Daily e-cigarette use shows 'clear benefit' in helping smokers to quit

A new study published today from King's College London highlights the 'clear benefit' of using e-cigarettes daily in order to quit smoking

KING'S COLLEGE LONDON

Research News

 

A new study published Tuesday 10 March, No Smoking Day, from King's College London highlights the 'clear benefit' of using e-cigarettes daily in order to quit smoking, and supports their effectiveness when compared to other methods of quitting, including nicotine replacement therapy or medication.

Although the number of people in England who smoke has continued to fall in recent years, tobacco smoking is still the leading preventable cause of premature death and disease - killing nearly 75,000 people in England in 2019.

While e-cigarettes have been around for more than a decade, evidence on their effectiveness for helping people to quit smoking is still limited. Recent studies have produced inconsistent findings or failed to measure important factors such as frequency of use or the effect of different types of e-cigarette on attempts to quit.

In their Cancer Research UK-funded study, the researchers analysed data from an online survey of more than 1,155 people, which included smokers, ex-smokers who had quit within one year prior to completing the survey, and e-cigarette users.

Five waves of data were collected between 2012 and 2017. The researchers analysed the effectiveness of e-cigarettes in aiding abstinence from smoking for at least one month at follow-up, and at least one month of abstinence between the first survey and subsequent follow-up waves.

Published today in the journal Addiction, the study found that people who used a refillable e-cigarette daily to quit smoking were over five times more likely to achieve abstinence from tobacco smoking for one month, compared to those using no quitting aids at all.

Similarly, people who used a disposable or cartridge e-cigarette daily were three times more likely to quit for one month, compared to those using no help.

Daily use of e-cigarettes was also more effective for quitting than other evidence-based methods of quitting - including nicotine replacement therapy, medication such as bupropion or varenicline, or any combination of these aids. None of these methods were associated with abstinence from smoking at follow-up, compared to using no help at all. However, in a secondary analysis, prescription medicine was associated with achieving at least one month of abstinence from smoking.

Dr Máirtín McDermott, Research Fellow at King's College London's National Addiction Centre and lead author of the study, said: "Our results show that when used daily, e-cigarettes help people to quit smoking, compared to no help at all. These findings are in line with previous research, showing that e-cigarettes are a more effective aid for quitting than nicotine replacement therapy and prescribed medication.

"It's important that we routinely measure how often people use e-cigarettes, as we've seen that more sporadic use at follow up - specifically of refillable types - was not associated with abstinence."

Dr Leonie Brose, Reader at King's College London's national Addiction Centre added: "Despite the World Health Organization's (WHO) cautious stance on e-cigarettes, studies like ours show they are still one of the most effective quitting aids available.

"The WHO is especially concerned about refillable e-cigarettes, as these could allow the user to add harmful substances or higher levels of nicotine. However, we've shown that refillable types in particular are a very effective quitting aid when used daily, and this evidence should be factored into any future guidance around their use."

King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2018/19) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff.

The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) which is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on mental health than any other centre (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) in the world for highly cited neuroscience outputs. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain. https://www.kcl.ac.uk/ioppn @KingsIoPPN

Third-hand smoke is no joke, can convey hazardous chemicals

by Yale University

Credit: CC0 Public Domain

People can carry hazardous compounds from cigarette smoke that cling to their bodies and clothes and then release those compounds into non-smoking environments—exposing people nearby to cigarettes' adverse effects, a new study shows.

For the last decade, third-hand smoke has been described as the residual contamination from cigarette smoking that adheres to walls and other surfaces in places where smoking has previously occurred. For example, hotels and rental car companies have implemented smoking restrictions to limit this contaminating odor from their rooms and cars.

A team of researchers led by Yale's Drew Gentner shows for the first time that this third-hand smoke can travel in large quantities into indoor, non-smoking environments by way of humans. The research suggests that even if someone is in a room where no one has smoked, that person could still be exposed to many of the hazardous chemical compounds that make up cigarette smoke, depending on who else had entered the room or previously visited it. The results were published March 4 in Science Advances.

"In real-world conditions, we see concentrated emissions of hazardous gases coming from groups of people who were previously exposed to tobacco smoke as they enter a non-smoking location with strict regulations against indoor smoking," said Gentner, associate professor of chemical & environmental engineering. "People are substantial carriers of third-hand smoke contaminants to other environments. So, the idea that someone is protected from the potential health effects of cigarette smoke because they're not directly exposed to second-hand smoke is not the case." Third-hand smoke was long considered stationary. Now, a new study shows people can carry it with them and transport it to other locations. Credit: Yale School of Engineering & Applied Science

VIDEO

The researchers brought highly sensitive analytical instrumentation into a movie theater to track thousands of compounds, present as either gases or particles, over the course of a week. A diverse range of volatile organic compounds found in tobacco smoke spiked dramatically when certain audiences arrived for the movies. These increases were minor for G-rated movies, while audiences for R-rated movies—which included moviegoers more likely to smoke or to be exposed to smoke—consistently released much larger quantities of these compounds into the theater. The relative proportions of these emitted compounds confirmed that they were from slightly aged cigarette smoke.

"Despite regulations preventing people from smoking indoors, near entryways, and near air intakes, hazardous chemicals from cigarette smoke are still making their way indoors," said Roger Sheu, a Ph.D. student in Gentner's lab and lead author of the study.

The amount of these hazardous and reactive gases wasn't trivial, the researchers said. The gas emissions were equal to that of being exposed to 1-10 cigarettes of secondhand smoke in a one-hour period. These emissions and air concentrations peaked upon audience arrival and decreased over time, but not completely, even when the audiences left. In many cases, the movie-goers left a persistent contamination observable the following days in the unoccupied theater. The researchers said that is because the chemicals don't remain entirely in the air, but are also adsorbed onto various surfaces and furnishings, just as it does with third-hand smoke contamination in places where smoking has occurred.

The researchers also found a predominance of nitrogen-containing compounds from cigarettes, which would have migrated from people to other indoor surfaces.

"In particular, we noticed that nicotine was the most prominent compound by far," said co-author Jenna Ditto, a Ph.D. student in Gentner's lab.

The researchers said these results on human transport of third-hand smoke now help to explain why previous studies had found notable quantities of nicotine on surfaces in numerous non-smoking environments.

