title: Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA).
abstract: It has been suggested that moist snuff (snus), a smokeless tobacco product that is high in nicotine and widespread in Scandinavia, increases the risk of Type 2 diabetes. Previous studies are however few, contradictory and, with regard to autoimmune diabetes, lacking. Our aim was to study the association between snus use and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA).
  
  
  
  Analyses were based on incident cases (Type 2 diabetes, n = 724; LADA, n = 200) and population-based controls (n = 699) from a Swedish case-control study. Additional analyses were performed on cross-sectional data from the Norwegian HUNT study (n = 21 473) with 829 prevalent cases of Type 2 diabetes. Odds ratios (OR) were estimated adjusted for age, BMI family history of diabetes and smoking. Only men were included.
  
  
  
  No association between snus use and Type 2 diabetes or LADA was seen in the Swedish data. For Type 2 diabetes, the OR for > 10 box-years was 1.00 [95% confidence interval (CI), 0.47 to 2.11] and for LADA 1.01 (95% CI, 0.45 to 2.29). Similarly, in HUNT, the OR for Type 2 diabetes in ever-users was estimated at 0.91 (95% CI, 0.75 to 1.10) and in heavy users at 0.92 (95% CI, 0.46 to 1.83).
  
  
  
  The risk of Type 2 diabetes and LADA is unrelated to the use of snus, despite its high nicotine content. This opens the possibility of the increased risk of Type 2 diabetes seen in smokers may not be attributed to nicotine, but to other substances in tobacco smoke.
authors.affiliation: Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Rasouli
authors.affiliation: Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.|Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Andersson
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: P-O
authors.initials: PO
authors.lastname: Carlsson
authors.affiliation: NTNU Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Endocrinology, Trondheim University Hospital, Trondheim, Norway.
authors.forename: V
authors.initials: V
authors.lastname: Grill
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Groop
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Martinell
authors.affiliation: HUNT Research Centre, Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Levanger, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Midthjell
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Storm
authors.affiliation: Department of Medicine, Helsinki University Central Hospital and Research Program for Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Tuomi
authors.affiliation: Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Carlsson
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D000071698:Latent Autoimmune Diabetes in Adults / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology; D064424:Tobacco Use / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*