Metabolic effects of smoking cessation

Non-Alcoholic Fatty Liver Disease Is Strongly Associated with Smoking Status and Is Improved by Smoking Cessation in Japanese Males: A Retrospective Study

BACKGROUND

Cigarette smoking is known to be a significant risk factor associated with non-alcoholic fatty liver disease (NAFLD). We aimed to examine the association between smoking status and the severity of fatty liver with regard to sex and smoking cessation.

METHODS

In total, 13,466 subjects (6,642 males and 6,824 females) who had undergone abdominal ultrasonography for health check-up, multivariable logistic regression analysis was retrospectively conducted to assess the association between smoking status and the prevalence of NAFLD stratified by sex after adjusting for other potential confounders.

RESULTS

Male sex (odds ratio [OR] 3.27, 95% confidence interval [CI] 3.00-3.57) and smoking history (former smoker: OR 1.23, 95% CI 1.10-1.38, current smoker: OR 1.31, 95% CI 1.17-1.47) were significantly associated with NAFLD. In males with a smoking history, an increased pack-year was strongly associated with the prevalence and severity of NAFLD (prevalence of moderate to severe fatty liver: Pack-year from 0.01 to 9.99, 21.3%; Pack-year from 10.00 to 19.99, 27.2%; Pack-year ≥20.00, 33.7%; P<0.0001), although the prevalence of moderate to severe fatty liver was inversely associated with the duration of smoking cessation (more than 10 years vs. within 5 years, OR 0.71, 95% CI 0.53-0.96). In female subjects, light current smoking was negatively associated with NAFLD (current smoker with a pack-year from 0.01 to 9.99 vs. never smoker, OR 0.41, 95% CI 0.19-0.76).

CONCLUSIONS

Smoking status and pack-year were strongly associated with the prevalence and severity of NAFLD, especially in Japanese males. However, smoking cessation improved NAFLD in this population.

N-acetylcysteine as an adjunctive treatment for smoking cessation: a randomized clinical trial

Objective:

This randomized controlled trial examined the efficacy and safety of N-acetylcysteine as an adjunctive treatment for smoking cessation.

Methods:

Heavy smokers were recruited from smoking cessation treatment for this 12- week randomized controlled trial. Eligible tobacco use disorder outpatients (n=34) were randomized to N-acetylcysteine or placebo plus first-line treatment. Abstinence was verified by exhaled carbon monoxide (CO_exh). The assessment scales included the Fagerström Test for Nicotine Dependence, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Minnesota Nicotine Withdrawal Scale, and the Medication Adherence Rating Scale. We also assessed anthropometrics, blood pressure, lipid profile, and soluble tumor necrosis factor receptor (sTNF-R) levels 1 and 2.

Results:

First-line treatment for smoking cessation plus adjunctive N-acetylcysteine or placebo significantly reduced CO_exh (p < 0.01). In the N-acetylcysteine group, no significant changes were found in nicotine withdrawal symptoms, depressive and anxiety symptoms, anthropometric measures, blood pressure, or glucose compared to placebo. However, there was a significant reduction in sTNF-R2 levels between baseline and week 12 in the N-acetylcysteine group.

Conclusions:

These findings highlight the need to associate N-acetylcysteine with first-line treatment for smoking cessation, since combined treatment may affect inflammation and metabolism components.

Clinical trial registration:

NCT02420418

Nicotinic Acetylcholine Receptor Signaling in the Hypothalamus: Mechanisms Related to Nicotine's Effects on Food Intake

Despite health risks associated with smoking, up to 20% of the US population persist in this behavior; many smoke to control body weight or appetite, and fear of post-cessation weight gain can motivate continued smoking. Nicotine and tobacco use is associated with lower body weight, and cessation yields an average weight gain of about 4 kg, which is thought to reflect a return to the body weight of a typical nonsmoker. Nicotine replacement therapies can delay this weight gain but do not prevent it altogether, and the underlying mechanism for how nicotine is able to reduce weight is not fully understood. In rodent models, nicotine reduces weight gain, reduces food consumption, and alters energy expenditure, but these effects vary with duration and route of nicotine administration. Nicotine, acting through nicotinic acetylcholine receptors (nAChRs), increases the firing rate of both orexigenic agouti-related peptide and anorexigenic proopiomelanocortin neurons in the arcuate nucleus of the hypothalamus (ARC). Manipulation of nAChR subunit expression within the ARC can block the ability of nicotine and the nicotinic agonist cytisine from decreasing food intake; however, it is unknown exactly how this reduces food intake. This review summarizes the clinical and preclinical work on nicotine, food intake, and weight gain, then explores the feeding circuitry of the ARC and how it is regulated by nicotine. Finally, we propose a novel hypothesis for how nicotine acts on this hypothalamic circuit to reduce food intake. Implications: This review provides a comprehensive and updated summary of the clinical and preclinical work examining nicotine and food intake, as well as a summary of recent work examining feeding circuits of the hypothalamus. Synthesis of these two topics has led to new understanding of how nAChR signaling regulates food intake circuits in the hypothalamus.

