Contribution of Swedish moist snuff to the metabolic syndrome: A wolf in sheep's clothing?

Abstract

Aim: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between several lifestyle factors and MetSy, with a focus on the possible role of smokeless tobacco in the form of Swedish moist snuff (snus). Methods: A population-based longitudinal cohort study within the Västerbotten Intervention Programme in Northern Sweden. All inhabitants at the ages of 30, 40, 50, and 60 are invited to participate in a health survey that includes a questionnaire on psychosocial conditions and lifestyle and measurement of biological variables. Individuals examined in 1990—94 (n=24,230) and who also returned for follow-up after 10 years were included (total of 16,492 individuals: 46.6% men and 53.4% women). Regression analyses were performed. MetSy was the outcome and analyses were adjusted for age, sex, alcohol abuse, and family history of CVD and diabetes. Results: Ten-year development of MetSy was associated with high-dose consumption of snus at baseline (OR 1.6 [95% CI 1.26—2.15]), low education (2.2 [1.92—2.63]), physical inactivity (1.5 [1.22—1.73]) and former smoking (1.2 [1.06—1.38]). Snus was associated with separate components of MetSy, including triglycerides (1.6, 1.30—1.95), obesity (1.7 [1.36—2.18]) but not hypertension, dysglycemia and low HDL cholesterol. Conclusions: MetSy is independently associated with high consumption of snus, even when controlling for smoking status. The finding is of public health interest in societies with widespread use of snus. More research is needed to better understand the mechanisms underlying this effect.

Keywords

Lifestyle metabolic syndrome smokeless tobacco risk factors public health

Get full access to this article

View all access options for this article.

References

WHO. Global strategy on diet, physical activity and health. Geneva: WHO; 2005.

Isomaa B. , Almgren P. , Tuomi T. , Forsen B. , Lahti K. , Nissen M. , et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683—9.

Alberti KG , Zimmet PZ Definition, diagnosis and classification of diabetes mellitus and its complications, Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539—53.

Grundy SM , Cleeman JI , Daniels SR , Donato KA , Eckel RH , Franklin BA , et al. Diagnosis and management of the metabolic syndrome. An American Heart Association/ National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005 .

Alberti KG , Zimmet P. , Shaw J. The metabolic syndrome: A new worldwide definition . Lancet 2005;366:1059—62.

Kahn R. , Buse J. , Ferrannini E. , Stern M. The metabolic syndrome: Time for a critical appraisal. Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2005;48:1684—99.

Gale EA The myth of the metabolic syndrome. Diabetologia 2005;48:1679—83.

Lidfeldt J. , Nyberg P. , Nerbrand C. , Samsioe G. , Schersten B. , Agardh CD Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes Obes Metab 2003;5:106—12.

Zhu S. , St-Onge MP , Heshka S. , Heymsfield SB Lifestyle behaviors associated with lower risk of having the metabolic syndrome. Metabolism 2004;53:1503—11.

10.

Lindahl B. , Stegmayr B. , Johansson I. , Weinehall L. , Hallmans G.

Trends in lifestyle 1986—99 in a 25- to 64-year-old population of the Northern Sweden MONICA project. Scand

J Public Health 2003;61(Suppl):31—7.

11.

Rodu B. , Stegmayr B. , Nasic S. , Cole P. , Asplund K. Evolving patterns of tobacco use in northern Sweden. J Intern Med 2003;253:660—5.

12.

Gilljam H. , Galanti MR Role of snus (oral moist snuff) in smoking cessation and smoking reduction in Sweden. Addiction 2003;98:1183—9.

13.

Eliasson B. Cigarette smoking and diabetes. Prog Cardiovasc Dis 2003;45:405—13.

14.

Westman EC

Does smokeless tobacco cause hypertension?

South Med J 1995;88:716—20.

15.

Wallenfeldt K. , Hulthe J. , Bokemark L. , Wikstrand J. , Fagerberg B. Carotid and femoral atherosclerosis, cardiovascular risk factors and C-reactive protein in relation to smokeless tobacco use or smoking in 58-year-old men. J Intern Med 2001 ;250:492—501.

16.

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.

17.

Rodu B. , Stegmayr B. , Nasic S. , Cole P. , Asplund K. The influence of smoking and smokeless tobacco use on weight amongst men. J Intern Med 2004;255:102—7.

18.

Rohani M. , Agewall S. Oral snuff impairs endothelial function in healthy snuff users. J Intern Med 2004;255:379—83.

19.

Bolinder G. , Alfredsson L. , Englund A. , de Faire U. Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers . Am J Public Health 1994;84:399—404.

20.

Huhtasaari F. , Lundberg V. , Eliasson M. , Janlert U. , Asplund K. Smokeless tobacco as a possible risk factor for myocardial infarction: A population-based study in middle-aged men. J Am Coll Cardiol 1999 ;34:1784—90.

21.

Hergens MP , Ahlbom A. , Andersson T. , Pershagen G. Swedish moist snuff and myocardial infarction among men. Epidemiology 2005;16:12—16.

22.

Asplund K. , Nasic S. , Janlert U. , Stegmayr B. Smokeless tobacco as a possible risk factor for stroke in men: A nested case-control study. Stroke 2003;34:1754—9.

23.

Persson PG , Carlsson S. , Svanstrom L. , Ostenson CG , Efendic S. , Grill V. Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000;248: 103—10.

24.

Eliasson M. , Asplund K. , Nasic S. , Rodu B. Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: Rhe northern Sweden MONICA study . J Intern Med 2004;256:101—10.

25.

Kilaru S. , Frangos SG , Chen AH , Gortler D. , Dhadwal AK , Araim O. , et al. Nicotine: A review of its role in atherosclerosis. J Am Coll Surg 2001;193:538—46.

26.

Asplund K. Smokeless tobacco and cardiovascular disease. Prog Cardiovasc Dis 2003;45:383—94.

27.

Hatsukami DK , Lemmonds C. , Tomar SL

Smokeless tobacco use: Harm reduction or induction approach?

Prev Med 2004;38:309—17.

28.

Weinehall L. , Hallgren CG , Westman G. , Janlert U. , Wall S. Reduction of selection bias in primary prevention of cardiovascular disease through involvement of primary health care. Scand J Prim Health Care 1998;16:171—6.

29.

Aertgeerts B. , Buntinx F. , Kester A. The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: A diagnostic meta-analysis. J Clin Epidemiol 2004;57:30—9.

30.

Oh SW , Yoon YS , Lee ES , Kim WK , Park C. , Lee S. , et al. Association between cigarette smoking and metabolic syndrome: The Korea National Health and Nutrition Examination Survey. Diabetes Care 2005;28:2064—6.

31.

Bolinder G. , Noren A. , de Faire U. , Wahren J. Smokeless tobacco use and atherosclerosis: An ultrasonographic investigation of carotid intima media thickness in healthy middle-aged men. Atherosclerosis 1997;132:95—103.

32.

England LJ , Levine RJ , Mills JL , Klebanoff MA , Yu KF , Cnattingius S. Adverse pregnancy outcomes in snuff users . Am J Obstet Gynecol 2003;189:939—43.

33.

Schroder H. , Marrugat J. , Elosua R. , Covas MI Tobacco and alcohol consumption: Impact on other cardiovascular and cancer risk factors in a southern European Mediterranean population. Br J Nutr 2002;88:273—81.

34.

Canoy D. , Wareham N. , Luben R. , Welch A. , Bingham S. , Day N. , et al. Cigarette smoking and fat distribution in 21,828 British men and women: A population-based study. Obes Res 2005;13:1466—75.