The researchers emphasized that avoiding movie theaters is not the solution to avoiding third-hand smoke. In fact, the theater used for the study is modern, large, and well-ventilated, which reduced the effect of the emissions on concentrations of hazardous compounds in the room. In less well-ventilated spaces—such as public transit, bars, offices, and homes—similar third-hand smoke emissions would likely result in considerably higher concentrations of many of these compounds.

Exposure to smoking before and after birth linked to hearing impairment in toddlers

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More information: "Human transport of thirdhand tobacco smoke: A prominent source of hazardous air pollutants into indoor nonsmoking environments," Science Advances (2020). advances.sciencemag.org/content/6/10/eaay4109

Dramatic decline in cigarette use among U.S. teens over three decades

 Peer-Reviewed Publication

FLORIDA ATLANTIC UNIVERSITY

 

IMAGE: 

GRAPH SHOWS CIGARETTE SMOKING TRENDS BY GRADE FROM 1991 TO 2021.

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CREDIT: FLORIDA ATLANTIC UNIVERSITY

Cigarette smoking remains the leading avoidable cause of premature death in the United States, accounting for approximately 500,000 deaths or 1 in 5 deaths annually. According to the U.S. Department of Health and Human Services, most adults who smoke cigarettes started before age 18, so preventing cigarette smoking in adolescents is important to reducing smoking in adults. 

In a new study, researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators explored overall trends in cigarette smoking among a large sample of U.S. adolescents in grades nine to 12 from 1991 to 2021. They also explored differences by gender as well as race/ethnicity.

Cigarette smoking measures included: ever tried cigarette smoking, which was defined as taking even one or two puffs; currently smoked cigarettes occasionally; currently smoked cigarettes frequently; and currently smoked cigarettes daily. 

Results of the study, published in Ochsner Journal online ahead of print, show cigarette smoking in all usage categories (ever, occasional, frequent and daily) significantly decreased from 1991 to 2021.

Among the study findings:

• Ever use cigarettes significantly decreased from 70.1 percent in 1991 to 17.8 percent in 2021, an almost fourfold decline.
• Occasional cigarette use significantly decreased from 27.5 percent in 1991 to 3.8 percent in 2021, a greater than sevenfold decline.
• Frequent cigarette use significantly decreased from 12.7 percent to 0.7 percent, a greater than eighteenfold decline.
• Daily cigarette use declined from 9.8 percent in 1991 to 0.6 percent in 2021, a greater than sixteenfold decline.
• Interestingly, while all grades experienced a significant decline in cigarette use, 12th graders consistenly reported the highest percentage of occasional smokers compared to the other school grades, even in 2021. This finding suggests that while smoking has decreased across all age groups, older adolescents might still be more prone to experimenting with cigarettes than their younger counterparts.

“The substantial decrease in cigarette use among U.S. adolescents spanning three decades is an encouraging public health achievement,” said Panagiota “Yiota” Kitsantas, Ph.D., senior author, professor and chair, Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. “This decrease underscores the importance of continued vigilance, research, and intervention to further reduce tobacco use and its associated harms.”

Overall, inequalities in cigarette use among adolescents by gender have been present for decades. However, by 2021, discrepancies in smoking cigarettes by gender were diminished. 

With respect to race/ethnicity, by 2021, the decreases in cigarette consumption were even more pronounced among Black and Asian adolescents, while the rates among whites and Hispanic/Latino youth remained higher but were still significantly lower than the 1997 rates.

“These results show reassuring trends but they also suggest residual clinical and public health challenges that will require targeted interventions,” said Charles H. Hennekens, M.D., Dr.PH, co-author, First Sir Richard Doll Professor of Medicine and senior academic advisor, FAU Schmidt College of Medicine. “Quitting smoking significantly reduces risks of cardiovascular disease beginning within a matter of months and reaching the non-smoker status within a few years, even among older adults. However, for lung and other cancers, reductions do not even begin to emerge for years after quitting, and even after 10 years, remain midway between the continuing smoker and lifelong nonsmoker. Thus, for reducing cardiovascular disease risks it’s never too late to quit, but to reduce risks of cancer, it’s never too early.”

Study co-authors are Maria Mejia, M.D., first author and an associate professor, Baylor College of Medicine; Robert S. Levine, M.D., professor of family and community medicine, Baylor College of Medicine, and an affiliate professor, FAU Schmidt College of Medicine; and Adedamola Adele, a recent biomedical science graduate, FAU Schmidt College of Medicine.

In 2014, Hennekens received the prestigious Ochsner Award for Smoking and Health for reducing premature deaths from cigarettes presented by the American College of Chest Physicians. Hennekens joined other luminaries who previously received the award, including his mentors and colleagues, Sir Richard Doll and Sir Richard Peto. 

- FAU -

About the Charles E. Schmidt College of Medicine:

FAU’s Charles E. Schmidt College of Medicine is one of approximately 156 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 70 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 64 medical students each year and has been nationally recognized for its innovative curriculum. To further FAU’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The Consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology.

 

About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visit www.fau.edu.

 

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JOURNAL

Ochsner Journal

DOI

10.31486/toj.23.0113 

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Trends in Cigarette Smoking Among United States Adolescents

The long read
The great vape debate: are e-cigarettes saving smokers or creating new addicts? 

Photograph: Bloomberg via Getty Images


The US is cracking down on vaping while the UK is promoting e-cigarettes as an aid to giving up smoking. Where does the truth lie? By Sarah Boseley


Tue 18 Feb 2020

Gone With the Smoke is already no more than a distant whiff of bubblegum-flavoured vapour. The vape shop and lounge, one of many in San Francisco, has been forced to close. So have Vapor Den (“eclectic lounge & hipster go-to”) and Happy Vape. From late January, it became illegal to sell e-cigarettes and e-liquids in San Francisco. Even online sales to addresses within the city limits have been stopped. Stores outside the city that dispatch e-cigarettes to an SF postcode will face prosecution.

While vaping is banned, sales of legal marijuana and tobacco will continue as usual. San Francisco has often been considered more progressive than the rest of the US in its approach to drugs and unorthodox lifestyles: marijuana was legalised in California for medical use in 1996, after a campaign by Aids activists from the city, and for recreational use in 2016. Vaping, on the other hand, has crossed a line.

