcohol consumption were the strongest predictors for the development of hypertension. Dietary calcium and magnesium had independent and significant inverse associations with hypertension. For women with a calcium intake of at least 800 mg/day, the relative risk of hypertension was 0.78 (95% confidence interval, 0.69-0.88) when compared with an intake of less than 400 mg/day. The relative risk for magnesium intake of 300 mg/day or more compared with an intake of less than 200 mg/day was 0.77 (95% confidence interval, 0.67-0.88). For women with high intakes of both calcium and magnesium compared with those having low intakes of both, the relative risk of hypertension was 0.65 (95% confidence interval, 0.53-0.80). No independent associations with hypertension were observed for intakes of potassium, fiber, and saturated and polyunsaturated fatty acids. These prospective findings add to the growing evidence to support the need for randomized trials to determine whether there is a protective role of dietary calcium and magnesium in the regulation of blood pressure.     

Dynamic transitions between marijuana use and cigarette smoking among US adolescents and emerging adults

Background: Marijuana and tobacco are considered two closely related substances. It is of great significance to understand the mutual impact of marijuana and cigarette use when more states in the US have legalized marijuana use. Objective: This study aims to investigate the transitions between marijuana and cigarette use among adolescents and emerging adults. Method: Guided by the probabilistic discrete events systems (PDES) theory, a five-stage model with 21 transition paths was constructed to quantify dynamic transitions between marijuana and cigarette use. The five stages were NU: Never-user, MU: Current marijuana user, CU: Current cigarette user, MCU: Current marijuana–cigarette user, and FU: Former-user. The proposed five-stage PDES model was tested using the 2013 National Survey on Drug Use and Health data (N = 26,665, 50.45% male). Transition probabilities were estimated using the Moore–Penrose generalized inverse matrix method. Result: Among the adolescents, 51.14% of the CUs transited to use marijuana (MCU/MU), higher than the proportion of those who first used marijuana and then transferred to cigarettes (MCU/CU) (41.66%). The quitting rates for MUs, CUs and MCUs were 29.38%, 25.93% and 27.76%, respectively. Of the total FUs, 31.90% transited to MUs, 17.06% to CUs, and 17.39% to MCUs. Among the young adults, more people progressed from MUs to CUs. Transition probabilities by single year of age were also estimated. Conclusion: This is the first study to quantify marijuana–cigarette transitions. Study findings indicate more cigarette-to-marijuana transitions for adolescents and more marijuana-to-cigarette transitions for emerging adults. Future intervention programs should consider this age-related difference in marijuana–cigarette use transitions.     

Cigarette smoking and diabetes mellitus

OBJECTIVE: To assess whether an independent relationship between cigarette smoking and type 2 diabetes exists in both men and women selected from a French population, and to assess the effects of active smoking and smoking cessation on the prevalence of diabetes. METHODS: A population-based cross sectional study in 28,409 volunteers. RESULTS: After adjustment for age, BMI, waist-hip ratio (WHR) and alcohol, the risk of diabetes mellitus (estimated by the odds ratio) was 1.49 (1.13-1.96, P=0.004) and 1.31 (1.01-1.17, P=0.03) for current and former smoker men, respectively, as compared to non-smoker men. The risk was even higher in men aged 40 to 69. No association was found with the duration of smoking cessation. In women, the risk of diabetes associated with current smoking was much less significant [HR: 1.46 (0.92-2.22, P=0.09)], even in women aged 40 to 69 [HR: 1.60 (1.00-2.58, P=0.05)]. No relationship was found for past smoking in women. In non-diabetic men, the adjusted fasting glucose was similar in current and in non smokers, but it was higher in current smokers aged 40 to 69 (99.2 +/- 0.27 vs 98.7 +/- 0.14 mg/dl, P=0.05). It was higher in former than in non smokers (97.4 +/- 0.20 vs 96.0 +/- 0.10 mg/dl, P=0.0001), regardless of age. In non-diabetic women, the adjusted fasting glucose was lower in current than in non smokers (90.7 +/- 0.20 vs 91.4 +/- 0.12 mg/dl, P=0.0001), even in women aged 40 to 69 (93.0 +/- 0.35 vs 93.7 +/- 0.18 mg/dl, P=0.03). It was similar in former and in non smokers, regardless of the age. CONCLUSIONS: Current and past smoking are associated with a risk of diabetes mellitus essentially in men, but much less in women, and the relationship between fasting glucose and smoking appears different in men and women. No dose-relationship between the number of cigarettes smoked and diabetes mellitus was found. Smoking cessation is not associated with a reduced risk of diabetes.     

A prospective study of nutritional factors and hypertension among US men.

