Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Determinants of glycated haemoglobin in the general population: associations with diet, alcohol and cigarette smoking

European Journal of Clinical Nutrition volume 55, pages 615–623 (2001)Cite this article

Abstract

Objective: We evaluated cigarette smoking, alcohol intake and consumption of different foods as determinants of glycated haemoglobin in a general population sample.

Design: Cross-sectional survey.

Setting: England.

Subjects: Representative sample of 15 809 adults aged 16 y and older. Data analysed for 9772 non-diabetic, white European subjects.

Main outcome measures: Glycated haemoglobin (GHb). Analyses were adjusted for age, sex, body mass index (BMI), waist–hip circumference ratio, activity level, and educational attainment.

Results: After adjusting for confounding, GHb was 0.277% (95% confidence interval 0.218 to 0.336) higher in current smokers of 20 or more per day, compared with non-smokers. GHb was 0.189% (0.101 to 0.277) lower in those drinking 42 or more units of alcohol per week than in non-drinkers. GHb was not associated with frequency of consumption of pulses, fruit, vegetables and salads, cakes, bread or confectionery. GHb was higher in subjects who took sugar in tea (0.051%, 0.015 to 0.087%) or in coffee (0.069%, 0.034 to 0.105%). GHb was higher in subjects who used solid fat for cooking (0.082%, 0.022 to 0.142%), or who drank whole rather than reduced-fat milk (0.088%, 0.036 to 0.140%), or used butter or hard margarine rather than low-fat spreads (0.075%, 0.029 to 0.121%).

Conclusions: In the general population, higher GHb may be associated with cigarette smoking, or frequent consumption of fat-containing foods. Consumption of alcohol may be associated with lower GHb.

Sponsorship: None.

European Journal of Clinical Nutrition (2001) 55, 615–623

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Balkau B, Eschwege E, Ducimetiere P, Richard JL & Warnet JM (1991) The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective study after 15 y of follow-up J. Clin. Epidemiol. 44 465–474

    Article  CAS  Google Scholar 

  • Boeing H, Weisgerber UM, Jeckel A, Rose HJ & Kroke A (2000) Association between GHb and diet and other lifestyle factors in a non-diabetic population: cross-sectional evaluation of data from the Potsdam cohort of the European prospective Investigation into Cancer and Nutrition study Am. J. Clin. Nutr. 71 1115–1122

    Article  CAS  Google Scholar 

  • Borkman M, Campbell LV, Chisholm DJ & Storlein LH (1991) Comparison of the effects on insulin sensitivity of high carbohydrate, high fat diets in normal subjects J. Clin. Endocrinol. Metab. 72 432–437

    Article  CAS  Google Scholar 

  • Brown DC, Byrne CD, Clark PMS, Cox BD, Day NE, Hales CN, Shackleton JR, Wang TWM & Williams DRR (1991) Height and glucose tolerance in adult subjects Diabetologia 34 531–533

    Article  CAS  Google Scholar 

  • Brownlee M (2000) Negative consequences of glycation Metabolism 49 9–13

    Article  CAS  Google Scholar 

  • Colditz GA, Manson JE, Stampfer MJ, Rosner B, Willett WC & Speizer FE (1992) Diet and risk of clinical diabetes in women Am. J. Clin. Nutr. 55 1018–1023

    Article  CAS  Google Scholar 

  • Colhoun H & Prescott-Clarke P (1996) Health Survey for England 1994 London: HMSO

    Google Scholar 

  • Coulston AM, Hollenbeck CB, Swislocki AL, Chen YD & Reaven GM (1987) Deleterious metabolic effects of high-carbohydrate, sucrose containing diets in patients with non-insulin-dependent diabetes mellitus Am. J. Med. 82 213–220

    Article  CAS  Google Scholar 

  • Daly M, Vale C, Walker M, Alberti KGMM & Mathers JC (1997) Dietary carbohydrates and insulin sensitivity: a review of the evidence and clinical implications Am. J. Clin. Nutr. 66 1072–1085

