CoChat
Sign Up
Cited by 56

Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts

Carlsson, S., Andersson, T., Araghi, M., Galanti, R., Lager, A., Lundberg, M., Nilsson, P., Norberg, M. +3 more·2017·Journal of Internal Medicine
DOI 10.1111/joim.12592
Open this paper in CoChat — free account

Abstract

Background: Smoking and nicotine exposure increase insulin resistance and the risk of type 2 diabetes. Swedish smokeless tobacco (snus) is high in nicotine, and its use is prevalent in Scandinavian countries, but few studies have investigated snus use in relation to diabetes risk. Objective: To explore the association between snus use and risk of type 2 diabetes using pooled data from five cohorts. Methods: Analyses were based on prospective studies conducted between 1990 and 2013 including 54 531 never‐smoking men and 2441 incident cases of type 2 diabetes identified through screening, self‐reporting and hospital and prescription registries. Hazard ratios (HR s) and 95% confidence intervals (CIs) were assessed and adjusted for age, body mass index, educational level, alcohol consumption and physical activity. Results: Compared to never users, the HR of type 2 diabetes was 1.15 (95% CI: 1.00–1.32) in current users of snus. In individuals consuming 5–6 boxes per week, the HR was 1.42 (95% CI: 1.07–1.87); in those consuming ≥7 boxes per week, the HR was 1.68 (95% CI: 1.17–2.41). Each additional box of snus consumed per week yielded an HR of 1.08 (95% CI: 1.01–1.16). Conclusion: Our findings indicate that high consumption of snus is a risk factor for type 2 diabetes. The risk was similar to that in smokers, implying that smokers will not reduce their risk of type 2 diabetes by changing to snus use. The results also support the notion that nicotine increases the risk of type 2 diabetes.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/joim.12592