Protective effect of smoking cessation on subsequent myocardial infarction and ischemic stroke independent of weight gain: A nationwide cohort study

Smoking cessation reduces the cardiovascular risk but increases body weight. We investigated the risk of subsequent myocardial infarction and ischemic stroke according to weight gain after smoking cessation, using a nationwide population based cohort. We enrolled 3,797,572 Korean adults aged over 40 years who participated in national health screenings between 2009 and 2010. Subjects who quit smoking were classified into three subgroups according to the weight change between baseline and 4 years prior. Myocardial infarctions and ischemic strokes were followed until the end of 2015. We compared the hazard ratios among smoking cessation subgroups, non-smokers, and current smokers. The mean changes in weight (1.5 ± 3.9 kg) of the smoking cessation group were higher than those of the other groups (p < 0.0001). A total of 31,277 and 46,811 subjects were newly diagnosed with myocardial infarction and ischemic stroke, respectively. Regardless of weight change, all subgroups of smoking cessation had significantly less risk than current smokers. The subgroup of smoking cessation with weight gain over 4kg showed the lowest risk for myocardial infarctions (hazard ratio 0.646, 95% confidence interval 0.583-0.714, p < 0.0001) and ischemic strokes (hazard ratio 0.648, 95% confidence interval 0.591-0.71, p < 0.0001) after multivariable adjustment. In conclusion, weight gain after smoking cessation did not adversely affect the cardiovascular protective effect.

Smoking Cessation, Weight Change, and Risk of Parkinson's Disease: Analysis of National Cohort Data

BACKGROUND AND PURPOSE

To determine whether the postcessation weight gain modifies the protective effect of smoking on the development of Parkinson's disease (PD).

METHODS

This nationwide cohort study included 3,908,687 Korean males aged ≥40 years who underwent at least 2 health checkups biennially between 2009 and 2015. They were grouped into current smokers; quitters with body mass index (BMI) increase, maintenance, and decrease; and never smokers. The occurrence of incident PD was tracked, and Cox proportional-hazard models were used to adjust for potential confounding factors. We also analyzed the impact of weight change regardless of smoking status in the study population.

RESULTS

There were 6,871 incident PD cases observed during the 13,059,208 person-years of follow-up. The overall risk of PD was significantly lower in quitters than in never smokers [hazard ratio (HR)=0.78, 95% confidence interval (CI)=0.70-0.86]. The risk of PD was still lower in quitters with BMI increase (HR=0.80, 95% CI=0.65-0.98) and in those with BMI maintenance (HR=0.77, 95% CI=0.68-0.87). This tendency was also observed in quitters with BMI decrease (HR=0.76, 95% CI=0.55-1.06), although it was not as robust as in the other two groups. With respect to weight change alone, BMI increase (HR=1.10, 95% CI=1.02-1.18) but not BMI decrease (HR=1.06, 95% CI=0.98-1.14) significantly increased the PD risk compared to BMI maintenance.

CONCLUSIONS

Postcessation weight gain in males did not offset the protective impact of smoking on PD development, although overall weight gain predicted an increased risk of PD.

Why young women gain weight: A narrative review of influencing factors and possible solutions

Significant weight gain occurs in women during young adulthood, which increases risk of diseases such as diabetes, cardiovascular disease, and many cancers. This review aims to inform future individually targeted weight gain prevention programmes and summarizes possible targets: key life events, mediators that influence energy intake and physical activity levels, and moderators that could identify groups of women at greatest risk. Life events affecting weight include pregnancy and motherhood, smoking cessation, marriage and cohabiting, attending university, and possibly bereavement. Research has identified successful methods for preventing weight gain associated with pregnancy and motherhood, which could now be used in practice, but evidence is inconclusive for preventing weight gain around other life events. Weight gain is mediated by lack of knowledge and skills around food and nutrition, depression, anxiety, stress, satiety, neural responses, and possibly sleep patterns and premenstrual cravings. A paucity of research exists into altering these to limit weight gain. Moderators include socioeconomic status, genetics, personality traits, and eating styles. More research is required to identify at-risk females and engage them in weight gain prevention. There is a need to address evidence gaps highlighted and implement what is currently known to develop effective strategies to limit weight gain in young women.

