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Lindholm, L., Stenling, A., Norberg, M., Stenlund, H. & Weinehall, L. (2018). A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort. BMC Public Health, 18, Article ID 452.
Open this publication in new window or tab >>A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort
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2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 452Article in journal (Refereed) Published
Abstract [en]

Background: Several large scale community-based cardiovascular disease prevention programs were initiated in the 80s, and one was the Västerbotten Intervention Programme, Sweden. As an initial step in 1985, a pilot study was introduced in the Norsjö municipality that combined individual disease prevention efforts among the middle-aged population with community-oriented health promotion activities. All citizens at 30, 40, 50, and 60 years of age were invited to a physical examination combined with a healthy dialogue at the local primary health care centre. Västerbotten Intervention Program is still running following the same lines and is now a part of the ordinary public health in the county. The purpose of this study is to estimate the costs of running Västerbotten Intervention Programme from 1990 to 2006, versus the health gains and savings reasonably attributable to the program during the same time period. Methods: A previous study estimated the number of prevented deaths during the period 1990-2006 which can be attributed to the programme. We used this estimate and calculated the number of QALYs gained, as well as savings in resources due to prevented non-fatal cases during the time period 1990 to 2006. Costs for the programmes were based on previously published scientific articles as well as current cost data from the county council, who is responsible for the programme. Result: The cost per QALY gained from a societal perspective is SEK 650 (Euro 68). From a health care sector perspective, the savings attributable to the VIP exceeded its costs. Conclusion: Our analysis shows that Västerbotten Intervention Programme is extremely cost-effective in relation to the Swedish threshold value (SEK 500000 per QALY gained or Euro 53,000 per QALY gained). Other research has also shown a favorable effect of Västerbotten Intervention Programme on population health and the health gap. We therefore argue that all health care organizations, acting in settings reasonably similar to Sweden, have good incentive to implement programs like Västerbotten Intervention Programme.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Prevention, Community-based, Cost-effectiveness
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147306 (URN)10.1186/s12889-018-5339-3 (DOI)000429848700006 ()29618323 (PubMedID)
Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2018-08-21Bibliographically approved
Lassale, C., Tzoulaki, I., Moons, K. G. M., Sweeting, M., Boer, J., Johnson, L., . . . Butterworth, A. S. (2018). Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis. European Heart Journal, 39(5), 397-406
Open this publication in new window or tab >>Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan-European case-cohort analysis
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 5, p. 397-406Article in journal (Refereed) Published
Abstract [en]

Aims: The hypothesis of 'metabolically healthy obesity' implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We tested this hypothesis in a large pan-European prospective study.

Methods and results: We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study ('EPIC-CVD'). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction ('unhealthy') as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.

Conclusion: Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of 'metabolically healthy obesity', encouraging population-wide strategies to tackle obesity.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Adiposity, Coronary heart disease, Epidemiology, Metabolic syndrome, Obesity
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143325 (URN)10.1093/eurheartj/ehx448 (DOI)000424198900016 ()29020414 (PubMedID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Parikh, N. I., Norberg, M., Ingelsson, E., Cnattingius, S., Vasan, R. S., Domellöf, M., . . . Edstedt Bonamy, A.-K. (2017). Association of Pregnancy Complications and Characteristics With Future Risk of Elevated Blood Pressure: The Västerbotten Intervention Program. Hypertension, 69(3), 475-483
Open this publication in new window or tab >>Association of Pregnancy Complications and Characteristics With Future Risk of Elevated Blood Pressure: The Västerbotten Intervention Program
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2017 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 69, no 3, p. 475-483Article in journal (Refereed) Published
Abstract [en]

Pregnancy characteristics are associated with risk of cardiovascular diseases, but their independent associations with hypertension or blood pressure (BP) levels remain uncertain. We linked the Swedish Medical Birth Register with Västerbotten Intervention Program data (Northern Sweden). Using linear and logistic regression, we related pregnancy factors in any prior pregnancy with BP and hypertension at 40 years of age in 15 896 parous women free of prepregnancy hypertension. Pregnancy factors included parity, age at first delivery, preeclampsia, gestational diabetes mellitus, placental abruption, shortest gestational age small for gestational age baby (<third percentile for birth weight) or stillbirth. We defined hypertension as systolic BP ≥140 mm Hg and diastolic BP ≥90 mm Hg or antihypertensive use. Multivariable models were adjusted for all pregnancy factors and potential lifestyle and sociodemographic confounders. At 40 years of age, 1535 women (9.6%) had hypertension. In multivariable models, lower parity, younger age at first birth, preeclampsia, small for gestational age, and placental abruption were independently associated with higher systolic and diastolic BP levels at 40 years of age. Younger age at first birth, preeclampsia, gestational age <32 versus ≥37 weeks, and small for gestational age were independently associated with hypertension. Our findings raise the possibility that earlier and more frequent BP screening may be desirable in women with these pregnancy characteristics.