    Article  CAS  Google Scholar 

  • Daly ME, Vale C, Walker M, Littlefield A, Alberti KGMM & Mathers JC (1998) Acute effects on insulin sensitivity and diurnal metabolic profiles of a high sucrose compared with a high starch diet Am. J. Clin. Nutr. 67 1186–1196

    Article  CAS  Google Scholar 

  • Dowse GK, Zimmet PZ, Gareebo H et al (1991) Abdominal obesity and physical activity as risk factors for NIDDM and impaired glucose tolerance in Indian, Chinese and Creole Mauritians Diabetes Care 14 271–282

    Article  CAS  Google Scholar 

  • Facchini FS, Hollenbeck CB, Jeppesen J, Chen YDI & Reaven GM (1992) Insulin resistance and cigarette smoking Lancet 339 1128–1130

    Article  CAS  Google Scholar 

  • Facchini F, Chen YDI & Reaven GM (1994) Light to moderate alcohol intake is associated with enhanced insulin sensitivity Diabetes Care 17 115–119

    Article  CAS  Google Scholar 

  • Feskens EJM & Kromhout D (1990) Habitual dietary intake and glucose tolerance in euglycemic men: the Zutphen study Int. J. Epidemiol. 19 953–959

    Article  Google Scholar 

  • Feskens EJM, Virtanen SM, Rasanen L, Tuomilehto J, Stengard J, Pekkanen J, Nissinen A & Kromhout D (1995) Dietary factors determining diabetes and impaired glucose tolerance Diabetes Care 18 1104–1111

    Article  CAS  Google Scholar 

  • Fugakawa NK, Anderson JW, Hageman G, Young VR & Minaker KL (1990) High carbohydrate, high fibre diets increase peripheral insulin sensitivity in healthy young and old adults Am. J. Clin. Nutr. 52 524–528

    Article  Google Scholar 

  • Goldstein H, Rasbash J, Plewis I, Draper D, Browne W, Yang M, Woodhouse G & Healy M (1998) A user's guide to MLwiN London: Institute of Education

    Google Scholar 

  • Gulliford MC, Ukoumunne OC & Chinn S (1999) Components of variance and intraclass correlations for the design of community-based surveys and intervention studies Am. J. Epidemiol. 149 876–883

    Article  CAS  Google Scholar 

  • Himsworth HP & Marshall EM (1935) The diet of diabetics prior to the onset of the disease Clin. Sci. 2 95–115

    Google Scholar 

  • Hodge AM, Dowse GK, Collins VR & Zimmet PZ (1993) Abnormal glucose tolerance and alcohol consumption in three populations at high risk of non-insulin-dependent diabetes mellitus Am. J. Epidemiol. 137 178–189

    Article  CAS  Google Scholar 

  • Holbrook TL, Barrett-Connor E & Wingard DL (1990) A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus Am. J. Epidemiol. 132 902–909

    Article  CAS  Google Scholar 

  • Hollenbeck CB & Coulston AM (1991) Effects of dietary carbohydrate and fat intake on glucose and lipoprotein metabolism in individuals with diabetes mellitus Diabetes Care 14 774–785

    Article  Google Scholar 

  • Jarvinen YH & Nikkila EA (1985) Ethanol decreases glucose utilisation in healthy man J. Clin. Endocrinol. Metab. 61 941–945

    Article  Google Scholar 

  • Jenkins DJ, Wolever TM, Jenkins AL, Thorne MJ, Lee R, Kalmusky J, Reichert R & Wong GS (1983) The glycemic index of foods tested in diabetic patients: a new basis for carbohydrate exchange favouring the use of legumes Diabetologia 24 257–264

    Article  CAS  Google Scholar 

  • Kilpatrick ES & Maylor PW (1998) Biological variation of GHb Diabetes Care 21 261–263

    Article  Google Scholar 

  • Laws A, Terry RB & Barrett-Connor E (1990) Behavioural covariates of waist to hip ratio in Rancho Bernardo Am. J. Public Health 80 1358–1362

    Article  CAS  Google Scholar 

  • Little RR, England JD, Wiedmeyer HM, Madsen RW, Pettit DJ, Knowler WC & Goldstein DE (1994) GHb predicts progression to diabetes mellitus in Pima Indians with impaired glucose tolerance Diabetologia 37 252–256