Behavioral correlates of self-reported health status in US active duty military

Trends and relationships between health behaviors and conditions in US active duty military and Coast Guard personnel are understudied. Self-reported data from the 2011 and 2015 Department of Defense Health Related Behaviors Surveys were analyzed to estimate associations between seven behaviors (reasons for not exercising; moderate, vigorous, and strength training exercise; alcohol intake; sleep; and smoking) and five health conditions (high blood pressure [BP], blood sugar [BG], cholesterol [CH]; overweight/obesity [OW]; or obesity [OB]). In 33,531 respondents, 14.8%, 1.7%, 13.6%, 65.5%, and 12.1% had high BP, BG, CH, OW, or OB, respectively. Respondents in 2015, versus 2011, had higher odds of BP, BG, OW, and OB. Compared to exercising as much as desired, citing a disability or injury, or work commitments as reasons for not exercising associated with higher odds of each condition. Longer sleep associated with lower odds of each condition except BG. Current and former smoking associated with higher odds of BP; former smoking also associated with higher odds of high CH and OW. Three behaviors contributing to the best predictive models of each condition resulted in associations of reasons for not exercising with all conditions; strength training for OW and OB; alcohol intake for BP and BG; sleep for BP and CH; and moderate exercise for BG. Disability and injury and time constraints limiting exercise were consistent markers of self-reported health conditions. Military-specific initiatives to promote strategies for overcoming barriers to exercising, continued emphasis on adequate sleep, and reduction of alcohol intake and smoking are warranted.

Effect of weight change and lifestyle modifications on the development or remission of nonalcoholic fatty liver disease: sex-specific analysis

The effects of changes in various lifestyle habits on nonalcoholic fatty liver disease (NAFLD) have not been well elucidated. We aimed to clarify how weight change and lifestyle modifications were associated with the development or remission of NAFLD. In this longitudinal cohort study, we reviewed the periodic health checkup data of 1,421 subjects with no causes of liver disease besides NAFLD who had received at least two health checkups between 2009 and 2018. The prevalence of NAFLD at baseline was 34.1% (484/1,421). During follow-up period (4.6 ± 2.8 years), 104 subjects developed NAFLD and 127 subjects demonstrated NAFLD remission. The frequency of NAFLD development or that of NAFLD remission significantly increased as the larger weight gain or weight loss was, respectively (both, p < 0.001). Approximately 40% of the subjects who maintained ≥ 1%/year weight loss achieved NAFLD remission. By multivariate analysis, quitting smoking were independently associated with NAFLD development (adjusted odds ratio [AOR], 2.86; 95% CI, 1.24–6.62). Subjects who quit smoking demonstrated large weight gain (≥1%/year) significantly more frequently than the other subjects (p < 0.001). In sex-specific analysis, starting to exercise was independently associated with NAFLD remission in men (AOR, 2.38; 95% CI, 1.25–4.53).

The Other Obesity Epidemic-Of Drugs and Bugs

Chronic psychiatric patients with schizophrenia and related disorders are frequently treatment-resistant and may require higher doses of psychotropic drugs to remain stable. Prolonged exposure to these agents increases the risk of weight gain and cardiometabolic disorders, leading to poorer outcomes and higher medical cost. It is well-established that obesity has reached epidemic proportions throughout the world, however it is less known that its rates are two to three times higher in mentally ill patients compared to the general population. Psychotropic drugs have emerged as a major cause of weight gain, pointing to an urgent need for novel interventions to attenuate this unintended consequence. Recently, the gut microbial community has been linked to psychotropic drugs-induced obesity as these agents were found to possess antimicrobial properties and trigger intestinal dysbiosis, depleting Bacteroidetes phylum. Since germ-free animals exposed to psychotropics have not demonstrated weight gain, altered commensal flora composition is believed to be necessary and sufficient to induce dysmetabolism. Conversely, not only do psychotropics disrupt the composition of gut microbiota but the later alter the metabolism of the former. Here we review the role of gut bacterial community in psychotropic drugs metabolism and dysbiosis. We discuss potential biomarkers reflecting the status of Bacteroidetes phylum and take a closer look at nutritional interventions, fecal microbiota transplantation, and transcranial magnetic stimulation, strategies that may lower obesity rates in chronic psychiatric patients.