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 38

  1. Osterdahl BG, Jansson C, Paccou A. Decreased levels of tobacco-specific N-nitrosamines in moist snuff on the Swed- ish market. J Agric Food Chem 2004; 52: 5085-8.
  2. Song MA, Marian C, Brasky TM, Reisinger S, Djordjevic M, Shields PG. Chemical and toxicological characteristics of conventional and low-TSNA moist snuff tobacco products. Toxicol Lett 2016; 245: 68-77.
  3. Kozlowski LT, Abrams DB. Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction. BMC Public Health 2016; 16: 432.
  4. Hansson J, Galanti MR, Hergens MP et al. Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analy- ses of incidence and survival. J Intern Med 2014; 276: 87-95.
  5. Hansson J, Galanti MR, Hergens MP et al. Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies. Eur J Epidemiol 2012; 27: 771-9.
  6. Luo J, Ye W, Zendehdel K et al. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet 2007; 369: 2015-20.
  7. Nordenvall C, Nilsson PJ, Ye W, Nyr en O. Smoking, snus use and risk of right-and left-sided colon, rectal and anal cancer: a 37-year follow-up study. Int J Cancer 2011; 128: 157-65.
  8. Nordenvall C, Nilsson PJ, Ye W, Andersson TM, Nyr en O. Tobacco use and cancer survival: a cohort study of 40,230 Swedish male construction workers with incident cancer. Int J Cancer 2013; 132: 155-61.
  9. Pan A, Wang Y, Talaei M, Hu FB, Wu T. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endo- crinol 2015; 3: 958-67.
  10. Bajaj M. Nicotine and insulin resistance: when the smoke clears. Diabetes 2012; 61: 3078-80.
  11. Bergman BC, Perreault L, Hunerdosse D et al. Novel and reversible mechanisms of smoking-induced insulin resis- tance in humans. Diabetes 2012; 61: 3156-66.
  12. Liu S, Tinker L, Song Y et al. A prospective study of inflam- matory cytokines and diabetes mellitus in a multiethnic cohort of postmenopausal women. Arch Intern Med 2007; 167: 1676-85.
  13. Ostgren CJ, Lindblad U, Ranstam J, Melander A, Melander L. Skaraborg Hypertension and Diabetes Project. Associations between smoking and beta-cell function in a non-hyperten- sive and non-diabetic population. Skaraborg Hypertension and Diabetes Project. Diabet Med 2000; 17: 445-50.
  14. Digard H, Sholar MB, Goletiani N, Siegel AJ, Mello NK. Determination of nicotine absorption from multiple tobacco products and nicotine gum. Nicotine Tob Res 2013; 15: 255- 61.
  15. Persson PG, Carlsson S, Svanstr€ om L, Ostenson CG, Efendic S, Grill V. Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000; 248: 103-10.
  16. € Ostenson CG, Hilding A, Grill V, Efendic S. High consumption of smokeless tobacco ("snus") predicts increased risk of type 2 diabetes in a 10-year prospective study of middle-aged Swedish men. Scand J Public Health 2012; 40: 730-7.
  17. Eliasson M, Asplund K, Nasic S, Rodu B. Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA study. J Intern Med 2004; 256: 101-10.
  18. Rasouli B, Andersson T, Carlsson PO et al. Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA). Diabet Med 2016 Jun 29; doi:10.1111/dme.13179. · DOI · Paper page
  19. Pedersen W, von Soest T. Tobacco use among Norwegian adolescents: from cigarettes to snus. Addiction 2014; 109: 1154-62.
  20. Norberg M, Malmberg G, Ng N, Brostr€ om G. Who is using snus? -Time trends, socioeconomic and geographic charac- teristics of snus users in the ageing Swedish population. BMC Public Health 2011; 11: 929.
  21. Agaku IT, Awopegba AJ, Filippidis FT. The impact of inter- survey differences in the definition of current smokeless tobacco use on comparability of US national and state- specific prevalence estimates, 2009-2011. Prev Med 2015; 74: 86-92.
  22. Centers for Disease Control and Prevention. State-Specific Prevalence of Current Cigarette Smoking and Smokeless Tobacco Use Among Adults Aged ≥18 Years -United States, 2011-2013. Morb Mortal Wkly Rep 2015; 64: 532-6.
  23. Zhu SH, Gamst A, Lee M, Cummins S, Yin L, Zoref L. The use and perception of electronic cigarettes and snus among the U.S. population. PLoS One 2013; 8: e79332.
  24. Norberg M, Wall S, Boman K, Weinehall L. The V€ asterbotten Intervention Programme: background, design and implica- tions. Glob Health Action 2010; 22: 3.
  25. Svensson AC, Fredlund P, Laflamme L et al. Cohort profile: the Stockholm Public Health Cohort. Int J Epidemiol 2013; 42: 1263-72.
  26. Manjer J, Carlsson S, Elmst ahl S et al. The Malm€ o Diet and Cancer Study: representativity, cancer incidence and mortal- ity in participants and non-participants. Eur J Cancer Prev 2001; 10: 489-99.
  27. Lagerros YT, Bellocco R, Adami HO, Nyr en O. Measures of physical activity and their correlates: the Swedish National March Cohort. Eur J Epidemiol 2009; 24: 161-9.
  28. Lichtenstein P, Sullivan PF, Cnattingius S et al. The Swedish Twin Registry in the third millennium: an update. Twin Res Hum Genet 2006; 9: 875-82.
  29. Ludvigsson JF, Andersson E, Ekbom A et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011; 11: 450.
  30. Wettermark B, Hammar N, Fored CM et al. The new Swedish Prescribed Drug Register-opportunities for pharmacoepi- demiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007; 16: 726-35.
  31. Hartung J, Knapp G, Sinha BK. Statistical Meta-Analysis with Applications. Hoboken, NJ: Wiley, 2008. ISBN 978-0- 470-29089-7.
  32. Mendelson JH, Sholar MB, Goletiani N, Siegel AJ, Mello NK. Effects of low-and high-nicotine cigarette smoking on mood states and the HPA axis in men. Neuropsychopharmacology 2005; 30: 1751-63.
  33. Holm H, Jarvis MJ, Russell MA, Feyerabend C. Nicotine intake and dependence in Swedish snuff takers. Psychophar- macology 1992; 108: 507-11.
  34. Andersson G, Bj€ ornberg G, Curvall M. Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: a comparative study. J Oral Pathol Med 1994; 23: 161-7.
  35. Andersson T, Ahlbom A, Carlsson S. Diabetes Prevalence in Sweden at Present and Projections for Year 2050. PLoS One 2015; 10: e0143084.
  36. Eliasson M, Asplund K, Evrin PE, Lundblad D. Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin. The Northern Sweden MONICA Study. Atherosclerosis 1995; 113: 41-53.
  37. Hergens MP, Galanti R, Hansson J et al. Use of Scandinavian moist smokeless tobacco (snus) and the risk of atrial fibril- lation. Epidemiology 2014; 25: 872-6.
  38. International Diabetes Federation IDF diabetes Atlas 7th edition 2015. http://www.diabetesatlas.org/. Correspondence: Sofia Carlsson, Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden. (fax: 46 8 336981; e-mail: Sofia.carlsson@ki.se).

Cited by

Sorted by citations

Authors
Carlsson, S., Andersson, T., Araghi, M., Galanti, R., Lager, A., Lundberg, M., Nilsson, P., Norberg, M., Pedersen, N. L., Trolle‐Lagerros, Y., & Magnusson, C.
Venue
Journal of Internal Medicine
Publisher
Wiley
Published
2017-02-06
Volume
281
Issue
4
Pages
398-406
ISSN
  • 0954-6820
  • 1365-2796
DOI
10.1111/joim.12592
Cited by
56
References
2
Language
en
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review