Behind the outright ban on sales of e-cigarettes in San Francisco is a panic about teenagers vaping. More than one in four American teens have tried vaping, according to the US Centers for Disease Control and Prevention. A study published in the New England Journal of Medicine reported that 12% of 16- and 17-year-olds were addicted to nicotine, and raised the alarm about the effect of nicotine on the adolescent brain. The Food and Drug Administration (FDA) recently described the use of e-cigarettes as a “crisis among America’s youth”.

“San Francisco has never been afraid to lead. That will always be the case when the health of our children is on the line,” announced the San Francisco city attorney Dennis Herrera in a statement after the ban was passed by the the city legislature last June. He was scathing about the FDA’s failure to control e-cigarette sales. “Now, youth vaping is an epidemic. If the federal government is not going to act to protect our kids, San Francisco will,” he said.


In the UK, meanwhile, the medical establishment is endorsing vaping as an aid to giving up smoking. My local vape shop in London is colourful, thriving, offers a panoply of flavours and displays a banner the length of its storefront proclaiming: “Vaping is 97% safer than smoking, according to NHS and Cancer Research UK.” (The correct figure is 95%, according to a report in August 2015 by Public Health England, PHE, the government executive agency and watchdog that offers guidelines on health protection issues.)

A transatlantic schism has opened up over vaping and health. In the US, the war on vaping is being pursued by activists, politicians and scientists who believe that tobacco companies are cynically promoting e-cigarettes as a means to get people addicted to nicotine, which will – sooner or later – lead them to cigarettes. In the UK, anti-smoking campaigners and health experts counter that for many adult smokers, vaping offers the best hope of avoiding a premature death.

The two sides periodically break into open hostilities. The claim by PHE that vaping is 95% safer than smoking tobacco, frequently quoted by e-cigarette manufacturers and sellers, has been criticised as misleading by anti-smoking campaigners in the US. Matt Myers, who heads the Campaign for Tobacco-Free Kids in Washington DC, the biggest anti-smoking organisation in the world, has called the 95%-safer figure “mere fiction”.

Prof Ann McNeill of King’s College London, a tobacco and addiction expert who advises PHE, defends its position. “We are battling against misinformation on a massive scale,” she says. McNeill acknowledges there has been a rise in vaping among kids in the US and Canada, but does not see it as a reason for panic. “I don’t think it merits discussion of an ‘epidemic’. That word is overblown,” she said.


The soaring popularity of vaping among the young in the US is largely down to Juul – a tiny black or chrome device that looks like a USB stick and fits into the palm of the hand. In 2004, two design graduate students came up with the idea for an electronic alternative to smoking. They launched Juul in 2015, which quickly defined the market; by July 2019, Juul accounted for 75% of US e-cigarette sales. Since then, its fortunes have taken a dive. The company is accused, in dozens of lawsuits from San Diego to New York City, of targeting young users via social media campaigns featuring youthful models. Opponents claim Juul pods are easier for novice vapers to inhale, since they contain nicotine salts instead of straight nicotine, further softened with teen-friendly flavourings such as mango, cool cucumber and creme brulee. Juul has repeatedly denied it has marketed to teens.

There was fresh alarm in the US last year when 2,500 cases of lung disease and 55 deaths were associated with vaping. E-cigarettes work by heating liquid containing nicotine to produce vapour, which is then inhaled. There is no smoke or tar involved, but there are small amounts of chemical flavourings, including diacetyl, which has been linked to lung disease, and propylene glycol or vegetable glycerin. If the e-liquid overheats, formaldehyde can be formed. In fact, none of these chemicals were to blame in these cases – it turned out that the people who fell ill were using bootleg devices containing cannabis – but the reputational damage was done.

In the wake of this alarming spate of hospitalisations and deaths, the New York state governor, Andrew Cuomo, took emergency action in September, attempting to ban flavoured e-cigarette products. President Trump entered the fray, telling the FDA to act and imposing a temporary ban on any flavours that might appeal to young people. In December, New York City mayor, Bill de Blasio, signed a law banning flavours. “Manufacturers of fruit and candy-flavoured e-cigarettes are intentionally and recklessly targeting young people,” said Cuomo, citing flavours including bubblegum, cotton candy and Captain Crunch. The state ban was overturned in January 2020 by Justice Catherine Cholakis, who said it was an overreach.

In the UK, the NHS continues to edge as close as it can to approving the use of e-cigarettes to quit smoking. NHS hospitals in the West Midlands have sanctioned vape stores on the premises, while PHE launched, via YouTube, a video showing two white-coated experts with bell jars demonstrating how e-cigarettes are free of all the disgusting and damaging tar in a conventional cigarette.

The science is furiously disputed. Academics on both sides are accused of cherry-picking data to suit their own prejudices. PHE is a global authority on health issues such as vaccination and obesity, but on vaping, it is looking increasingly isolated. Deborah Arnott, head of Action on Smoking and Health (Ash) in the UK, says that Britain is losing ground in the e-cigarette debate because of the virulent campaign in the US against vaping. “The noise is causing problems in how we are perceived,” Arnott said. “We’re being written off.”


What should be settled by science has become a clash of faiths. In the US, the debate is dominated by those who believe people should “just say no” to drugs. In the UK, there is more support for the idea of “harm reduction”, in which addicts take controlled amounts of their drug, be it alcohol, heroin or in this case, nicotine, to keep them stable.

PHE’s support for e-cigarettes as a tool to help people quit smoking is shared by other respected health bodies, such as the Royal College of Physicians and Cancer Research UK. They point out that the UK regulates smoking and vaping far more rigorously than the US. The UK has rules on age, and health warnings, and caps on the nicotine content. Marketing to young people is forbidden – e-cigarettes cannot be advertised on TV. There is less nicotine in Juul pods or e-cigarette cartridges sold in the UK: Juul in the US contains up to 59mg per ml, while nicotine levels in e-cigarettes across Europe are capped at 20mg per ml by an EU directive enshrined in British law. In the US, at this point, there is no middle ground between unrestricted sales and an outright ban. 

A still from PHE’s video demonstrating how vapes are free from the tar and damaging substances found in cigarettes. Photograph: PHE

All sides agree that vaping nicotine is safer than getting it from cigarettes. Nicotine by itself is “relatively harmless”, according to the NHS, while the harm from cigarettes is in the smoke produced by burning tobacco and the residue of tar it leaves, which damages the airways, causing lung disease and cancer.

