title: Smoking and long-term risk of type 2 diabetes: the EPIC-InterAct study in European populations.
abstract: 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.
  
  
  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 were weaker, 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.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands annemieke.spijkerman@rivm.nl.
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.affiliation: Lund University, Malmö, Sweden.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nilsson
authors.affiliation: Navarre Public Health Institute (ISPN), Pamplona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Gavrila
authors.affiliation: Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Public Health Division of Gipuzkoa, San Sebastian, Spain Instituto BIO-Donostia, Basque Government, Donostia, Spain.
authors.forename: Larraitz
authors.initials: L
authors.lastname: Arriola
authors.affiliation: INSERM, CESP, U1018, Villejuif, France UMRS 1018, University Paris Sud 11, Villejuif, France.
authors.forename: Beverley
authors.initials: B
authors.lastname: Balkau
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Joline W
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: INSERM, CESP, U1018, Villejuif, France UMRS 1018, University Paris Sud 11, Villejuif, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: de Lauzon-Guillain
authors.affiliation: INSERM, CESP, U1018, Villejuif, France UMRS 1018, University Paris Sud 11, Villejuif, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: University of Wageningen, Wageningen, the Netherlands.
authors.forename: Edith J M
authors.initials: EJ
authors.lastname: Feskens
authors.affiliation: Lund University, Malmö, Sweden Umeå University, Umeå, Sweden.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Franks
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: University of Oxford, Oxford, U.K.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark Aalborg Hospital, Aalborg University, Aalborg, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Cancer Research and Prevention Institute (ISPO), Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Redondo
authors.affiliation: Umeå University, Umeå, Sweden.
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.affiliation: Department of Diet, Genes and Environment, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Nina
authors.initials: N
authors.lastname: Roswall
authors.affiliation: Center for Cancer Prevention, Torino, Italy Human Genetics Foundation (HuGeF), Torino, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Andalusian School of Public Health, Granada, Spain.
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Matthias B
authors.initials: MB
authors.lastname: Schulze
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.affiliation: German Cancer Research Centre (DKFZ), Heidelberg, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Teucher
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjonneland
authors.affiliation: Cancer Registry and Histopathology Unit, ASP 7, Ragusa, Italy AIRE-ONLUS - Ragusa, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: MRC Epidemiology Unit, Cambridge, U.K.
authors.forename: Claudia
authors.initials: C
authors.lastname: Langenberg
authors.affiliation: MRC Epidemiology Unit, Cambridge, U.K.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.affiliation: MRC Epidemiology Unit, Cambridge, U.K.
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, U.K.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: MRC Epidemiology Unit, Cambridge, U.K.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
mesh_terms: D050154:Adiposity / Q000502:physiology; D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*