    Article  CAS  Google Scholar 

  • Lovejoy J & DiGirolamo M (1992) Habitual dietary intake and insulin sensitivity in lean and obese adults Am. J. Clin. Nutr. 55 1174–1179

    Article  Google Scholar 

  • Lundgren H, Bengtsson C, Bloihme G, lsaksson B, Lapidus L, Lenner RA, Saaek A & Winther E (1989) Dietary habits and incidence of non-insulin-dependent diabetes mellitus in a population study of women in Gotheberg, Sweden Am. J. Clin. Nutr. 49 708–712

    Article  CAS  Google Scholar 

  • Margetts BM & Jackson AA (1993) Interactions between people's diet and their smoking habits: the dietary and nutritional survey of British adults Br. Med. J. 307 1381–1384

    Article  Google Scholar 

  • Marshall JA, Hamman RF & Baxter J (1991) High-fat, low-carbohydrate diet and the etiology of non-insulin-dependent diabetes mellitus: the San Luis Valley Diabetes study Am. J. Epidemiol. 134 590–603

    Article  CAS  Google Scholar 

  • Marshall JA, Hoag S, Shetterly S & Hamman RF (1994) Dietary fat predicts conversion from impaired glucose tolerance to non-insulin-dependent diabetes mellitus Diabetes Care 17 50–56

    Article  CAS  Google Scholar 

  • Marshall JA, Bessesen DH & Hamman RF (1997) High saturated fat and low starch and fibre are associated with hyperinsulinaemia in a non-diabetic population: the San Luis Valley Diabetes study Diabetologia 40 430–438

    Article  CAS  Google Scholar 

  • Nikkila EA & Taskinen MR (1975) Ethanol induced alterations of glucose tolerance, post glucose hypoglycaemia and insulin secretion in normal, obese and diabetic subjects Diabetes 24 933–943

    Article  Google Scholar 

  • Ohlson LO, Larsson B, Eriksson H, Swardsudd K, Welin L & Tibblin G (1987) Diabetes mellitus in Swedish middle-aged men. The study of men born in 1913 and 1923 Diabetologia 30 386–393

    Article  CAS  Google Scholar 

  • Park S, Barrett-Connor E, Wingard DL, Shan J & Edelstein S (1996) GHb is a better predictor of cardiovascular disease than fasting or post-challenge plasma glucose in women without diabetes: the Rancho Bernardo Study Diabetes Care 19 450–456

    Article  CAS  Google Scholar 

  • Perry IJ, Wannamethee SG, Whincup PH & Shaper AG (1994) Asymptomatic hyperglycaemia and major ischaemic heart disease events in Britain J. Epidemiol. Community Health 48 538–542

    Article  CAS  Google Scholar 

  • Perry IJ, Wannamethee SG, Walker MK, Thomson AG, Whincup PH & Shaper AG (1995) Prospective study of risk factors for development of non-insulin dependent diabetes in middle aged British men Br. Med. J. 310 560–564

    Article  CAS  Google Scholar 

  • Phillips GB & Safrit HF (1971) Alcoholic diabetes. Induction of glucose intolerance with alcohol J.A.M.A. 217 1513–1519

    Article  Google Scholar 

  • Reaven GM (1988) Role of insulin resistance in human disease Diabetes 37 1595–1607

    Article  CAS  Google Scholar 

  • Rewers M & Hamman RF (1995) Risk factors for non-insulin-dependent diabetes. In Diabetes in America, 2nd edn, ed. National Diabetes Data Group 179–214 Baltimore, MD: National Institutes of Health

    Google Scholar 

  • Rimm EB, Manson JE, Stampfer MJ, Colditz GA, Willett WC, Rosner B, Hennekens CH & Speizer FE (1993) Cigarette smoking and risk of diabetes in women Am. J. Public Health 83 211–214

    Article  CAS  Google Scholar 

  • Rimm EB, Chan J, Stampfer MJ, Colditz GA & Willett WC (1995) Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men Br. Med. J. 130 555–559

