Correspondence

Diet and Risk of Type 2 Diabetes

N Engl J Med 2002; 346:297-298January 24, 2002

Article

To the Editor:

In their article on diet, lifestyle, and type 2 diabetes mellitus in women (Sept. 13 issue),1 Hu et al. point out that obesity is an important cause of type 2 diabetes mellitus. I wish to point out that since diabetes does not develop in all overweight women (or men, of course), there must be other factors that predispose patients to the condition, as I illustrated in earlier reports.2-6 Therefore diet is certainly important, but particularly for women and men for whom this overlooked risk factor is involved.

Sergio Stagnaro, M.D.
Via Erasmo Piaggio, 23, 16037 Riva Trigosio, Italy
dottsergio@libero.it

6 References

1. 1

   Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001;345:790-797
   Full Text | Web of Science | Medline

2. 2

   Stagnaro-Neri M, Stagnaro S. La sindrome dispeptica funzionale da discinesia delle vie biliari: diagnosi percusso-ascoltatoria. Clin Ter 1988;127:363-372
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   Stagnaro S. Polimialgia reumatica acuta benigna variante. Clin Ter 1986;118:193-199
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   Stagnaro-Neri M, Stagnaro S. Diagnosi clinica precoce dell'osteoporosi con la percussione ascoltata. Clin Ter 1991;137:21-27
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   Stagnaro S. Percussione ascoltata degli attacchi ischemici transitori: ruolo dei potenziali cerebrali evocati. Minerva Med 1985;76:1211-1213
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   Stagnaro S, Stagnaro-Neri M. Appendicite. Minerva Med 1996;87:183-184
   Medline

To the Editor:

The recent article by Hu et al. concerning type 2 diabetes is misleading, since it implies that there is an association between diabetes and smoking. Has such an association been shown previously?

Paul J. West, M.D.
714 North Indiana Ave., Sheffield, SD 57103
paulandzitaw@juno.com

Author/Editor Response

The authors reply:

To the Editor: As shown in Table 1 of our paper, the majority of patients with diabetes were overweight or obese. In our cohort, approximately 60 percent of incident cases of diabetes were attributable to overweight and obesity. However, this does not mean that other factors are not important. We showed that even after adjustment for body-mass index, a poor diet, lack of exercise, and cigarette smoking were each associated with a significantly elevated risk of diabetes. In addition, among overweight and obese women, the combination of a healthy diet (a diet high in cereal fiber and polyunsaturated fat and low in trans fat and glycemic load), regular exercise, and abstinence from smoking could substantially lower the risk of type 2 diabetes. Furthermore, diet and exercise are the primary factors that determine body weight.

There is convincing evidence that cigarette smoking is a risk factor for type 2 diabetes. Cigarette smoking has been consistently associated with a relatively small but significantly increased risk of type 2 diabetes in both men1,2 and women3 in large prospective cohort studies. Cigarette smoking has also been associated with insulin resistance. Facchini et al. found that smokers had higher insulin concentrations as well as higher glucose concentrations after infusions of steady-state insulin than nonsmokers with similar ages, body-mass indexes, and family histories of diabetes.4 Although smoking is generally associated with a lower body-mass index, it is associated with a greater waist-to-hip circumference and abdominal adiposity,5 a documented risk factor for type 2 diabetes.

Frank B. Hu, M.D.
Harvard School of Public Health, Boston, MA 02115
frank.hu@channing.harvard.edu

JoAnn E. Manson, M.D.
Brigham and Women's Hospital, Boston, MA 02115

Walter C. Willett, M.D.
Harvard School of Public Health, Boston, MA 02115

5 References

1. 1

   Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ 1995;310:555-559
   CrossRef | Web of Science | Medline

2. 2

   Manson JE, Ajani UA, Liu S, Nathan DM, Hennekens CH. A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. Am J Med 2000;109:538-542
   CrossRef | Web of Science | Medline

3. 3

   Rimm EB, Manson JE, Stampfer MJ, et al. Cigarette smoking and the risk of diabetes in women. Am J Public Health 1993;83:211-214
   CrossRef | Web of Science | Medline

4. 4

   Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet 1992;339:1128-1130[Erratum, Lancet 1992;339:1492.]
   CrossRef | Web of Science | Medline

5. 5

   Shimokata H, Muller DC, Andres R. Studies in the distribution of body fat. III. Effects of cigarette smoking. JAMA 1989;261:1169-1173
   CrossRef | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   S Stagnaro. (2007) Epidemiological evidence for the non-random clustering of the components of the metabolic syndrome: multicentre study of the Mediterranean Group for the Study of Diabetes. European Journal of Clinical Nutrition 61:9, 1143-1144
   CrossRef

2. 2

   Robert D. Truog. (2005) Will ethical requirements bring critical care research to a halt?. Intensive Care Medicine 31:3, 338-344
   CrossRef