Long-Term Sequelae of Smoking and Cessation in Spontaneously Hypertensive Rats

Smoking is a major risk factor for heart attack, stroke, and lung cancer. Tobacco smoke (TS) causes bronchitis, emphysema, persistent cough, and dyspnea. Smoking cessation minimizes risks of TS-related disease. To determine whether smoking cessation could reverse TS-induced pulmonary changes, 10-week-old male spontaneously hypertensive rats were exposed to TS or filtered air (FA) for 39 weeks and allowed to live out their normal lifespan. Significantly (P ≤ .05) decreased survival was noted by 21 months in TS versus FA rats. In TS rats, persistent peribronchiolar, perivascular, alveolar, and subpleural inflammation were observed with pervasive infiltration of pigmented foamy macrophages and plausible intra-alveolar fibrosis and osseous metaplasia. Alveolar airspace was significantly (P ≤ .05) increased in TS versus FA rats as was the volume of stored epithelial mucosubstances in the left central axial airway. Increased mucin contributes to airflow obstruction and increased lung infection risks. Findings suggest TS-induced changes do not attenuate with smoking cessation but result in irreversible damage similar to chronic obstructive pulmonary disease. The observed persistent pulmonary changes mirror common TS effects such as chest congestion, sputum production, and shortness of breath long after smoking cessation and represent important targets for treatment of former smokers.

Muscarinic receptors in energy homeostasis: Physiology and pharmacology

Despite increased awareness and intensified biomedical research efforts, the prevalence of obesity continues to rise worldwide. This is alarming, because obesity accelerates the progression of several chronic disorders, including type 2 diabetes, cancer and cardiovascular disease. Individuals who experience significant weight loss must combat powerful counter-regulatory energy homeostatic processes, and, typically, most individuals regain the lost weight. Therefore, decoding the neural mechanisms underlying the regulation of energy homeostasis is necessary for developing breakthroughs in obesity management. It has been known for decades that cholinergic neurotransmission both directly and indirectly modulates energy homeostasis and metabolic health. Despite this insight, the molecular details underlying the modulation remain ill-defined, and the potential for targeting cholinergic muscarinic receptors for treating metabolic disease is largely uncharted. In this MiniReview, we scrutinize the literature that has formed our knowledge of muscarinic acetylcholine receptors (mAChRs) in energy homeostasis. The role of mAChRs in canonical appetite-regulating circuits will be discussed as will the more indirect regulation of energy homoeostasis via neurocircuits linked to motivated behaviours and emotional states. Finally, we discuss the therapeutic prospects of targeting mAChRs for the treatment of obesity and type 2 diabetes.

Lycopene Inhibits Smoke-Induced Chronic Obstructive Pulmonary Disease and Lung Carcinogenesis by Modulating Reverse Cholesterol Transport in Ferrets

Chronic obstructive pulmonary disease (COPD) and lung cancer share the same etiologic factor, cigarette smoking. Higher consumption of dietary lycopene has been associated with lower risks of COPD and lung cancer in smokers. We investigated whether lycopene feeding protects against COPD and lung cancer in ferrets, a nonrodent model that closely mimics cigarette smoke (CS)-induced chronic bronchitis, emphysema, and lung tumorigenesis in human. We also explored whether the protective effect of lycopene is associated with restoring reverse cholesterol transport (RCT), a key driver in persistent inflammation with CS exposure. Ferrets (4 groups, n = 12-16/group) were exposed to a combination of tobacco carcinogen (NNK) and CS with or without consuming lycopene at low and high doses (equivalent to ∼30 and ∼90 mg lycopene/day in human, respectively) for 22 weeks. Results showed that dietary lycopene at a high dose significantly inhibited NNK/CS-induced chronic bronchitis, emphysema, and preneoplastic lesions, including squamous metaplasia and atypical adenomatous hyperplasia, as compared with the NNK/CS alone (P < 0.05). Lycopene feeding also tended to decrease the lung neoplastic lesions. Furthermore, lycopene feeding significantly inhibited NNK/CS-induced accumulation of total cholesterol, and increased mRNA expression of critical genes related to the RCT (PPARα, LXRα, and ATP-binding cassette transporters ABCA1 and ABCG1) in the lungs, which were downregulated by the NNK/CS exposure. The present study has provided the first evidence linking a protective role of dietary lycopene against COPD and preneoplastic lesions to RCT-mediated cholesterol accumulation in lungs.

