Association Between Incident Type 2 Diabetes and Opium Use: Mediation by Body Mass and Adiposity

Mahdi Nalini, Hossein Poustchi, Gholamreza Roshandel, Farin Kamangar, Masoud Khoshnia, Abdolsamad Gharavi, Paul Brennan, Paolo Boffetta, Sanford M. Dawsey, Christian C. Abnet, Reza Malekzadeh, Arash Etemadi

Research output: Contribution to journalArticlepeer-review


Opiates can affect glucose metabolism and obesity, but no large prospective study (to our knowledge) has investigated the association between long-term opium use, body mass index (BMI; weight (kg)/height (m)2), and incident type 2 diabetes mellitus (T2DM). We analyzed prospective data from 50,045 Golestan Cohort Study participants in Iran (enrollment: 2004-2008). After excluding participants with preexisting diseases, including diabetes, we used adjusted Poisson regression models to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2DM in opium users compared with nonusers, using mediation analysis to assess the BMI-mediated association of opium use with incident T2DM. Of 40,083 included participants (mean age = 51.4 (standard deviation, 8.8) years; 56% female), 16% were opium users (median duration of use, 10 (interquartile range), 4-20) years). During follow-up (until January 2020), 5,342 incident T2DM cases were recorded, including 8.5% of opium users and 14.2% of nonusers. Opium use was associated with an overall decrease in incident T2DM (IRR = 0.83, 95% CI: 0.75, 0.92), with a significant dose-response association. Most (84.3%) of this association was mediated by low BMI or waist circumference, and opium use did not have a direct association with incident T2DM (IRR = 0.97, 95% CI: 0.87, 1.08). Long-term opium use was associated with lower incidence of T2DM, which was mediated by low body mass and adiposity.

Original languageEnglish
Pages (from-to)2050-2062
Number of pages13
JournalAmerican Journal of Epidemiology
Issue number12
StatePublished - 1 Dec 2023
Externally publishedYes


  • body mass index
  • diabetes mellitus, type 2
  • incidence
  • obesity
  • opium
  • prevention


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