“People smoke for nicotine but they die from the tar,” wrote Michael Russell, a professor in addiction at the Institute of Psychiatry in London and a pioneer of harm reduction, in 1976. His work laid the foundations for the introduction of nicotine replacement therapy – the nicotine patches and gum the NHS hands out today.


Russell, who died in 2009, wanted to develop a low-tar cigarette that would be high in nicotine, to give smokers the hit they wanted without inhaling more deeply. His research on the low tar product was funded by the tobacco company RJ Reynolds, now owned by British American Tobacco (BAT). This relationship with a tobacco company, which Russell later claimed was normal practice at the time, is now seen as fatally compromising. It has since been used to undermine his research and attack his reputation.

Ann McNeill, who worked with Russell as a young researcher, believes he was ahead of his time. “His pioneering research improved the quality of life of smokers and saved the lives of many more,” she said in a paper celebrating Russell, co-written with Debbie Robson of the UK Centre for Tobacco & Alcohol Studies. “It is a sad indictment of our community that his work is still not recognised adequately by all those working in tobacco control, some of whom still fail to recognise the centrality of nicotine in tobacco use and the implications of this.”

Anti-tobacco activists – whether they are for or against e-cigarettes – believe they are defending the gains they have made in the battle against smoking. Vaping’s defenders say the tobacco firms are diversifying into a product that won’t kill their customer base. Hardline opponents are convinced e-cigarette sales will keep the hated tobacco companies in business.

The major tobacco companies – Philip Morris, Imperial, British American Tobacco and Japan Tobacco – did not take long to realise the potential of e-cigarettes, and all are now players in the vaping business. Blu, launched in the US in 2009 by an Australian entrepreneur, was bought by Lorillard Tobacco, and later acquired by the British company Imperial. In 2013, BAT launched Vype. In 2015, RJ Reynolds, makers of Camel and Lucky Strike, produced Vuse, which was the most popular brand in the US before Juul came along. Altria, the parent company of Philip Morris USA, acquired a 35% stake in Juul.

Most scientists and health campaigners in the US will have no dealings with the tobacco industry, because of its history of devious marketing practices and underhand tactics. Under the terms of a World Health Organization (WHO) treaty in the early 00s, governments agree not to have any discussions with tobacco industry representatives (over trade terms, for example, taxation, regulation or investment). But anti-smoking campaigners now fear that, by promoting the benefit of their e-cigarettes as an alternative to smoking, tobacco companies are acquiring respectability. WHO shares that anxiety and has advised measures to control e-cigarettes. Many countries, including Brazil, Thailand, Singapore, the Seychelles and Uruguay, have banned e-cigarettes as a result, while others have imposed regulations limiting their use.


Anumber of health professionals and academics have dedicated their careers to exposing lies about the safety of tobacco products and stopping the promotion of cigarettes around the world. Recent hard-won victories include smoking bans in public spaces and plain packaging with severe health warnings. Despite their efforts, there are still over 1 billion smokers in the world. The global cigarette market was worth $888bn (£682bn) in 2018 and forecast to rise to $1,124bn by 2024.

Stanton Glantz, professor of medicine at the Center for Tobacco Control, Research and Education at the University of California San Francisco, is the loudest of the anti-tobacco lobbyists – in his choice of Hawaiian shirts as well as his pronouncements. Glantz claims he was agnostic when e-cigarettes first appeared. He isn’t now. In December, he tweeted: “Using e-cigs increases exposure to toxic chemicals for most users; they would be better off just smoking.”

This was a new extreme, even for Glantz. Alex Berezow, vice-president of scientific affairs at the American Council on Science and Health, described the tweet as “mind-boggling”. “Unfortunately, Dr Glantz has become something of an ideologue. His (justifiable) animosity toward the tobacco industry has been turned (unjustifiably) to other industries, such as vaping,” he wrote on his blog. The research paper that had prompted Glantz’s tweet, Berezow pointed out, actually shows that e-cigarette users get less exposure to toxic chemicals than tobacco smokers – not more.

Glantz, who you have to interrupt if you want to ask a question, told me that in the tweet, he was talking about dual-users – people who are both smoking and vaping. “Maybe it was worded inarticulately,” he conceded. But he won’t back down. He claims the evidence suggests that most people are dual users (in the UK, about a third of vapers are still smoking as well, according to a survey by YouGov).

A giant in the anti-tobacco lobby, Glantz does not understand how researchers he respects can support vaping. Glantz claims that confidence in e-cigarettes, at PHE and among the UK scientists who condone it, is starting to crack. He is convinced the “95% safer” figure is wrong. It came from a paper published in 2014 by a group of experts led by David Nutt – the former government drugs adviser famous in the UK for declaring that ecstasy and LSD were safer than alcohol, which led to his sacking.

“The Nutt paper had no evidence whatsoever. It was 12 guys who sat around and pulled that number out of the air,” said Glantz. “The most generous thing you can say about that paper is that it was much earlier in the process and there wasn’t a lot of evidence out there.” He believes the credibility of Nutt’s group has been undermined by revelations that they were part-funded by a consultancy called EuroSwiss Health, run by Delon Human, a South African doctor who has accepted funding from BAT for some of his ventures.


Nutt says that’s nonsense. The group comprised 12 world experts. “Has [Glantz] ever read the paper?” he said. “There are 14 variables in that paper [possible harms, such as death from cancer]. It looks at the effect of 12 different forms of nicotine on 14 variables. And I bet he wouldn’t actually disagree with any of them.” He gives an example. “Does he actually think that tobacco is not much more harmful than vaping on the likelihood of lung cancer?” The paper, he said, “comes up with an answer he doesn’t want. That’s why he thinks it’s bad science.”Get the Guardian’s award-winning long reads sent direct to you every Saturday morning

Nutt, a professor in neuropsychopharmacology at Imperial College London, says he is “saddened” by Glantz’s attacks. “He was a hero of mine. He was one of the pioneers in demolishing the myth that tobacco wasn’t addictive and opposing the fraud and misinformation and lies of the tobacco industry. But the problem is he is still basically playing the same tune and we’re now in a different era.” It’s proven impossible to stop people selling tobacco, Nutt said. “So the anti-tobacco people have got to attack something else, because that’s what they do – they attack and they ban. So basically they’ve fixed their wagons against vaping because it is one thing they can ban, and they’re very successful. It’s laughable that in India people go to prison for selling vaping when the government allows advertising of tobacco.”

