title: Association of cigarette smoking and metabolic syndrome in a puerto rican adult population.
abstract: BACKGROUND
  Metabolic syndrome (MetSyn) is related to an increased risk for type 2 diabetes and cardiovascular disease. Smokers are at greater risk than nonsmokers of becoming insulin resistant and to develop cardiovascular disease. This study aimed to explore the association between cigarette smoking, MetSyn, and its components among Puerto Rican adults.
  
  
  METHODS
  A representative sample of 856 persons aged 21-79 years from the San Juan Metropolitan area participated in this study. Demographic and lifestyle characteristics, including smoking habits, were gathered from a self-reported questionnaire. MetSyn was defined according to the revised NCEP-ATP III criteria and measured using biochemical measurements and anthropometric indices. Logistic regression models were used to estimate prevalence odds ratios (POR) and its 95% confidence intervals (CI).
  
  
  RESULTS
  MetSyn was significantly (P < 0.001) more prevalent in former smokers (48.4%) as compared to current (42.7%) and never smokers (40.0%). However, after adjusting for possible confounders, current smokers who used more than 20 cigarettes per day were 2.24 (95% CI = 1.00-4.99) times more likely to have MetSyn as compared to never smokers. Heavy smokers were also more likely to have high triglyceride levels (POR = 2.22, 95% CI = 1.12-4.38) and low HDL-cholesterol levels (POR = 2.49, 95% CI = 1.28-4.86) as compared to never smokers.
  
  
  CONCLUSIONS
  This study supports previous reports of an increased risk of MetSyn among current smokers, particularly those with a heavier consumption. Tobacco control strategies, such as preventing smoking initiation and disseminating evidence-based cessation programs, are necessary to reduce the burden of MetSyn in Puerto Rico.
authors.affiliation: Division of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston, Texas, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Calo
authors.affiliation: Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, USA ; Department of Biostatistics and Epidemiology, University of Puerto Rico, Graduate School of Public Health, USA.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Ortiz
authors.affiliation: Department of Biostatistics and Epidemiology, University of Puerto Rico, Graduate School of Public Health, USA.
authors.forename: Erick
authors.initials: E
authors.lastname: Suárez
authors.affiliation: School of Medicine, University of Puerto Rico, San Juan, Puerto Rico, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Guzmán
authors.affiliation: Department of Biostatistics and Epidemiology, University of Puerto Rico, Graduate School of Public Health, USA.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Pérez
keywords: Metabolic syndrome; Puerto Rico; smoking
references.citation: Obes Res. 2002 Sep;10(9):891-5
references.pmid: 12226137
references.citation: Int J Obes Relat Metab Disord. 2004 Aug;28(8):1091-6
references.pmid: 15197410
references.citation: Diabetes Care. 1996 Nov;19(11):1229-32
references.pmid: 8908385
references.citation: Intern Med. 2006;45(18):1039-43
references.pmid: 17043374
references.citation: Addict Behav. 1986;11(1):1-9
references.pmid: 3716910
references.citation: Saudi Med J. 2009 Feb;30(2):267-71
references.pmid: 19198718
references.citation: Natl Health Stat Report. 2009 May 5;(13):1-7
references.pmid: 19634296
references.citation: J Cardiovasc Risk. 1996 Apr;3(2):213-9
references.pmid: 8836866
references.citation: Lancet. 1992 May 9;339(8802):1128-30
references.pmid: 1349365
references.citation: Hypertension. 2004 Dec;44(6):859-65
references.pmid: 15492131
references.citation: Atherosclerosis. 2005 Aug;181(2):381-8
references.pmid: 16039294
references.citation: Diabetes Care. 2005 Oct;28(10):2501-7
references.pmid: 16186287
references.citation: Diabetes Care. 2005 Aug;28(8):2064-6
references.pmid: 16043763
references.citation: MMWR Morb Mortal Wkly Rep. 2008 Oct 31;57(43):1169-73
references.pmid: 18971918
references.citation: J Epidemiol. 2010;20(5):391-7
references.pmid: 20699598
references.citation: Am J Clin Nutr. 2008 Apr;87(4):801-9
references.pmid: 18400700
references.citation: Circulation. 2005 Nov 15;112(20):3066-72
references.pmid: 16275870
references.citation: Circulation. 1989 Jan;79(1):8-15
references.pmid: 2642759
references.citation: Diabetes Care. 2007 Mar;30(3):694-700
references.pmid: 17327343
references.citation: MMWR Morb Mortal Wkly Rep. 2004 Oct 15;53(40):935-7
references.pmid: 15483525
references.citation: Curr Diab Rep. 2005 Jun;5(3):217-25
references.pmid: 15929869
references.citation: Diabetes Obes Metab. 2004 Mar;6(2):127-32
references.pmid: 14746578
references.citation: Am Heart J. 1981 Mar;101(3):319-28
references.pmid: 7008566
references.citation: J Clin Epidemiol. 1995 Sep;48(9):1159-66
references.pmid: 7636518
references.citation: BMJ. 1995 Mar 4;310(6979):555-9
references.pmid: 7888928
references.citation: Ethn Dis. 2008 Autumn;18(4):434-41
references.pmid: 19157247
references.citation: J Hypertens. 1997 Mar;15(3):245-9
references.pmid: 9468451
references.citation: Metabolism. 2008 Apr;57(4):544-8
references.pmid: 18328358
references.citation: Am J Hypertens. 2009 Feb;22(2):156-62
references.pmid: 19039311
references.citation: N Engl J Med. 2001 Sep 13;345(11):790-7
references.pmid: 11556298
references.citation: Circulation. 2009 Oct 20;120(16):1640-5
references.pmid: 19805654
references.citation: Am Heart J. 1991 May;121(5):1569-70
references.pmid: 2017998
references.citation: Diabetes Res Clin Pract. 2005 Jan;67(1):70-7
references.pmid: 15620436
references.citation: Obes Rev. 2004 May;5(2):95-103
references.pmid: 15086863
references.citation: Eur Heart J. 1986 Apr;7(4):279-88
references.pmid: 3720755
references.citation: Am J Cardiol. 2005 Dec 15;96(12):1681-5
references.pmid: 16360357
references.citation: JAMA. 2002 Dec 4;288(21):2709-16
references.pmid: 12460094
references.citation: J Nutr. 2009 Jul;139(7):1360-7
references.pmid: 19458029
references.citation: Obes Res. 2005 Aug;13(8):1466-75
references.pmid: 16129730
references.citation: Int J Prev Med. 2011 Oct;2(4):229-37
references.pmid: 22174962
references.citation: Intern Med. 2007;46(14):1079-82
references.pmid: 17634703
references.citation: Metab Syndr Relat Disord. 2009 Aug;7(4):279-88
references.pmid: 19284314
references.citation: Circulation. 2005 Oct 25;112(17):2735-52
references.pmid: 16157765
references.citation: N Engl J Med. 1995 Nov 2;333(18):1165-70
references.pmid: 7565970
references.citation: J Nutr. 2007 Apr;137(4):860-70
references.pmid: 17374645
references.citation: Circulation. 2007 Aug 28;116(9):1081-93
references.pmid: 17671237
references.citation: MMWR Suppl. 2011 Jan 14;60(1):109-13
references.pmid: 21430635