The relationship between environmental tobacco smoke (ETS) exposure at different locations and diabetes remains unclear. We explored the abovementioned associations and combined mendelian randomization (MR) techniques to further investigate the causality. In this observational study, data collected by the National Health and Nutrition Examination Survey (NHANES) 2013–2016 were assessed, which included nonsmokers aged ≥20 years (n = 3749). Subsequently, MR analysis was performed using the inverse variance weighted (IVW) approach to assess the causal connection between different locations of ETS exposure and diabetes from the UK Biobank, DIAbetes Genetic Replication And Meta-analysis (DIAGRAM) consortium, and FinnGen datasets. Multivariate logistic regression analyses demonstrated that exposure to ETS outside the home was positively associated with diabetes in nonsmokers over 60 years (OR = 2.19; 95%CI, 1.19–4.02, = 0.018). This positive connection was sustained in a subgroup analysis among females (OR = 3.19; 95%CI, 1.48–6.88, = 0.006) but not in males. In the MR analysis, exposure to ETS outside the home was linked with an elevated risk of type 2 diabetes mellitus (OR = 4.52; 95%CI: 1.54–13.32, = 0.006) according to the IVW outcomes. Findings from our observational study identified exposure to ETS outside the home might be associated with an increased risk of diabetes in nonsmokers, and further MR analysis revealed the causal associations between genetically predicted ETS exposure outside the home on T2DM.These findings assist the need for targeted strategies, including more compulsory smoke-free policies, to address this issue effectively.

中文翻译：

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环境烟草烟雾暴露与糖尿病之间的关联：NHANES 2013-2016 和孟德尔随机分析的结果

不同地点的环境烟草烟雾（ETS）暴露与糖尿病之间的关系仍不清楚。我们探索了上述关联，并结合孟德尔随机化 (MR) 技术来进一步研究因果关系。在这项观察性研究中，对 2013-2016 年国家健康和营养检查调查 (NHANES) 收集的数据进行了评估，其中包括年龄 ≥20 岁的非吸烟者 (n = 3749)。随后，使用逆方差加权 (IVW) 方法进行 MR 分析，以评估来自英国生物银行、糖尿病基因复制和荟萃分析 (DIAGRAM) 联盟以及 FinnGen 数据集的不同 ETS 暴露位置与糖尿病之间的因果关系。多变量逻辑回归分析表明，60 岁以上非吸烟者在户外接触 ETS 与糖尿病呈正相关（OR = 2.19；95% CI，1.19–4.02，= 0.018）。这种正相关在女性亚组分析中得以维持（OR = 3.19；95%CI，1.48–6.88，= 0.006），但在男性中则不然。在 MR 分析中，根据 IVW 结果，在户外接触 ETS 与 2 型糖尿病风险升高相关（OR = 4.52；95%CI：1.54–13.32，= 0.006）。我们的观察性研究结果表明，在户外暴露于 ETS 可能与非吸烟者患糖尿病的风险增加有关，进一步的 MR 分析揭示了基因预测的户外 ETS 暴露与 T2DM 之间的因果关系。这些发现有助于需要有针对性的治疗战略，包括更强制的无烟政策，以有效解决这一问题。