Effects of different pharmacologic smoking cessation treatments on body weight changes and success rates in patients with nicotine dependence: A network meta-analysis

Smoking cessation is a public health priority to reduce smoking-related morbidity and mortality. However, weight gain is a known primary reason for not trying to quit smoking. The aim of the current study was to investigate differences in weight gain associated with different pharmacological smoking cessation interventions. Randomized controlled trials (RCTs) that reported weight gain related to pharmacologic treatments for smoking cessation were analysed using network meta-analysis with a random effects model. Thirty-one RCTs with 5650 participants were included. Ten drugs and 22 regimens were identified. Nicotine patches plus fluoxetine, topiramate with/without nicotine patches, nicotine patches plus methylphenidate, nicotine spray/gum/lozenges, high-dose nicotine patches (42 mg/21 mg), naltrexone with/without nicotine patches, or bupropion with/without nicotine patches were associated with less weight gain than the placebo/control arm. Nicotine patches plus fluoxetine were associated with the least weight gain of all smoking cessation treatments. In addition, the nicotine patch plus topiramate and nicotine inhaler was associated with the best success rate and the least dropout rate, respectively. Overall, the nicotine patch 14 mg plus fluoxetine 40 mg, nicotine patch 14 mg plus fluoxetine 20 mg, and topiramate 200 mg would be the three best pharmacologic treatments based upon both weight gain effect and success rate.

A comprehensive diagnostic approach to detect underlying causes of obesity in adults

Obesity is a worldwide growing problem. When confronted with obesity, many health care providers focus on direct treatment of the consequences of adiposity. We plead for adequate diagnostics first, followed by an individualized treatment. We provide experience-based and evidence-based practical recommendations (illustrated by clinical examples), to detect potential underlying diseases and contributing factors. Adult patients consulting a doctor for weight gain or obesity should first be clinically assessed for underlying diseases, such as monogenetic or syndromic obesity, hypothyroidism, (cyclic) Cushing syndrome, polycystic ovarian syndrome (PCOS), hypogonadism, growth hormone deficiency, and hypothalamic obesity. The most important alarm symptoms for genetic obesity are early onset obesity, dysmorphic features/congenital malformations with or without intellectual deficit, behavioral problems, hyperphagia, and/or striking family history. Importantly, also common contributing factors to weight gain should be investigated, including medication (mainly psychiatric drugs, (local) corticosteroids, insulin, and specific β-adrenergic receptor blockers), sleeping habits and quality, crash diets and yoyo-effect, smoking cessation, and alcoholism. Other associated conditions include mental factors such as chronic stress or binge-eating disorder and depression.Identifying and optimizing the underlying diseases, contributing factors, and other associated conditions may not only result in more effective and personalized treatment but could also reduce the social stigma for patients with obesity.

Preclinical evidence for combining the 5-HT2C receptor agonist lorcaserin and varenicline as a treatment for nicotine dependence

Varenicline, a nicotinic acetylcholine receptor partial agonist, is used to treat nicotine dependence. Lorcaserin, a 5-HT_2C receptor agonist has been approved in some countries to treat obesity. Based on preclinical and preliminary clinical evidence, lorcaserin may have potential to treat nicotine dependence. These experiments examined in rats the effects of combining varenicline (0.5 or 1 mg/kg) and lorcaserin (0.3, 0.6 and 1 mg/kg) on nicotine self-administration, reinstatement of nicotine seeking, responding for food and impulsive action. Both drugs alone reduced nicotine self-administration. Combining varenicline and 0.6 mg/kg lorcaserin reduced responding to a greater extent than either drug alone. In a relapse model, extinguished nicotine seeking was reinstated by a priming injection of nicotine and nicotine-associated cues. Reinstatement was reduced by varenicline (1 mg/kg) and by lorcaserin (0.3 mg/kg). Combining lorcaserin (0.3 mg/kg) with varenicline (0.5 or 1 mg/kg) reduced reinstatement to a greater degree than either drug alone. Both drugs had minimal effects on responding for food, alone or in combination. In the five-choice serial reaction time test, varenicline (0.5 or 1 mg/kg) increased impulsivity, measured as increased premature responding. This effect was reduced by lorcaserin (0.3 mg/kg). Plasma levels of varenicline or lorcaserin were not altered by co-administration of the other drug. Varenicline and lorcaserin have additive effects on nicotine self-administration, and on nicotine seeking. Lorcaserin prevents impulsivity induced by varenicline. This pattern of effects suggests that co-administration of varenicline and lorcaserin has potential as a treatment for nicotine dependence that may exceed the value of either drug alone.