    Article  Google Scholar 

  • Salmeron J, Asherio A, Rimm EB, Colditz GA, Spiegelman D, Jernkins DJ, Stampfer MJ, Wing AL & Willett WC (1997) Dietary fibre, glycaemic load, and risk of NIDDM in man Diabetes Care 20 545–550

    Article  CAS  Google Scholar 

  • Sargeant LA, Wareham NJ, Bigham S, Day NE, Luben RN, Oakes S, Welch A & Khaw KT (2000) Vitamin C and hyperglycaemia in the Euopean Prospective Investigation into cancer—Norfolk (EPIC-Norfolk) study Diabetes Care 23 726–732

    Article  CAS  Google Scholar 

  • Shaw JE, Hodge AM, de Courten M, Chitson P & Zimmet PZ (1999) Isolated post-challenge hyperglycaemia confirmed as a risk factor for mortality Diabetologia 42 1050–1054

    Article  CAS  Google Scholar 

  • Singer DE, Nathan DM, Anderson KM, Wilson PWF & Evans JC (1992) Association of HbA1c with prevalent cardiovascular disease in the original cohort of the Framingham Heart Study Diabetes 41 202–208

    Article  CAS  Google Scholar 

  • Stampfer MJ, Colditz GA, Willett WC, Manson JE, Arby RA, Hennekens CH & Speizer FE (1998) A prospective study of moderate alcohol drinking and risk of diabetes in women Am. J. Epidemiol. 128 549–558

    Article  Google Scholar 

  • Trowell H (1975) Diabetes mellitus and obesity In Refined Carbohydrate Foods and Disease. Some Implications of Dietary Fibre, eds. DP Burkitt & HC Trowell 227–249 London: Academic Press

    Google Scholar 

  • Tucker R, Lampe F, Colhoun H & Dong W (1996) Quality control of blood analyses. In Health Survey for England 1994, Volume II. Survey Methodology and Documentation. ed H Colhoun & P Prescott-Clarke 503–515 London: HMSO

    Google Scholar 

  • Wei M, Gibbons LW, Mitchell TL, Kampert JB & Blair SN (2000) Alcohol intake and incidence of type 2 diabetes in man Diabetes Care 23 18–22

    Article  CAS  Google Scholar 

  • West KM (1978) Epidemiology of Diabetes and its Vascular Lesions p 273. New York: Elsevier

    Google Scholar 

  • Williams DEM, Wareham NJ, Cox BD, Byrne CD, Hales CN & Day NE (1999) Frequent salad vegetable consumption is associated with a reduction in the risk of diabetes mellitus J. Clin. Epidemiol. 52 329–335

    Article  CAS  Google Scholar 

  • Wolever TM, Jenkins DJ, Vuksan V, Jenkins AL, Wong GS & Josse RG (1992) Beneficial effect of low-glycemic index diet in overweight non-insulin-dependent subjects Diabetes Care 15 562–564

    Article  CAS  Google Scholar 

  • Yudkin JS, Forrest RD, Jackson CA, Ryle AJ, Davie S & Gould BJ (1990) Unexplained variability of GHb in non-diabetic subjects not related to glycaemia Diabetologia 33 208–215

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Data from the Health Survey for England 1994 are Crown Copyright and were used by permission of the UK Office for National Statistics (ONS) and the Data Archive, University of Essex, England. Neither the Data Archive nor ONS bear any responsibility for the analysis and interpretation presented here.

Author information

Author notes

  1. MC Gulliford: Guarantor: MC Gulliford.

  2. MC Gulliford and OC Ukoumunne: Contributors: M Gulliford, O Ukoumunne.

Authors and Affiliations

  1. Department of Public Health Sciences, GKT School of Medicine, King's College, London, UK

    MC Gulliford & OC Ukoumunne

Authors
  1. MC Gulliford
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. OC Ukoumunne
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to MC Gulliford.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gulliford, M., Ukoumunne, O. Determinants of glycated haemoglobin in the general population: associations with diet, alcohol and cigarette smoking. Eur J Clin Nutr 55, 615–623 (2001). https://doi.org/10.1038/sj.ejcn.1601233

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601233

Keywords

This article is cited by

Search

Advanced search

Quick links