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American Journal of Epidemiology Advance Access originally published online on April 5, 2006
American Journal of Epidemiology 2006 163(10):929-937; doi:10.1093/aje/kwj136
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Associations of Serum Carotenoid Concentrations with the Development of Diabetes and with Insulin Concentration: Interaction with Smoking

The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Atsushi Hozawa1,2, David R. Jacobs, Jr.1,3, Michael W. Steffes4, Myron D. Gross4, Lyn M. Steffen1 and Duk-Hee Lee1,5

1 Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN
2 Division of Epidemiology and Forensic Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
3 Department of Nutrition, University of Oslo, Oslo, Norway
4 Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN
5 Department of Preventive Medicine, College of Medicine, Kosin University, Pusan, Korea

Correspondence to Dr. David R. Jacobs, Jr., Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN 55454 (e-mail: jacobs{at}epi.umn.edu).

Smoking is associated with low serum carotenoid concentrations. Prospective studies have found lower diabetes risk among persons with high-carotenoid diets. Whether diabetes risk is low in the rare smoker who has high serum carotenoid levels is unknown. The authors investigated the interaction of serum carotenoid concentrations and smoking with diabetes mellitus in 4,493 Black and White men and women aged 18–30 years in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors assessed 15-year (1985–2001) incident diabetes (148 cases), insulin concentration, and insulin resistance (homeostasis model assessment) in smokers and nonsmokers according to baseline levels of serum {alpha}-carotene, ß-carotene, zeaxanthin, ß-cryptoxanthin, and lycopene. Diabetes incidence was inversely associated with the sum of carotenoid concentrations in nonsmokers (per standard deviation (SD) increase, relative hazard = 0.74, 95% confidence interval: 0.55, 0.99) but not in current smokers (relative hazard = 1.13, 95% confidence interval: 0.83, 1.53) (p for interaction = 0.02). Similarly, year 15 insulin and insulin resistance values, adjusted for baseline levels, were inversely related to sum of carotenoids only in nonsmokers (per SD increase in insulin level, slope = –0.46 (p = 0.03); per SD increase in insulin resistance, slope = –0.14 (p = 0.01)). In CARDIA, higher serum carotenoid concentrations are associated with lower risk of diabetes and insulin resistance in nonsmokers but not in smokers.

carotenoids; diabetes mellitus; insulin resistance; prospective studies; smoking

Abbreviations: CARDIA, Coronary Artery Risk Development in Young Adults; HOMA, homoeostasis model assessment; YALTA, Young Adult Longitudinal Trends in Antioxidants


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