Glantz became an icon of the anti-tobacco movement after he received 4,000 leaked documents from Brown and Williamson, then the US’s third-biggest tobacco company, in 1994. They proved the industry knew that smoking caused cancer and had hidden it. Since then, Glantz has always objected vigorously to any compromise with the industry. In 1997, a deal was broached with the tobacco industry by Matt Myers of the Campaign for Tobacco-Free Kids. It would have brought in tight federal regulatory control of cigarettes, prohibiting the sort of advertising and marketing that is still ubiquitous in the US, as well as sales to children. But Glantz was opposed to any deal that would allow cigarette manufacturers to continue in business. His goal was to close them down altogether. Myers was stymied by his own allies, and the US still does not have the anti-tobacco regulations that are common in Europe.

Myers is calm and quietly authoritative. He is not against harm reduction, he says. Nor are other public health bodies such as the American Cancer Society or the American Heart Association. “All of us have said that under appropriate circumstances, if e-cigarettes are shown to actually significantly help smokers quit or switch completely, and that there are rules in place to prevent them being marketed in a way that doesn’t unduly impact youth, we would be supportive,” he said.

Up until now, on a national level, the US has had no regulatory control of e-cigarette sales, marketing, minimum age, or limits on nicotine content. “It’s the wild west,” said Myers. Tobacco-Free Kids has brought legal action against the FDA over its failure to regulate e-cigarette use and last year won a ruling from a federal judge that there was no excuse for further delay. The e-cigarette companies are irresponsible too, Myers added.

Myers says both sides in the argument interpret scientific studies according to their prior beliefs. He describes PHE’s “95% safer” figure as worthless, because not enough research has been done. “I have very little doubt that e-cigarettes under appropriate circumstances are significantly less harmful to a smoker. Do we know exactly how much less harmful? The answer is no, because we have no clue how much nicotine it is delivering, how pure they are, what else they’re putting in them. Comparing it to the most lethal product ever created, for public relations purposes, is not helpful.”

In March 2018, Myers and Glantz, as well as representatives of PHE and almost every other influential anti-smoking scientist or campaigner, attended the World Conference on Tobacco or Health in Cape Town – just up the road from BAT’s South Africa HQ. At this meeting, held every two years, activists can discuss the perfidy of the industry, celebrate their successes and plan for the future.

Nobody connected with the tobacco industry is allowed in the building. The WHO’s Framework Convention for Tobacco Control, which came into force in 2005, lays down recommended anti-smoking measures for governments, from taxing cigarettes to marketing controls and smoking bans in enclosed public places. It has been signed by 168 countries (the US is a notable exception). The Framework document says governments “need to be alert to any efforts by the tobacco industry to undermine or subvert tobacco control efforts” and must limit their contact to the absolute minimum. Activists now take this to mean there must be an impenetrable wall between themselves and anyone in any way connected with tobacco.

The man who did as much as anyone to establish the Framework Convention while an executive director of WHO, Derek Yach – originally from Cape Town but now based in the US – finds himself on the wrong side of that wall. Yach was pointedly excluded from the conference in his home city – and yet much of the conversation was about him. Yach had done the unthinkable: accepting almost $1bn over 12 years from Philip Morris, makers of Marlboro and other leading brands, to set up his Foundation for a Smokefree World in New York in 2017 to fund research into alternatives to tobacco.

As part of its commitment to a “smokefree future”, Philip Morris International is heavily promoting its e-cigarettes and Iqos, a cigar-shaped electronic device designed to heat, rather than burn, tobacco. “These products will one day replace cigarettes,” it says on its website, claiming to be moving on from tobacco products because “society expects us to act responsibly”. Iqos has taken off in Japan, where 3 million people regularly use them. Smoking there was declining by 2% a year before Iqos arrived, and is now dropping by 10% per year, for which Philip Morris International claims the credit.

Yach believes it’s in the tobacco companies’ interests to develop products that will leave conventional cigarettes behind. His erstwhile colleagues believe he is working for the devil. Why, they ask, does Philip Morris still sell cigarettes if it cares about the world’s health?

As rumours circulated that Yach was in the building or lurking outside, Michael Bloomberg, the billionaire former mayor of New York and funder of vast amounts of anti-tobacco science and programmes, was launching his own campaign. Striding down the hallway, flanked by purple banners emblazoned with the words Bloomberg Philanthropies, the financial backer of the conference and his entourage made their way to the TV cameras to discuss his Stop initiative. Bloomberg announced he has set aside $20m to counter the lies of the tobacco industry. Top of the watch list was Yach’s Foundation. 

Attorney general Letitia James announces 

a lawsuit by the state of New York against 

e-cigarette maker Juul.

 Photograph: Lucas Jackson/Reuters

Bloomberg helps pay for WHO’s work on tobacco. I was offered a five-minute audience – just long enough to ask if he thinks there’s a role for e-cigarettes in combating smoking. “It is like marijuana: one of the stupid things we’re doing is legalising it,” he said. “I think there’s no place for e-cigarettes. I think it’s a terrible idea.”

Yach claims that “A-grade scientists and researchers around the world” are picking up grants from his foundation and doing useful work, but few believe he can succeed. He admits he was taken aback by the strength of feeling. “I wasn’t completely naive about it, but I didn’t actually appreciate how harsh it would be, particularly from a pretty small bunch of people who have incredible influence at WHO,” he says.

Clive Bates, the former head of the UK’s Ash, who blogs and campaigns for e-cigarettes from his home in Nigeria – he is married to the British High Commissioner – said he was amazed by the anti-vaping anger in Cape Town. “It was like a cult, almost,” he said. “Particularly the attacks on the foundation. It’s quite an achievement for Derek to create an institution that has a worse reputation than Philip Morris.”

However, Robert West, a professor of health psychology and director of tobacco studies at UCL, says: “It is playing out beautifully [for Philip Morris]. [The Foundation] has got the tobacco control community arguing among itself and divided. Result.”