Place, publisher, year, edition, pages
American Heart Association, 2017
Keywords
blood pressure, hypertension, preeclampsia, pregnancy complications, preterm birth, women
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131617 (URN)10.1161/HYPERTENSIONAHA.116.08121 (DOI)000394323100017 ()28137991 (PubMedID)
Available from: 2017-02-17 Created: 2017-02-17 Last updated: 2018-06-09Bibliographically approved
Feldman, A. L., Long, G. H., Johansson, I., Weinehall, L., Fhärm, E., Wennberg, P., . . . Rolandsson, O. (2017). Change in lifestyle behaviors and diabetes risk: evidence from a population-based cohort study with 10 year follow-up. International Journal of Behavioral Nutrition and Physical Activity, 14, Article ID 39.
Open this publication in new window or tab >>Change in lifestyle behaviors and diabetes risk: evidence from a population-based cohort study with 10 year follow-up
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2017 (English)In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 14, article id 39Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Promoting positive changes in lifestyle behavior in the whole population may be a feasible and effective approach to reducing type 2 diabetes burden, but the impact of population shifts of modifiable risk factors remains unclear. Currently most of the evidence on modifiable lifestyle behavior and type 2 diabetes risk on a population level comes from studies of between-individual differences. The objective of the study was to investigate the association and potential impact on disease burden for within-individual change in lifestyle behavior and diabetes risk.

METHODS: Population-based prospective cohort study of 35,680 participants aged 30-50 at baseline in 1990-2003 in Västerbotten County, Sweden (follow-up until 2013). Five self-reported modifiable lifestyle behaviors (tobacco use, physical activity, alcohol intake, dietary fiber intake and dietary fat intake) were measured at baseline and 10 year follow-up. Lifestyle behaviors were studied separately, and combined in a score. Incident diabetes was detected by oral glucose tolerance tests. Multivariate logistic regression models and population attributable fractions (PAF) were used to analyze the association between change in lifestyle behavior between baseline and 10 year follow-up, and risk of incident diabetes.

RESULTS: Incident diabetes was detected in 1,184 (3.3%) participants at 10 year follow-up. There was a reduced diabetes risk associated with increase in dietary fiber intake, odds ratio (OR) 0.79 (95% confidence interval (CI) 0.66, 0.96) for increase of at least one unit standard deviation (3.0 g/1,000 kcal) of the baseline distribution, PAF 16.0% (95% CI 4.2, 26.4%). Increase in the lifestyle behavior score was associated with reduced diabetes risk, OR 0.92 (95% CI 0.85, 0.99) per unit increase of the score.

CONCLUSIONS: These results support a causal link between lifestyle behavior and type 2 diabetes incidence. A small shift in lifestyle behaviors, in particular intake of dietary fiber, has the potential to reduce diabetes burden in the population and might be a suitable target for public health intervention.

Keywords
Diabetes Mellitus, Epidemiology, Health Behaviour, Life Style, Public Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-133493 (URN)10.1186/s12966-017-0489-8 (DOI)000397679700001 ()28351358 (PubMedID)
Available from: 2017-04-11 Created: 2017-04-11 Last updated: 2018-06-09Bibliographically approved
Feldman, A. L., Griffin, S. J., Ahern, A. L., Long, G. H., Weinehall, L., Fhärm, E., . . . Wennberg, P. (2017). Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants. BMC Public Health, 17, Article ID 170.
Open this publication in new window or tab >>Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants
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2017 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 170Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Weight loss in individuals at high risk of diabetes is an effective prevention method and a major component of the currently prevailing diabetes prevention strategies. The aim of the present study was to investigate the public health potential for diabetes prevention of weight maintenance or moderate weight loss on a population level in an observational cohort with repeated measurements of weight and diabetes status.

METHODS: Height, weight and diabetes status were objectively measured at baseline and 10 year follow-up in a population-based cohort of 33,184 participants aged 30-60 years between 1990 and 2013 in Västerbotten County, Sweden. The association between risk of incident diabetes and change in BMI or relative weight was modelled using multivariate logistic regression. Population attributable fractions (PAF) were used to assess population impact of shift in weight.

RESULTS: Mean (SD) BMI at baseline was 25.0 (3.6) kg/m(2). Increase in relative weight between baseline and follow-up was linearly associated with incident diabetes risk, odds ratio (OR) 1.05 (95% confidence interval (CI) 1.04-1.06) per 1% change in weight. Compared to weight maintenance (±1.0 kg/m(2)), weight gain of > +1.0 kg/m(2) was associated with an increased risk of incident diabetes, OR 1.52 (95% CI 1.32, 1.74), representing a PAF of 21.9% (95% CI 15.8, 27.6%). For moderate weight loss (-1.0 to -2.0 kg/m(2)) the OR was 0.72 (95% CI 0.52, 0.99).

