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Association Between Cigarette Smoking and Metabolic Syndrome

Response to Masulli and Vaccaro

¹ Department of Family Medicine and Center for Health Promotion, Ilsan-Paik Hospital, Inje University, College of Medicine, Gyeonggi-Do, Korea
² Department of Family Medicine, Seoul National University, College of Medicine, Seoul, Korea

Address correspondence to Sang Woo Oh, MD, PhD, Department of Family Medicine and Center for Health Promotion, Inje University Ilsan-paik Hospital, Daewha-Dong, Ilsan-Gu, Goyang-Si, Gyeonggi-Do, 411-706, (South) Korea. E-mail: osw6021{at}yahoo.co.kr

We thank Massulli and Vaccaro (1) for their interest and comments regarding our article (2). Moreover, we are pleased to hear that they found results similar to ours in a population-based study of Italian men. They reported that, like Korean smokers, Italian smokers had higher triglycerides and lower HDL cholesterol levels than those who had never smoked. They also showed that smoking is not associated with high fasting glucose or high blood pressure, which is similar to our findings. It is a general belief that insulin resistance is the main mechanism underlying the development of metabolic syndrome. Therefore, they tested the association between smoking and insulin resistance using the homeostasis model assessment of insulin resistance index (HOMA-IR). Contrary to their expectation, they could not find an association with HOMA-IR and they suggested that smoking-associated dyslipidemia is mediated by mechanisms other than insulin resistance.

We agree with their suggestions; however, we would like to comment on some points that must be considered. First, both their study and our own used cross-sectional observational data. As we mentioned in our article, the cross-sectional observational design has inherent limitations. Patients with type 2 diabetes and hypertension are more likely to be taking medicines that influence insulin sensitivity. Furthermore, the lifestyles, diet, and other behavioral factors that can influence insulin sensitivity may have differed. Second, HOMA-IR and fasting insulin values have an inherent limitation for predicting insulin resistance. Third, previous cohort data, which investigated temporal associations to identify causal relationships, have demonstrated that smoking increases the risks of diseases such as type 2 diabetes (3, 4), which are known to have insulin resistance as their underlying mechanism. From these findings, although we agree with their suggestion, we cannot be totally confident that the association between smoking and metabolic syndrome is not mediated by insulin resistance. Further well-designed study of the temporal relationships is needed to evaluate this hypothesis.

References

1. Masulli M, Vaccaro O: Association between cigarette smoking and metabolic syndrome (Letter). Diabetes Care 29:482, 2006[Free Full Text]
   
2. Oh SW, Yoon YS, Lee ES, Kim WK, Park C, Lee S, Jeong EK, Yoo T: Association between cigarette smoking and metabolic syndrome: the Korea National Health and Nutrition Examination Survey (Brief Report). Diabetes Care 28:2064–2066, 2005[Free Full Text]
   
3. Foy CG, Bell RA, Farmer DF, Goff DC Jr, Wagenknecht LE: Smoking and incidence of diabetes among U.S. adults: findings from the Insulin Resistance Atherosclerosis Study. Diabetes Care 28:2501–2507, 2005[Abstract/Free Full Text]
   
4. Sairenchi T, Iso H, Nishimura A, Hosoda T, Irie F, Saito Y, Murakami A, Fukutomi H: Cigarette smoking and risk of type 2 diabetes mellitus among middle-aged and elderly Japanese men and women. Am J Epidemiol 160:158–162, 2004[Abstract/Free Full Text]
   

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				S. W. Oh and T. Yoo Association Between Cigarette Smoking and Metabolic Syndrome: Response to Masulli and Vaccaro Diabetes Care, February 1, 2006; 29(2): 482 - 483. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Oh, S. W. Articles by Yoo, T. Search for Related Content PubMed Articles by Oh, S. W. Articles by Yoo, T. Social Bookmarking                What's this?