Snus and Cardiometabolic Health Markers Among Swedish Young Adults

Abstract

Introduction: Snus is suggested as a risk factor for cardiometabolic disease, but little is known about health effects in young populations, particularly in women. We aimed to investigate associations between snus and cardiometabolic health markers among young men and women.

Aims and methods: This study was conducted within the BAMSE (Swedish acronym for Children, Allergy, Environment, Stockholm, Epidemiology) birth cohort and included participants followed up around 24 years (n = 2256) and 26 years (n = 1011). Snus use was assessed at 24 years by questionnaires. Cardiometabolic health markers were recorded at clinical examinations at 24 and 26 years. Associations between snus use and cardiometabolic markers were assessed by multivariable linear regression.

Results: Snus was used by 6.4% (n = 81) among women and 21.9% (n = 219) among men. Compared to no tobacco use, daily exclusive snus use among women at 24 years was associated with higher body mass index (BMI) (adjusted β: 1.93 kg/m2, 95% confidence interval [CI] = 0.54, 3.33) and waist circumference (WC) (aβ: 3.80 cm, 95% CI = 0.41, 7.18) at 24 years, and with higher BMI (aβ: 2.73 kg/m2, 95% CI = 0.53 to 4.93) at 26 years. Among men, using ≥4 cans/week was associated with increased BMI (aβ: 2.48 kg/m2, 95% CI = 0.73, 4.24) and a tendency toward increased body fat (aβ: 2.31%, 95% CI = -0.53, 5.14) at 26 years. Snus use was not associated with glycemic status or blood pressure.

Conclusions: Our results suggest that snus is associated with increased BMI, and possibly other measures of adiposity, among young women and heavy-using young men. Given the cross-sectional study design, the results should be interpreted with caution.

Implications: We found cross-sectional associations between snus use and measures of increased adiposity in a cohort of Swedish young adults, including BMI and WC among women and BMI among heavy snus-using men. We did not find associations between snus use and body fat %, glycemic status, or blood pressure. This is one of few studies to investigate the health effect of snus among both women and men as well as cardiometabolic health markers in young adults. Given the recent trends of increased snus use among young adults, our findings highlight the need for further research on snus on cardiometabolic health.

Figure 1.

Associations between exclusive snus use at around 24 years and cardiometabolic markers at around 24 years for women and men as compared to nontobacco users for any, occasional, daily, <4 and ≥4 cans/week snus use (n = 1724). Results from linear regression models adjusted for education level, occupation, sedentary level, area-level income, SHS in utero or during infancy and former tobacco use. BMI = body mass index; DBP = diastolic blood pressure; TG/HDL = triglyceride/high-density lipoprotein cholesterol ratio; SBP = systolic blood pressure; WC = waist circumference.

Figure 2.

Associations between exclusive snus use at around 24 years and cardiometabolic markers at around 26 years for women and men as compared to nontobacco users, for any, occasional, daily, <4 and ≥4 cans/week snus use (n = 787). Results from linear regression models adjusted for education level, occupation, sedentary level, area-level income, SHS in utero or during infancy and former tobacco use. BMI = body mass index; DBP = diastolic blood pressure; HbA1c: glycosylated hemoglobin; TG/HDL = triglyceride/high- density lipoprotein cholesterol ratio; SBP = systolic blood pressure; WC = waist circumference.