CONCLUSIONS: Weight maintenance in adulthood is strongly associated with reduced incident diabetes risk and there is considerable potential for diabetes prevention in promoting this as a whole population strategy.

Keywords
Body mass index, Body weight change, Diabetes mellitus, Public health, Epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-131616 (URN)10.1186/s12889-017-4081-6 (DOI)000394292500001 ()28166764 (PubMedID)
Available from: 2017-02-17 Created: 2017-02-17 Last updated: 2018-06-09Bibliographically approved
Jacobsson, S., Larsson, P., Johansson, G., Norberg, M., Wadell, G., Hallmans, G., . . . Söderberg, S. (2017). Leptin independently predicts development of sepsis and its outcome. Journal of Inflammation, 14, Article ID 19.
Open this publication in new window or tab >>Leptin independently predicts development of sepsis and its outcome
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2017 (English)In: Journal of Inflammation, ISSN 1476-9255, E-ISSN 1476-9255, Vol. 14, article id 19Article in journal (Refereed) Published
Abstract [en]

Background: Sepsis is a life-threatening condition and obesity is related to the clinical outcome. The underlying reasons are incompletely understood, but the adipocyte derived hormones leptin and adiponectin may be involved.

Methods: Patients aged 18 years or more with documented first time sepsis events were included in a nested case-referent study if they had participated in previous health surveys. Two matched referents free of known sepsis were identified. Circulating levels of leptin and adiponectin were determined in stored plasma, and their impact on a future sepsis event and its outcome was evaluated.

Results: We identified 152 patients (62% women) with a sepsis event and a previous participation in a health survey. Eighty-three % had also blood samples from the acute event. Hyperleptinemia at health survey associated with a future sepsis event (OR 1.77, 95% CI 1.04-3.00) and with hospital death. After adjustment for BMI leptin remained associated with sepsis in men, but not in women. High levels in the acute phase associated with increased risk for in hospital death in women (OR 4.18, 95% CI 1.17-15.00), while being protective in men (OR 0.05, 95% CI 0.01-0.48). Furthermore, leptin increased more from baseline to the acute phase in men than in women. Adiponectin did not predict sepsis and did not relate to outcome.

Conclusions: Hyperleptinemia independently predicted the development of sepsis and an unfavourable outcome in men, and inertia in the acute response related to worse outcome.

Place, publisher, year, edition, pages
London: BioMed Central, 2017
Keywords
Sepsis, Leptin, Adiponectin, Obesity, Case-referent study, Sex
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-140039 (URN)10.1186/s12950-017-0167-2 (DOI)000410649100001 ()28919840 (PubMedID)
Available from: 2017-10-05 Created: 2017-10-05 Last updated: 2018-08-31Bibliographically approved
Ljungberg, J., Holmgren, A., Bergdahl, I. A., Hultdin, J., Norberg, M., Näslund, U., . . . Söderberg, S. (2017). Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 6(12), Article ID e007160.
Open this publication in new window or tab >>Lipoprotein(a) and the Apolipoprotein B/A1 Ratio Independently Associate With Surgery for Aortic Stenosis Only in Patients With Concomitant Coronary Artery Disease
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2017 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 12, article id e007160Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Aortic stenosis (AS) has different clinical phenotypes, including AS with or without concomitant coronary artery disease (CAD). It is unknown whether these phenotypes share the same risk factors. In particular, lipoprotein(a) [Lp(a)] and apolipoproteins (Apo) are associated with AS, but it is unknown whether these associations differ among phenotypes. In this prospective analysis we examined the impact of Lp(a) and Apo in subgroups of patients with AS.

METHODS AND RESULTS: We identified 336 patients (mean age at survey 56.7 years, 48% female) who underwent surgery for AS after a median 10.9 years (interquartile range 9.3 years), participants in 1 of 3 large population surveys. For each patient, 2 matched referents were allocated. Lp(a) and Apo were analyzed in the baseline samples. Uni- and multivariable logistic regression analyses were used to estimate risks related to a 1 (ln) standard deviation increase in Lp(a) and the ratio of Apo B to Apo A1 (Apo B/A1 ratio). High levels of Lp(a) predicted surgery for AS in 203 patients with concomitant CAD (odds ratio [95% confidence intervals]) (1.29 [1.07-1.55]), but not in 132 patients without CAD (1.04 [0.83-1.29]) in the fully adjusted model. Similarly, a high Apo B/A1 ratio predicted surgery in patients with concomitant CAD (1.43 [1.16-1.76]) but not in those without CAD (0.87 [0.69-1.10]).

