Smoking and long-term risk of type 2 diabetes: The EPIC-InterAct study in European populations

Annemieke M.W. Spijkerman*, Daphne L. Van Der A, Peter M. Nilsson, Eva Ardanaz, Diana Gavrila, Antonio Agudo, Larraitz Arriola, Beverley Balkau, Joline W. Beulens, Heiner Boeing, Blandine De Lauzon-Guillain, Guy Fagherazzi, Edith J.M. Feskens, Paul W. Franks, Sara Grioni, José María Huerta, Rudolf Kaaks, Timothy J. Key, Kim Overvad, Domenico PalliSalvatore Panico, M. Luisa Redondo, Olov Rolandsson, Nina Roswall, Carlotta Sacerdote, María José Sánchez, Matthias B. Schulze, Nadia Slimani, Birgit Teucher, Anne Tjonneland, Rosario Tumino, Yvonne T. Van Der Schouw, Claudia Langenberg, Stephen J. Sharp, Nita G. Forouhi, Elio Riboli, Nicholas J. Wareham, InterAct Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

66 Citations (Scopus)


OBJECTIVE: The aims of this study were to investigate the association between smoking and incident type 2 diabetes, accounting for a large number of potential confounding factors, and to explore potential effect modifiers and intermediate factors. RESEARCH DESIGN AND METHODS: The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct is a prospective case-cohort study within eight European countries, including 12,403 cases of incident type 2 diabetes and a random subcohort of 16,835 individuals. After exclusion of individuals with missing data, the analyses included 10,327 cases and 13,863 subcohort individuals. Smoking status was used (never, former, current), with never smokers as the reference. Country-specific Prentice-weighted Cox regression models and random-effects meta-analysis were used to estimate hazard ratios (HRs) for type 2 diabetes. RESULTS: In men, the HRs (95% CI) of type 2 diabetes were 1.40 (1.26, 1.55) for former smokers and 1.43 (1.27, 1.61) for current smokers, independent of age, education, center, physical activity, and alcohol, coffee, and meat consumption. In women, associations wereweaker, with HRs (95% CI) of 1.18 (1.07, 1.30) and 1.13 (1.03, 1.25) for former and current smokers, respectively. There was some evidence of effect modification by BMI. The association tended to be slightly stronger in normal weight men compared with those with overall adiposity. CONCLUSIONS: Former and current smoking was associated with a higher risk of incident type 2 diabetes compared with never smoking in men and women, independent of educational level, physical activity, alcohol consumption, and diet. Smoking may be regarded as a modifiable risk factor for type 2 diabetes, and smoking cessation should be encouraged for diabetes prevention.

Original languageEnglish
Pages (from-to)3164-3171
Number of pages8
JournalDiabetes Care
Issue number12
Publication statusPublished - 1 Dec 2014
Externally publishedYes


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