Smoking Status and Metabolic Syndrome in the Multi-Ethnic Study of Atherosclerosis. A cross-sectional study
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Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Université P. & M. Curie, Faculté de médecine, Paris, France
Center for Family and Community Medicine, Columbia University, New York, NY, USA
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Wake Forest University School of Medicine, Winston-Salem, NC, USA
Ivan Berlin   

Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Université P. & M. Curie, Faculté de médecine, INSERM 894, Paris, France
Publish date: 2012-06-20
Tobacco Induced Diseases 2012;10(June):9
Current smoking is associated with type 2 diabetes mellitus and impaired glucose tolerance but its association with the metabolic syndrome (metS), particularly with sufficiently sampled African American representation, has not been clearly established.

To assess whether a) metS is associated with smoking; b) any increased risk of metS among smokers is independent of body mass index (BMI) compared with non-smokers; c) smoking status is differentially associated with the metS and its components across different ethnic groups.

Cross sectional analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) a community populationbased sample free of cardiovascular disease.

Current smokers (N = 769) had higher risk of metS (odds ratio [OR, 95% confidence interval]: 1.4, 1.1-1.7) versus never (reference, N = 2981) and former smokers (1.0, 0.8-1.1, N = 2163) and for metS components: high waist circumference (WC) (OR:1.9, 1.2-2.1), low high density lipoprotein cholesterol (HDL-C) (1.5, 1.3-1.8), elevated plasma triglycerides (TG) (OR:1.4, 1.2-1.7) as well as high C-reactive protein (CRP, an inflammatory marker) concentration (OR: 1.6,1.3-2.0) compared to never and former smokers after adjustment for BMI. A smoking status by ethnicity interaction occurred such that African American current and former smokers had greater likelihood of low HDL-C than White counterparts.

