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Published on: April 26, 2019
Alcohol, Smoking, and Their Synergy as Risk Factors for Incident Type 2 Diabetes
Indira Paz-Graniel1, Junko Kose2, Pauline Duquenne3
1Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentació, Nutrició, Desenvolupament i Salut Mental (ANUT-DSM), Reus, Spain; Nutritional Epidemiology Research Team (EREN), INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France; CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
Introduction:
Smoking has been independently related to an increased risk of Type 2 diabetes, whereas the role of alcohol remains controversial. The joint impact of tobacco and alcohol use on Type 2 diabetes risk is understudied. This study investigated individual and combined effects of smoking and alcohol on Type 2 diabetes risk.
Methods:
Data from 110,076 participants in the NutriNet-Santé cohort (2009-2023), who were free from Type 2 diabetes at baseline and with alcohol and smoking data, were analyzed. Multivariable Cox regression models assessed the association of alcohol consumption (<2 vs ≥2 portions/day, <10 vs ≥10 portions/week, grams/day of ethanol) and smoking (never versus former/current smoking) with Type 2 diabetes risk. Combined effects of heavy smoking (≥20 cigarettes/day) and heavy drinking (>8 and >15 portions/week for women and men, respectively) were also evaluated.
Results:
Over 7.5 years of follow-up (820,470 person-years), 1,175 Type 2 diabetes cases were identified. Alcohol consumption, including heavy intake, was not significantly associated with Type 2 diabetes risk. People who formerly or currently smoke had a 36% higher risk of Type 2 diabetes than people who have never smoked (hazard ratio=1.36; 95% CI=1.20, 1.53). Those who smoked heavily had over twice the risk of those who smoked lightly or moderately (hazard ratio=2.10; 95% CI=1.46, 3.02). Combined exposure to smoking and heavy alcohol use did not significantly increase Type 2 diabetes risk (hazard ratio=1.11; 95% CI=0.95, 1.29).
Conclusions:
These findings support smoking as an independent risk factor for Type 2 diabetes and show that alcohol consumption did not confer protection. The combined effect of alcohol and tobacco use on Type 2 diabetes risk and the mechanisms behind this relationship should be further explored.
Trial Registration:
This trial is registered at NCT03335644 at ClinicalTrials.gov.
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