Endocrinology of obese and nonobese endometrial cancer patients: is there role of tumor molecular-biological type?

Aim: To compare endocrine characteristics of  endometrial cancer (EC) patients based on recent molecular EC types classification. Materials & methods: A total of 234 treatment-naive EC patients as well their tumors were studied. Results: Patients with POLE mutations demonstrated tendency to lower body mass index (BMI) and higher serum estradiol. Patients with p53 overexpression were older and had higher diabetes incidence. In the without characteristic molecular profile group there was no difference in fasting serum insulin, estradiol and testosterone levels between women with BMI ≥30.0 and <30.0. The mismatch repair deficient group patients had a tendency toward later menarche compared with the without characteristic molecular profile group one. Conclusion: Studied endocrine characteristics are associated with BMI or tumor molecular-biological type that might be relevant to EC genesis, course and prognosis.

Weight change after smoking cessation and incident metabolic syndrome in middle-aged Korean men: an observational study

We aimed to examine the effect of weight change attributable to cessation of cigarette smoking on newly diagnosed metabolic syndrome (MetS). We prospectively followed 5,809 men aged between 40 to 69 years without MetS at baseline in the Health Examinees-Gem (HEXA-G) study up to 4 years. The participants were grouped into continual smokers, quitters with weight gain, quitters without weight change, quitters with weight loss, and never smokers. We constructed multivariable logistic regression models adjusted for sociodemographic factors, health status, and health conditions to estimate the odds of newly diagnosed MetS. During the follow-up, there were 609 cases of newly diagnosed MetS in 5,809 men of the HEXA-G study. After adjustment for potential confounders, the odd ratios (OR) and 95% confidence intervals (95% CI) for MetS were 1.90 (95% CI: 1.43–2.52) in quitters with weight gain, 0.77 (95% CI: 0.60–1.00) in quitters without weight change, and 0.40 (95% CI: 0.28–0.57) in quitters with weight loss compared with continual smokers. Never smokers also had lower odds of MetS (OR = 0.54; 95% CI: 0.42–0.71) compared to continual smokers. Weight management program following smoking cessation may be necessary in clinical practice to reduce worsening of cardiometabolic risk factors related to post-cessation weight gain.

Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies

Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and is currently the 4th largest cause of death in the world. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction) and infective viral and bacterial acute exacerbations (AECOPD). Current pharmacological treatments for COPD are relatively ineffective and the development of effective therapies has been severely hampered by the lack of understanding of the mechanisms and mediators underlying COPD. Since comorbidities have a tremendous impact on the prognosis and severity of COPD, the 2015 American Thoracic Society/European Respiratory Society (ATS/ERS) Research Statement on COPD urgently called for studies to elucidate the pathobiological mechanisms linking COPD to its comorbidities. It is now emerging that up to 50% of COPD patients have metabolic syndrome (MetS) as a comorbidity. It is currently not clear whether metabolic syndrome is an independent co-existing condition or a direct consequence of the progressive lung pathology in COPD patients. As MetS has important clinical implications on COPD outcomes, identification of disease mechanisms linking COPD to MetS is the key to effective therapy. In this comprehensive review, we discuss the potential mechanisms linking MetS to COPD and hence plausible therapeutic strategies to treat this debilitating comorbidity of COPD.

Does everyone who quit smoking gain weight? A real-world prospective cohort study

Objective:

To evaluate weight changes after 12 months of biochemically confirmed smoking abstinence, comparing patients who lost weight or maintained their baseline weight with those who gained weight.

Methods:

This was a real-world prospective cohort study conducted at the Outpatient Smoking Cessation Clinic of São Lucas Hospital, in the city of Porto Alegre, Brazil, between 2010 and 2016. The patients evaluated received intensive smoking cessation counseling, focused especially on weight issues, together with pharmacotherapy, and were followed for 12 months. The baseline and final weights were measured. Continuous abstinence was confirmed by determining the concentration of exhaled carbon monoxide (eCO).