In the UK, a small number of prominent public health academics vehemently oppose e-cigarettes. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, and Simon Capewell, professor of clinical epidemiology at Liverpool, believe the tobacco companies are using e-cigarettes as a route back to respectability. Sally Davies, until recently the UK’s chief medical officer (the most senior government adviser on public health matters), backs a ban on flavours that might attract children. She’s worried that we don’t know the long-term health effects of vaping, which she described as a “ticking time bomb”.

Ann McNeill says there is not much growth in vaping among kids in the UK. Her key concern would be a rise in vaping among young people who have never smoked, but there’s no sign of that. She thinks the key to reducing youth uptake is “getting adult smoking down”, because young people tend to imitate their elders’ behaviour.

She feels she and her colleagues at PHE have been unfairly attacked for saying vaping is 95% safer than smoking tobacco. She points out that they never said it was harmless. A 5% risk of harm, she insisted, “is not an insubstantial number”. She feels that the statement has been twisted as if PHE had said vaping was completely safe.

There is evidence that smoking is going down as e-cigarette use goes up, both in the UK and in the US. In 1942, 82% of British men smoked. By 2006, when e-cigarettes first appeared, 22% of adults in England smoked. The number of smokers is now at an all-time low of 14.7%, while 7% of the UK population are vaping regularly. Bans on smoking in public places, no-logo cigarette packaging with gruesome pictures of tumours, and the removal of cigarettes from sight in shops have all had an impact, but, McNeill says: “All the evidence, I believe, points to e-cigarettes playing a role.”

The best evidence that vaping helps people stop smoking comes from a study showing that e-cigarettes double the quitting success rate compared to gum or other aids. Peter Hayek from Queen Mary University of London and colleagues carried out the trial among more than 880 people who went to the NHS for help to give up smoking. Half were given nicotine replacement therapy in whatever form they wanted, such as patches or gum. The other half were given a starter e-cigarette kit and encouraged to buy their own when it ran out. The results, published in the New England Journal of Medicine in January 2019, showed that, at a year, the quit rate in the e-cigarette group was twice that of the nicotine replacement group, 18% versus 9.9%.

Of course, it did not satisfy the critics. When the researchers went back to the subjects after a year, most of the e-cigarette group were still vaping, whereas few of the ex-smokers in the other group were still chewing gum. So, they insisted, the study showed just how addictive e-cigarettes are.

Juul, once the leading e-cigarette, is struggling against public outrage and bad press. Sales have dropped and hundreds of staff have been laid off. The company said to be worth $38bn in 2018 was written down to $24bn by Altria in October last year, and valued at just $19bn by one of its major investors, Tiger Global Management, in December.

In the storm over child users, and anticipating an FDA ban, Juul stopped selling its fruit medley and mango flavours in the US in October and even dropped mint the following month. In January, the FDA acted, banning all flavours except tobacco and menthol from e-cigarettes that use a cartridge – as the Juul devices do. These are the devices kids use, said the FDA: flavours will not be banned from the refillable e-cigarettes that are more popular with adults. The FDA is also finally getting going on regulation, and has instructed manufacturers of e-cigarettes to apply for a right to trade by May.

The WHO, taking its cue from the US and from Bloomberg, has advised countries to control vaping, warning about the unknown impact on health and stating that e-cigarettes are risky for teenage brains, as well as for the foetus. That may leave the UK isolated, a lone bastion where (highly regulated) vaping is actually encouraged in the hopes of cutting smoking rates. Many public health experts in the UK believe they are witnessing an unnecessary tragedy, and that failure to promote the most promising method of helping people quit smoking is endangering the lives of millions.

McNeill insists public health experts in the UK do care about young people. But those whose lives are at risk are adults living in disadvantaged communities, who cannot kick their smoking habit. “I have lived with smokers and watched smokers die. You want them to do anything they can to prevent them from smoking.”

• This article was amended on 19 February 2020: to clarify that Altria is the parent company of Philip Morris USA and that Iqos is a product of Philip Morris International and to correct an error in attributing a quote from the WHO’s Framework Convention for Tobacco Control.

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IT DID NOT TEST POT SMOKERS ONLY!!!

Smoking marijuana and cigarettes may increase risk of lung problems compared to only smoking cigarettes, study suggests

LEGAL POT ALLOWED FOR THIS STUDY


Smoking marijuana and cigarettes may increase risk of lung problems

 compared to only smoking cigarettes, study suggests

Allana Akhtar
Tue, November 15, 2022 

A small study found higher rates of a rare form of emphysema, a lung condition that causes shortness of breath, in marijuana smokers versus tobacco-only smokers.Crystal Cox/Business Insider

A study found higher rates of emphysema among marijuana smokers compared to tobacco smokers of the same age.

The study author told Insider her research raises concerns that marijuana smoking is not safer than cigarettes.

The results suggest smoking both marijuana and cigarettes is more harmful than smoking tobacco by itself.

A small study found higher rates of emphysema, a lung condition that causes shortness of breath, among marijuana smokers compared to tobacco smokers of the same age. The study also suggests marijuana and tobacco use together could be more harmful than tobacco use by itself.

Dr. Giselle Revah, a cardiothoracic radiologist at The Ottawa Hospital and the study's lead author, looked at chest CT scans at Ottawa Hospital from 2005 to 2020 and identified 56 patients who reported using marijuana.

The majority of marijuana users — 50 out of the 56 patients — said they also smoked cigarettes. She compared them to 33 tobacco-only smokers and 57 non-smokers.

The tobacco-only smokers' ages skewed higher because Revah collected these patient chest CTs through her hospital's lung cancer screening event, which was open to patients over 50 who self-reported as heavy smokers. Marijuana smokers in her sample tended to get a chest CT for reasons unrelated to emphysema.

When the radiologist matched tobacco-only smokers to marijuana smokers of the same age, marijuana smokers had higher rates of emphysema: 93% (28 out of 30) compared to 67% of similarly-aged tobacco smokers.

The radiologist found marijuana users overall — including younger people who hadn't been exposed to as much smoke — had significantly higher rates in particular of paraseptal emphysema, a rare form of the condition that damages tiny ducts which connect the lung's air sacs.

The way marijuana smokers use the drug might damage air sacs. Marijuana users tend to take deep breaths and hold smoke in for longer, causing pressure changes that can irritate the lung's air sacs, Revah told Insider.