WHO Report on the Global Tobacco Epidemic: Warning about the dangers of tobacco. 2012, Accessed on Jan 19, 2012.
Center for Disease Control: Smoking & Tobacco Use - Tobacco related mortality. 2012, on Jan 19, 2012.
Ezzati M, Lopez AD: Estimates of global mortality attributable to smoking in 2000. Lancet. 2003, 362 (9387): 847-852. 10.1016/S0140-6736(03)14338-3.
Critchley J, Capewell S: Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev. 2004, 1: CD003041.
Berlin I: Smoking-induced metabolic disorders: a review. Diabetes Metab. 2008, 34: 307-314. 10.1016/j.diabet.2008.01.008.
Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J: Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2007, 298: 2654-2664. 10.1001/jama.298.22.2654.
Yeh HC, Duncan BB, Schmidt MI, Wang NY, Brancati FL: Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2010, 152: 10-17.
Luo J, Rossouw J, Tong E, Giovino GA, Lee C, Chen C, Ockene JK, Qi L, Margolis KL: Smoking cessation, weight gain, and risk of type 2 diabetes mellitus among postmenopausal women. Arch Intern Med. 2012, 172: 438-440.
Houston TK, Person SD, Pletcher MJ, Liu K, Iribarren C, Kiefe CI: Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study. BMJ. 2006, 332: 1064-1069. 10.1136/bmj.38779.584028.55.
Kowall B, Rathmann W, Strassburger K, Heier M, Holle R, Thorand B, Giani G, Peters A, Meisinger C: Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: the KORA S4/F4 cohort study. Eur J Epidemiol. 2010, 25: 393-402. 10.1007/s10654-010-9452-6.
Craig WY, Palomaki GE, Haddow JE: Cigarette smoking and serum lipid and lipoprotein concentrations: an analysis of published data. BMJ. 1989, 298: 784-788. 10.1136/bmj.298.6676.784.
Bakhru A, Erlinger TP: Smoking cessation and cardiovascular disease risk factors: results from the Third National Health and Nutrition Examination Survey. PLoS Med. 2005, 2 (6): e160-10.1371/journal.pmed.0020160.
Rouvre M, Vol S, Gusto G, et al: Low high density lipoprotein cholesterol: prevalence and associated risk-factors in a large French population. Ann Epidemiol. 2010, 21: 118-127. 10.1097/EDE.0b013e3181c297af.
Attvall S, Fowelin J, Lager I, Von Schenck H, Smith U: Smoking induces insulin resistance–a potential link with the insulin resistance syndrome. J Intern Med. 1993, 233: 327-332. 10.1111/j.1365-2796.1993.tb00680.x.
Reaven G, Tsao PS: Insulin resistance and compensatory hyperinsulinemia: the key player between cigarette smoking and cardiovascular disease?. J Am Coll Cardiol. 2003, 41: 1044-1047. 10.1016/S0735-1097(02)02982-0.
Borissova AM, Tankova T, Kirilov G, Dakovska L, Krivoshiev S: The effect of smoking on peripheral insulin sensitivity and plasma endothelin level. Diabetes Metab. 2004, 30: 147-152. 10.1016/S1262-3636(07)70100-3.
Bazzano LA, He J, Muntner P, Vupputuri S, Whelton PK: Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States. Ann Intern Med. 2003, 138: 891-897.
Tonstad S, Cowan JL: C-reactive protein as a predictor of disease in smokers and former smokers: a review. Int J Clin Pract. 2009, 63: 1634-1641. 10.1111/j.1742-1241.2009.02179.x.
Zhu S, St-Onge MP, Heshka S, Heymsfield SB: Lifestyle behaviors associated with lower risk of having the metabolic syndrome. Metabolism. 2004, 53: 1503-1511. 10.1016/j.metabol.2004.04.017.
Lee WY, Jung CH, Park JS, Rhee EJ, Kim SW: Effects of smoking, alcohol, exercise, education, and family history on the metabolic syndrome as defined by the ATP III. Diabetes Res Clin Pract. 2005, 67: 70-77. 10.1016/j.diabres.2004.05.006.
Katano S, Nakamura Y, Nakamura A, et al: Relationship among physical activity, smoking, drinking and clustering of the metabolic syndrome diagnostic components. J Atheroscler Thromb. 2010, 17: 644-650. 10.5551/jat.3699.
Geslain-Biquez C, Vol S, Tichet J, Caradec A, D'Hour A, Balkau B: The metabolic syndrome in smokers. The D.E.S.I.R. study. Diabetes Metab. 2003, 29: 226-234. 10.1016/S1262-3636(07)70031-9.
Carnethon MR, Loria CM, Hill JO, Sidney S, Savage PJ, Liu K: Risk factors for the metabolic syndrome: the Coronary Artery Risk Development in Young Adults (CARDIA) study, 1985–2001. Diabetes Care. 2004, 27: 2707-2715. 10.2337/diacare.27.11.2707.
Onat A, Ozhan H, Esen AM, et al: Prospective epidemiologic evidence of a "protective" effect of smoking on metabolic syndrome and diabetes among Turkish women–without associated overall health benefit. Atherosclerosis. 2007, 193: 380-388. 10.1016/j.atherosclerosis.2006.07.002.
Williamson DF, Madans J, Anda RF, Kleinman JC, Giovino GA, Byers T: Smoking cessation and severity of weight gain in a national cohort. N Engl J Med. 1991, 324: 739-745. 10.1056/NEJM199103143241106.
Shimokata H, Muller DC, Andres R: Studies in the distribution of body fat III. Effects of cigarette smoking. JAMA. 1989, 261: 1169-1173. 10.1001/jama.1989.03420080089037.
Molarius A, Seidell JC, Kuulasmaa K, Dobson AJ, Sans S: Smoking and relative body weight: an international perspective from the WHO MONICA Project. J Epidemiol Community Health. 1997, 51: 252-260. 10.1136/jech.51.3.252.
Albanes D, Jones DY, Micozzi MS, Mattson ME: Associations between smoking and body weight in the US population: analysis of NHANES II. Am J Public Health. 1987, 77: 439-444. 10.2105/AJPH.77.4.439.
