Abstract
Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM–associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil–lymphocyte ratio (NLR) and white blood cells (WBCs). A case–control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.
Highlights
Type 2 diabetes mellitus (T2DM), a chronic metabolic disorder characterized by hyperglycemia [1], has reached epidemic levels globally and has increased the risk of mortality [2]
People exposed to Secondhand smoke (SHS) had a 2.69-fold higher risk of having type 2 diabetes mellitus (T2DM) compared with nonsmokers after adjustment for confounding factors
Our study revealed that T2DM–related inflammatory markers, including white blood cells (WBCs) and neutrophil–lymphocyte ratio (NLR), are significantly and positively correlated with smoking status, daily average number of cigarettes creating
Summary
Type 2 diabetes mellitus (T2DM), a chronic metabolic disorder characterized by hyperglycemia [1], has reached epidemic levels globally and has increased the risk of mortality [2]. In Indonesia, the prevalence of T2DM has increased from 8.5–10.3 million in the period from 2013–2017 and will increase further to 14.1 million by 2035, possibly affecting as many as 16.6 million by 2045 [3,4]. Identifying potential risk factors of T2DM is strongly recommended. These factors include demographic characteristic regarding the disease and lifestyle behaviors factors. These factors may increase inflammatory markers and risk of developing T2DM [5]
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