"The main message of the whole study is there's this public perception that marijuana is safe; people believe that it's safer than cigarettes," Revah said. "And this study raises concerns that maybe marijuana's not as safe as everyone thinks it is, and suggests that ultimately we need more robust research before we can make sweeping conclusions."

The paper sheds light on the under-researched health effects of marijuana. Literature on the chest CTs of marijuana smokers is sparse, Revah said, since Canada only legalized the drug in 2018. The US has not legalized cannabis nationally, and getting funding for marijuana research involves cumbersome legal steps.

Lung doctors told Insider more research is needed on the health effects of marijuana use.

Dr. Philip Diaz, a pulmonary disease physician at the Ohio State University Wexner Medical Center who was not involved in the study, said because most marijuana smokers in the study were cigarette smokers, it's possible smoking both marijuana and cigarettes increases risk for lung damage. But Diaz stressed the results of the small study should not be overstated.

"You don't want to dilute the fact that it's really the cigarette smoking that's the problem," Diaz told Insider. "I think all you could say is there could be some increased risk if you do both."

Revah said she is working on a prospective study that asks patients how much marijuana they use, and hopes a larger study will confirm her findings.

Dr. Albert Rizzo, the chief medical officer at the American Lung Association, told Insider scientists and doctors need longer, in-depth studies on the long term health effects of marijuana, especially as the drug quickly becomes legalized in states across the US.

"I think this study's a good one in trying to show or support the fact that airway use of marijuana leads to problems, emphysema being among them," Rizzo told Insider. "Smoking marijuana is not safe, and we don't know really what the long term effect of smoking marijuana is."

Read the original article on Insider

 

Is universal screening for type 1 diabetes around the corner?

Reports and Proceedings

DIABETOLOGIA

The the latest data on  universal screening for type 1 diabetes (T1D) is reveiwed in a session at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (2-6 October). The talk will be given by Dr Emily K. Sims, Associate Professor of Pediatrics, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.

Research by various groups has established that individuals with multiple islet autoantibodies (biomarkers showing that the body is attacking and killing its own insulin producing beta cells in the pancreas) have a near 100% risk of developing T1D over their lifetime (Ziegler et al. JAMA. 2013 Jun 19;309(23):2473-9). Multiple groups including Ezio Bonifacio and colleagues from the TEDDY Consortium (Diabetes Care 2021) and Ghalwash and colleagues from Type 1 Diabetes Intelligence Study Group (The Lancet Diabetes & Endocrinology 2022) have shown that screening for islet auto-antibodies  at two ages – 2 and at 5-7 years - would predict most cases of type 1 diabetes that would develop by age 15 years.

Dr Sims will highlight that, although screening programs have previously most often focused on people with family members with T1D (who can have up to 15 times increased risk of developing T1D), most people who develop T1D (85-90%) have no family history of the condition. “Our knowledge of type 1 diabetes has now evolved from thinking it is a disease that suddenly develops, to knowing that it is something that gradually develops, after the appearance of multiple islet-autoantibodies. By screening children and adults to identify individuals with early, presymptomatic stages of disease, we can more accurately predict when they will first need insulin and prevent life-threatening DKA episodes that otherwise frequently occur at diagnosis,” she explains. “Natural history studies have shown us that once someone has reached the threshold of multiple islet autoantibodies, progression occurs similarly in relatives and those with no family history.”

Knowing who is likely to develop T1D will help prevent cases of diabetic ketoacidosis (DKA) that occurs when the body doesn't have enough insulin to allow blood sugar into the cells for use as energy. Instead, the liver breaks down fat for fuel, producing acids called ketones; the build-up of these ketones to dangerous levels causes DKA. These episodes can be dangerous and even fatal, causing a number of uncomfortable symptoms. The symptoms of DKA can be the first sign of T1D in people who haven’t yet been diagnosed.

Various research programs are going on worldwide to establish the best ways of implementing universal screening, including programmes in Germany, the USA, Israel, the UK, and Australia, and a new program (Edent1fi) has just been funded that is going to include multiple new countries in Europe, including the UK, Germany, Poland, Portugal, Italy and the Czech Republic.  “These are all research programs. The next steps before universal screening for type 1 diabetes becomes general policy will require guidelines for monitoring and endorsement of screening and monitoring guidelines by applicable societies,” explains Dr Sims. This will also be helped by broader access to disease modifying therapies to impact progression and the need to start insulin injections.

She explains that these research programmes are in many cases working with primary care doctors to obtain blood testing for autoantibodies - while some of them work through newborn screening (genetic testing performed on infant blood spots followed by antibody screening in individuals at higher genetic risk).
 

Dr Sims says: “The costs of screening, optimal ways to scale it up, and how to connect it with access to disease modifying therapies, such as the monoclonal anti-CD3 antibody that was recently FDA-approved in the US for delay of Stage 3 T1D in individuals meeting criteria for Stage 2 disease (multiple islet autoantibodies and changes in blood sugar), are all still to be worked out. Other important considerations moving forward include reaching traditionally understudied populations and more tailored approaches for individual patients.”

As the question of when we could see universal screening for T1D rolled, Dr Sims concludes: “ I think we will start to see increasing society endorsement of screening and monitoring guidelines over the next five years and that as this occurs, countries will start incorporating screening into routine care for young children at the general practitioner’s office – for example, when children are called for routine childhood vaccinations.” Screening for adults, who can also develop T1D, is less well studied. Although optimal approaches have yet to be clearly elucidated, this population will also likely benefit from identification of early stage disease and the advantages of education, monitoring, and access to therapy.

“Given that we know that individuals without a family history are the most likely to present with new T1D and that once they reach criteria for early stage disease, they are at similar risk to individuals with a family history, universal screening the of general population is key to ultimately allow the most individuals to benefit from access to education, monitoring, and disease modifying therapies.

Dr Sims will also take part in the embargoed press conference taking place at 1200H Noon CEST Hamburg time on Tues 3 Oct, in the Vienna Hall.

