Wednesday, March 1, 2017

Heavy Snus Use: Possible Link to Type 2 Diabetes

A Swedish research study finds that heavy consumption of snus is associated with type 2 diabetes (abstract here). 

Analyzing data from six groups of Swedish men, researchers found no risk of type 2 diabetes in all snus users combined, but they reported a modest elevated risk with higher levels of consumption, at 5-6 cans per week (Relative risk, RR = 1.42, 95% Confidence Interval, CI = 1.07 – 1.87) or 7+ cans per week (RR = 1.68, CI = 1.17 – 2.41).

In a Karolinska Institute press release (here), lead research author Sofia Carlsson said, “We can confirm earlier suspicions that snus-users have a higher risk of type 2 diabetes.”  In fact, the new study confirmed only one “earlier suspicion”, as Carlsson’s is only the second study to show an association at higher consumption levels.  Here are the results from the four studies that have been published to date:

Studies of Snus Use and Type 2 Diabetes in Sweden
Author, Year, Snus UsersRelative Risk (95% CI)

Eliasson et al., 2004
Current snus users (prevalent diabetes)1.06 (0.43 – 2.64)
Current snus users (follow-up diabetes)No cases

Ӧstenson et al., 2012
Current snus users1.1 (0.6 – 2.0)
1-5 cans per week0.6 (0.2 – 1.4)
6+ cans per week3.3 (1.4 – 8.1)

Rasouli et al., 2017
A. Current snus users0.96 (0.67 – 1.37)
A. Ever snus users
Less than 5 boxes per week0.78 (0.56 – 1.09)
5+ boxes per week0.95 (0.57 – 1.58)
B. Ever snus users0.91 (0.75 – 1.10)
Less than 3 boxes per week0.88 (0.72 – 1.08)
3 + boxes per week0.92 (0.46 – 1.83)

Carlsson et al., 2017
Current snus users1.15 (1.00 – 1.32)
1-2 boxes per week1.14 (0.86 – 1.50)
3-4 boxes per week1.03 (0.82 – 1.29)
5-6 boxes per week1.42 (1.07 – 1.87)
7+ boxes per week1.68 (1.17 – 2.41)

A.    Swedish snus users
B.    Norwegian snus users
    Significantly elevated RRs

While those two studies suggest that high snus consumption is associated with type 2 diabetes, more research is needed to confirm a link. Many other factors are known to contribute to this type of diabetes (here), including age, overweight or obesity, inactive lifestyle, smoking (here), family history, high blood pressure and high blood cholesterol levels.  Research and analysis must fully account for these factors in order to confirm or refute a snus link.


Anonymous said...

It would help knowing how much a box is... If a box is like a roll of Copenhagen, e.g. then using 7+ rolls a week definitely would cause issues. Levels like that would be ridiculous!

Brad Rodu said...

It is almost certain that a box of Swedish snus in this study is similar to a can of American moist snuff.

Brad Rodu