Chiolero A, Faeh D, Paccaud F, Cornuz J: Consequences of smoking for body weight, body fat distribution, and insulin resistance. Am J Clin Nutr. 2008, 87: 801-809.
Canoy D, Wareham N, Luben R, et al: Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study. Obes Res. 2005, 13: 1466-1475. 10.1038/oby.2005.177.
Bamia C, Trichopoulou A, Lenas D, Trichopoulos D: Tobacco smoking in relation to body fat mass and distribution in a general population sample. Int J Obes Relat Metab Disord. 2004, 28: 1091-1096. 10.1038/sj.ijo.0802697.
C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant metaanalysis. Lancet. 2010, 375: 132-140.
Bild DE, Bluemke DA, Burke GL, et al: Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002, 156: 871-881. 10.1093/aje/kwf113.
Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol. 2004, 24: e13-e18.
Alberti KG, Zimmet P, Shaw J: Metabolic syndrome–a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006, 23: 469-480.
Bertoni AG, Burke GL, Owusu JA, et al: Inflammation and the incidence of type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2010, 33: 804-810. 10.2337/dc09-1679.
Bahrami H, Bluemke DA, Kronmal R, et al: Novel metabolic risk factors for incident heart failure and their relationship with obesity: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008, 51: 1775-1783. 10.1016/j.jacc.2007.12.048.
Ainsworth BE, Haskell WL, Whitt MC, et al: Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000, 32: S498-S504. 10.1097/00005768-200009001-00009.
Bertoni AG, Whitt-Glover MC, Chung H, et al: The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2009, 169: 444-454.
Fiore MC, Baker TB: Treating smokers in the health care setting. N Engl J Med. 2011, 365: 1222-1231. 10.1056/NEJMcp1101512.
Leone A: Does smoking act as a friend or enemy of blood pressure? Let release Pandora's box. Cardiol Res Pract. 2011, 264894.
Barnaards CM, Twisk JWR, Snel J, van Mechelen W, Kemper HCG: In a prospective study in young people, associations between changes in smoking behavior and risk for cardiovascular dieseas were complex. J Clin Epidemiol. 2005, 58: 1165-1171. 10.1016/j.jclinepi.2005.02.019.
Teshima K, Imamura H, Uchida K, Miyamoto N, Masuda Y, Kobata D: Cigarette smoking, blood pressure and serum lipids in Japanese men aged 20–39 years. J Physiol Anthropol Appl Human Sci. 2001, 20: 43-45. 10.2114/jpa.20.43.
Imamura H, Teshima K, Miyamoto N, Shirota T: Cigarette smoking, high-density lipoprotein cholesterol subfractions, and lecithin: cholesterol acyltransferase in young women. Metabolism. 2002, 51: 1313-1316. 10.1053/meta.2002.34040.
Henkin L, Zaccaro D, Haffner S, Karter A, Rewers M, Sholinsky P, Wagenknecht L: Cigarette smoking, environmental tobacco smoke exposure and insulin sensitivity. Ann Epidemiol. 1999, 9: 290-296. 10.1016/S1047-2797(99)00003-4.
Lin SX, Carnethon M, Szklo M, Bertoni A: Racial/ethnic differences in the association of triglycerides with other metabolic syndrome components: the Multi-Ethnic Study of Atherosclerosis. Metab Syndr Relat Disord. 2010, 9: 35-40.
Metcalf PA, Sharrett AR, Folsom AR, et al: African American-white differences in lipids, lipoproteins, and apolipoproteins, by educational attainment, among middle-aged adults: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 1998, 148: 750-760. 10.1093/oxfordjournals.aje.a009696.
Cowie CC, Howard BV, Harris MI: Serum lipoproteins in African Americans and whites with non-insulin-dependent diabetes in the US population. Circulation. 1994, 90: 1185-1193. 10.1161/01.CIR.90.3.1185.
Morrison JA, Khoury P, Mellies M, Kelly K, Horvitz R, Glueck CJ: Lipid and lipoprotein distributions in black adults. The Cincinnati Lipid Research Clinic's Princeton School Study. JAMA. 1981, 245: 939-942. 10.1001/jama.1981.03310340029022.
Carnethon MR, Palaniappan LP, Burchfiel CM, Brancati FL, Fortmann SP: Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults: the atherosclerosis risk in communities study: 1987–1998. Diabetes Care. 2002, 25: 1358-1364. 10.2337/diacare.25.8.1358.
Fulkerson JA, French SA: Cigarette smoking for weight loss or control among adolescents : Gender and racial/ethnic differences. J Adolesc Health. 2003, 32: 306-313. 10.1016/S1054-139X(02)00566-9.
Clark MM, Decker PA, Offord KP, Patten CA, Vickers KS, Croghan IT, Taylor-Hays T, Hurt RD, Dale LC: Weight concerns among male smokers. Addictive Behaviors. 2004, 29: 1637-1641. 10.1016/j.addbeh.2004.02.034.
Pisinger C, Jorgensen T: Weight concerns and smoking in a general population: the Inter99 study. Preventive Medicine. 2007, 44: 296-297. 10.1016/j.ypmed.2007.01.001.
Pomerleau CS, Zucker AN, Stewart AJ: Characterizing concerns about post-cessation weight gain: results from a national survey of women smokers. Nicotine Tob Res. 2001, 3: 51-60.
Twardella D, Loew M, Rothenbacher D, Stegmaier C, Ziegler H, Brenner H: The impact of body weight on smoking cessation in German adults. Preventive Medicine. 2006, 42: 109-113. 10.1016/j.ypmed.2005.11.008.
Clair C, Berlin I, Cornuz J: Tabagisme, obésité et diabète : une interaction cliniquement importante. Rev Med Suisse. 2011, 7: 2338-2342.
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