To join by zoom, use this link

https://us06web.zoom.us/j/86523053998?pwd=0CxM4PetJCn8K6CbnavJVbp3uIZ3aa.1

For press conference slide presentation, click here

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ARTICLE PUBLICATION DATE

3-Oct-2023

COI STATEMENT

Dr Emily Sims, Associate Professor of Pediatrics, Center for Diabetes and Metabolic Disease, Indiana University School of Medicine, Indianapolis, IN, USA. Please e-mail to arrange interview. E) eksims@iu.edu Alternative contact in the EASD Press Room: Tony Kirby T) + 44 7834 385827 E) tony@tonykirby.com This press release is based on session S27 to take place in the Barcelona Hall at the European Association for the Study of Diabetes (EASD) Annual Meeting in Hamburg at 0900H AM CEST on Wednesday 4 October. The presenter is happy to answer any questions. Dr Sims will also take part in the embargoed press conference taking place at 1200H Noon CEST Hamburg time on Tues 3 Oct, in the Vienna Hall. To join by zoom, use this link https://us06web.zoom.us/j/86523053998?pwd=0CxM4PetJCn8K6CbnavJVbp3uIZ3aa.1

 For press conference slide presentation, click here

Metabolic signature can help predict which smokers will develop type 2 diabetes

UK Biobank analysis of over 93,000 adults finds that smoking increases the risk of type 2 diabetes in part through its effects on the metabolism

Reports and Proceedings

DIABETOLOGIA

New research being presented at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD), Hamburg (2-6 Oct) finds that cigarette smoking increases the risk of developing type 2 diabetes in part by affecting a variety of metabolites—small chemicals produced in the processes of metabolism—that circulate in the bloodstream.

The influence of these metabolic changes on diabetes risk appears to be amplified in individuals with genetic susceptibility to type 2 diabetes or insulin resistance.

The analysis of over 93,000 UK Biobank participants also identified a metabolic signature of 131 metabolic traits that can help predict which smokers are more likely to develop type 2 diabetes.

“Our metabolism is constantly changing depending on what we ingest or are exposed to”, says lead author Yuxia Wei from the Karolinska Institutet in Sweden. “Our study is the first to develop a metabolic signature for smoking based on comprehensive metabolomic profiles, and provides new insights into how smoking influences certain metabolites to increase the risk of type 2 diabetes. The findings underscore the importance of refraining from or quitting smoking to prevent diabetes, particularly for individuals with genetic risk factors for diabetes who seem to be more vulnerable to these changes.”

Previous observational evidence suggests that smokers are 20-60% more likely to develop type 2 diabetes, but the underlying mechanisms are unclear.

To address this knowledge gap, researchers used nuclear magnetic resonance spectroscopy (NMR) to analyse hundreds of metabolites in blood samples from 93,722 never, former, and current smokers (aged 37-73 years) without diabetes at the start of the study (2006-10) from the UK biobank—which holds genetic, health, and medical information from approximately half a million British volunteers. Metabolomics data were collected again in 2012-13.

During an average (median) follow-up of 13 years, 1,869 new cases of diabetes were identified.

The observational analysis and causal relationship analysis identified 131 metabolites affected by smoking, including glycoprotein acetyls (an inflammatory biomarker), fatty acids, and lipids, which collectively indicated whether an individual would go on to develop type 2 diabetes.

Compared with people who never smoked, current smoking increased the risk of type 2 diabetes by 73%; and 38% of this excess risk was mediated through the smoking-related metabolic signature (44% in men and 30% in women), after accounting for traditional diabetes risk factors such as age, sex, education level, ethnicity, BMI, physical activity, diet, and family history of diabetes.

For free fatty acids, smoking seemed to lead to higher levels of unhealthy saturated and monosaturated fatty acids, and lower percentages of healthy polyunsaturated ones such as DHA, omega-6 fatty acids, and omega-3 fatty acids (mainly found in seafood). Smoking was also positively associated with metabolites including different lipids in very-low-density lipoproteins (VLDL), triglycerides, and LDL cholesterol (also called ‘bad’ cholesterol), and lower levels of all forms of HDL cholesterol (often know as good cholesterol).

Importantly, the findings indicate that most of the smoking-related metabolic changes are reversible after quitting smoking.

The analysis also found that a high level of the metabolic signature was associated with a 61% higher risk of developing type 2 diabetes compared to a low level.

Genetic susceptibility also made a difference. Individuals with both a high level of the metabolic signature and a high genetic susceptibility to type 2 diabetes were three times as likely to develop the condition as those with low levels of the signature and genetic susceptibility.

The interaction between genetic susceptibility and the metabolic signature enhances their overall impact on type 2 diabetes. As the Wei explains: “The excess risk of developing type 2 diabetes in people with both a high genetic susceptibility and a high level of the signature surpasses what we would expect by simply adding the excess risk in people with only a high genetic susceptibility and the excess risk in people with only a high level of the signature. Our findings suggest that it is even more important for people with high genetic susceptibility to avoid smoking than the general population.”

The researchers further tested and verified the metabolic signature in blood samples from 3,626 participants in the TwinGene Study, a cohort nested in the Swedish Twin Register. They noted that the ability for the metabolic signature to determine risk of type 2 diabetes was highly reproducible despite the fact that individuals living in the UK and Sweden have different dietary habits, lifestyles, and environmental exposures.

“The reproducibility of the findings in the Swedish population indicate the robustness of the approach”, says Wei. “Nevertheless, more than half of the smoking-diabetes link was not explained by the metabolic signature, suggesting that other pathophysiological consequences of smoking play a role in diabetes development. These mechanisms may include the adverse effects of smoking on pancreatic tissue and beta cell function.”

Despite the important findings, the researchers note several limitations of the study, including that smoking status and metabolite levels may have changed during follow-up, which may have influenced the results; and that the study was conducted in people mainly of European origin, so the findings may not be generalisable to other populations.

This work was supported by the Swedish Research Council, FORTE, the Novo Nordisk Foundation, and the China Scholarship Council.

This press release is based on poster presentation 322 at the annual meeting of the European Association for the Study of Diabetes (EASD). The material has been peer reviewed by the congress selection committee. There is no full paper at this stage, but the research has been submitted to a medical journal for publication. The authors are happy to answer any questions.

 

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ARTICLE PUBLICATION DATE

3-Oct-2023

COI STATEMENT

This work was supported by the Swedish Research Council, FORTE, the Novo Nordisk Foundation, and the China Scholarship Council.