BACKGROUND. An effect of diet in determining blood pressure is suggested by epidemiological studies, but the role of specific nutrients is still unsettled. METHODS AND RESULTS. The relation of various nutritional factors with hypertension was examined prospectively among 30,681 predominantly white US male health professionals, 40-75 years old, without diagnosed hypertension. During 4 years of follow-up, 1,248 men reported a diagnosis of hypertension. Age, relative weight, and alcohol consumption were the strongest predictors for the development of hypertension. Dietary fiber, potassium, and magnesium were each significantly associated with lower risk of hypertension when considered individually and after adjustment for age, relative weight, alcohol consumption, and energy intake. When these nutrients were considered simultaneously, only dietary fiber had an independent inverse association with hypertension. For men with a fiber intake of < 12 g/day, the relative risk of hypertension was 1.57 (95% confidence interval, 1.20-2.05) compared with an intake of > 24 g/day. Calcium was significantly associated with lower risk of hypertension only in lean men. Dietary fiber, potassium, and magnesium were also inversely related to baseline systolic and diastolic blood pressure and to change in blood pressure during the follow-up among men who did not develop hypertension. Calcium was inversely associated with baseline blood pressure but not with change in blood pressure. No significant associations with hypertension were observed for sodium, total fat, or saturated, transunsaturated, and polyunsaturated fatty acids. Fruit fiber but not vegetable or cereal fiber was inversely associated with incidence of hypertension. CONCLUSIONS. These results support hypotheses that an increased intake of fiber and magnesium may contribute to the prevention of hypertension.     

A change in the sex incidence of diabetes mellitus

Summary The standardised male to female ratio (M/F) of newly diagnosed diabetics aged 35–49 has changed from 0.65 in 1945–1949 to 1.78 in 1960–1963. A similar but less dramatic change has occurred in the older age groups and the overall standardised sex ratio for newly diagnosed diabetes is now unity. Attention is drawn to the fact that in the last century diabetes was always regarded as being more common in men than women. Diabetic mortality rates also showed this and female mortality did not exceed the male until about 1920. The recent apparent change towards the nineteenth century pattern does not appear to be the result of any difference in the type of diabetic patient seen, and no satisfactory explanation is offered for its occurrence.

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Zusammenfassung Bei frisch entdeckten Diabetikern zwischen 35 und 49 Jahren hat sich das Standardverhältnis von Männern zu Frauen (M/F) von 0.65 in den Jahren 1945–1949 auf 1.78 in den Jahren 1960–1963 verändert. Bei Diabetikern höheren Alters ist es zu einer ähnlichen, doch weniger starken Änderung gekommen. Für alle Altersgruppen ist das standardisierte Geschlechtsverhältnis der frisch entdeckten Diabetiker jetzt einheitlich. Beachtung verdient die Tatsache, daß man im letzten Jahrhundert das Vorkommen des Diabetes bei Männern für häufiger hielt als bei Frauen. Das zeigte auch die Mortalitätsrate der Diabetiker. Die Mortalität der Frauen überstieg die der Männer erst etwa 1920. Die jetzige offensichtliche Rückkehr zum Verteilungsmodus des 19. Jahrhunderts scheint nicht auf einer Änderung des Diabetikertyps zu beruhen. Eine befriedigende Erklärung kann dafür nicht gegeben werden.

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Résumé Le rapport standardisé entre les hommes et les femmes (M/F) atteints d'un diabète récemment diagnostiqué, âgés de 35 à 49 ans, s'est transformé de 0,65 au cours de la période de 1945 à 1949 en 1,78 pour les années 1960 à 1963. Un changement semblable mais moins spectaculaire s'est produit dans les groupes de diabétiques plus âgés et le rapport standardisé des diabétiques récemment diagnostiqués est en définitive, pour les deux sexes, égal maintenant à l'unité. L'attention est attirée sur le fait que dans le siècle passé le diabète a toujours été considéré comme étant plus répandu chez les hommes que chez les femmes. La mortalité parmi les diabétiques l'a également démontré, et la mortalité des femmes n'a pas dépassé celle des hommes jusqu'à environ 1920. La modification récente apparente dans le sens de celle qui avait été observée au cours du dix-neuvième siècle n'apparaît pas être le résultat d'une différence dans le type de patient diabétique examiné, et aucune explication satisfaisante se présente pour expliquer ce phénomène.

     

上海地区男性吸烟习惯与2型糖尿病患病风险的研究

目的探索上海地区男性吸烟习惯与2型糖尿病患病风险的相关性。方法 2010年3月至8月选取上海郊区社区3521名40岁以上的男性进行调查。根据有无吸烟史以及每日吸烟支数分为不吸烟组、少量吸烟组(≤20支/d)、中量吸烟组(21～39支/d)和大量吸烟组(≥40支/d)。数据分析采用方差分析、卡方检验及Logistic回归分析。结果大量吸烟组的空腹血糖、糖化血红蛋白明显高于不吸烟组,差异有统计学意义(P<0.05)。以不吸烟组、少量吸烟组、中量吸烟组和大量吸烟组为自变量,是否患有2型糖尿病为因变量,进行多元Logistic回归分析,大量吸烟是2型糖尿病患病的独立危险因素(OR=1.53,95%CI 1.02～2.28,P<0.05)。结论大量吸烟是2型糖尿病患病的独立危险因素。