CONCLUSIONS: High levels of Lp(a) and a high Apo B/A1 ratio were associated with surgery for AS in patients with concomitant CAD but not in those with isolated AS. This finding may lead to a new avenue of research for targeted risk factor interventions in this population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
aortic stenosis, aortic valve surgery, apolipoproteins, lipoprotein(a), prospective cohort study, risk markers
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-143323 (URN)10.1161/JAHA.117.007160 (DOI)000418951100046 ()29246959 (PubMedID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Yang, F., Pedersen, N. L., Ye, W., Liu, Z., Norberg, M., Forsgren, L., . . . Wirdefeldt, K. (2017). Moist smokeless tobacco (Snus) use and risk of Parkinson's disease. International Journal of Epidemiology, 46(3), 872-880
Open this publication in new window or tab >>Moist smokeless tobacco (Snus) use and risk of Parkinson's disease
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2017 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 3, p. 872-880Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease.

METHODS: Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking.

RESULTS: During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83).

CONCLUSIONS: Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.

Keywords
Parkinson’s disease, individual participant data, risk factors, epidemiology, nicotine
National Category
Neurology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131145 (URN)10.1093/ije/dyw294 (DOI)000406242600021 ()27940486 (PubMedID)
Available from: 2017-02-06 Created: 2017-02-06 Last updated: 2018-06-09Bibliographically approved
Feldman, A. L., Griffin, S. J., Fhärm, E., Norberg, M., Wennberg, P., Weinehall, L. & Rolandsson, O. (2017). Screening for type 2 diabetes: do screen-detected cases fare better?. Diabetologia, 60(11), 2200-2209
Open this publication in new window or tab >>Screening for type 2 diabetes: do screen-detected cases fare better?
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2017 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 60, no 11, p. 2200-2209Article in journal (Refereed) Published
Abstract [en]

AIMS/HYPOTHESIS: We aimed to investigate whether diabetes cases detected through screening have better health outcomes than clinically detected cases in a population-based cohort of adults who were eligible to be screened for diabetes at 10 year intervals.

METHODS: The Västerbotten Intervention Programme is a community- and individual-based public health programme in Västerbotten County, Sweden. Residents are invited to clinical examinations that include screening for diabetes by OGTTs at age 30, 40, 50 and 60 years (individuals eligible for screening, n = 142,037). Between 1992 and 2013, we identified 1024 screen-detected cases and 8642 clinically detected cases of diabetes using registry data. Clinically detected individuals were either prior screening participants (n = 4506) or people who did not participate in screening (non-participants, n = 4136). Study individuals with diabetes were followed from date of detection until end of follow-up, emigration, death or incident cardiovascular disease (CVD), renal disease or retinopathy event, and compared using Cox proportional hazard regression adjusted for calendar time, age at detection, year of detection, sex and socioeconomic status.

RESULTS: The average age at diabetes diagnosis was 4.6 years lower for screen-detected individuals compared with clinically detected individuals. Overall, those who were clinically detected had worse health outcomes than those who were screen-detected (HR for all-cause mortality 2.07 [95% CI 1.63, 2.62]). Compared with screen-detected study individuals, all-cause mortality was higher for clinically detected individuals who were screening non-participants (HR 2.31 [95% CI 1.82, 2.94]) than for those clinically detected who were prior screening participants (HR 1.70 [95% CI 1.32, 2.18]). Estimates followed a similar pattern for CVD, renal disease and retinopathy.

CONCLUSIONS/INTERPRETATION: Individuals with screen-detected diabetes were diagnosed earlier and appeared to fare better than those who were clinically detected with regard to all-cause mortality, CVD, renal disease and retinopathy. How much of these associations can be explained by earlier treatment because of screening rather than healthy user bias, lead time bias and length time bias warrants further investigation.

Place, publisher, year, edition, pages
New York: Springer, 2017
Keywords
Diabetes mellitus, Early diagnosis, Epidemiology, Mass screening, Public health
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-138834 (URN)10.1007/s00125-017-4402-4 (DOI)000412414700010 ()28831538 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2018-06-09Bibliographically approved
Carlsson, S., Andersson, T., Araghi, M., Galanti, R., Lager, A., Lundberg, M., . . . Magnusson, C. (2017). Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts. Journal of Internal Medicine, 281(4), 398-406
Open this publication in new window or tab >>Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts
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2017 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 281, no 4, p. 398-406Article in journal (Refereed) Published
Abstract [en]

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 (HRs) 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.

Keywords
meta-analysis, public health, tobacco, type 2 diabetes
National Category
Endocrinology and Diabetes Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131618 (URN)10.1111/joim.12592 (DOI)000397490100006 ()28164394 (PubMedID)
Available from: 2017-02-17 Created: 2017-02-17 Last updated: 2018-06-09Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2475-7131

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