Results:

Of a total of 348 patients evaluated, 161 (46.2%) achieved continuous abstinence (eCO < 10 ppm) over the 12-month follow-up period. Of those 161 patients, 104 (64.6%) maintained their initial weight or had a weight change of no more than 5% in relation to their baseline weight, whereas the remaining 57 (35.4%) had a weight gain of more than 5%, 18 of those patients showing a > 10% increase over their baseline weight. The number needed to harm (i.e., the number of patients required in order to detect one patient with a weight increase) was calculated to be 3.6 (95% CI: 2.8-5.4).

Conclusions:

Weight gain is not necessarily associated with smoking cessation, and smokers who are motivated to quit should be informed of that fact. This information could also be useful for addressing smokers who are still undecided because of possibility of weight gain.

Changes in oxidative stress levels during two weeks of smoking cessation treatment and their association with nutritional characteristics in Japanese smokers

Although several experimental studies have reported that oxidative stress levels decrease during smoking cessation, how they change among general smokers has yet to be completely elucidated. In the present study, a total of 23 smokers who underwent smoking cessation treatment were observed for two-week changes in their levels of 8-OHdG and 8-isoprostane. Physical and nutritional characteristics were measured at the initial patient visit, and casual urine samples were collected at the initial visit and at a follow-up visit two weeks later. Oxidative stress was measured by a high performance liquid chromatography electrochemical detector, and the two-week difference in the levels of oxidative stress was assessed according to demographic and nutrient factors. Neither the urinary level of 8-OHdG nor that of 8-isoprostane decreased, although the cotinine level was decreased at two weeks. A Two-way repeated ANOVA revealed a significant interaction for fat intake by time for the change in the 8-OHdG level (P=0.03) and significant interactions for α-tocopherol intake (P=0.03), iron intake, and carbohydrate intake (P=0.03), all of which were time-dependent for the change in the 8-isoprostane level. The 8-OHdG level decreased among smokers with a high fat intake and was increased with a low fat intake. The 8-isoprostane levels were decreased among smokers with a high carbohydrate intake and increased with a low carbohydrate intake, decreased with a low iron intake and increased with a high iron intake and decreased with a low α-tocopherol intake and increased with a high α-tocopherol intake. Although the present study failed to observe a decrease in oxidative stress levels during the two-week smoking cessation period, we hypothesize that the intake levels of specific nutrients when initiating smoking cessation treatment may predict any subsequent changes in the oxidative stress levels.

Dietary and Lifestyle Risk Factors and Metabolic Syndrome: Literature Review

Metabolic syndrome (MetS) is considered a threat to public health due to its rapid growing prevalence worldwide. MetS can result from interrelated metabolic abnormalities including insulin resistance (IR), hypertension, dyslipidemia, and abdominal adiposity. Although the pathogenesis of this syndrome is not distinctly understood, it is strongly influenced by multiple genetic variations that interact with many environmental factors such as positive family history of MetS, adherence to unhealthy dietary patterns, low physical activity and smoking and that explain the variations in the prevalence of the MetS within and across populations. All of these factors were found to be associated with IR, obesity, and triglycerides elevation which therefore increase the risk of the MetS Several studies highlighted the effective preventive approach includes lifestyle changes, primarily losing weight, adopting healthy diet, and practicing exercise. All of the mentioned factors can reduce the risk of MetS.

Effect of Cardiorespiratory Fitness on Co-Morbidities and Mortality in Never, Past, and Current Smokers

Smoking is a strong risk factor for cardiovascular (CV) disease and mortality, but quitting may cause weight gain and increase the risk of co-morbidities. Our aim was to investigate the effect of smoking and exercise on weight-associated co-morbidities and mortality. We included Minnesota residents without baseline CV disease who underwent exercise testing from 1993 to 2010. Mortality was determined from Mayo Clinic records and Minnesota Death Index. Total, CV and cancer mortality by smoking status and cardiorespiratory fitness (CRF): (1) <80%, (2) 80% to 99%, (3) ≥100%. Differences were tested using logistic and Cox regression adjusting for age and gender. A total of 21,981 patients (7,090 past, 2,464 current smokers) were included. Past smokers had more obesity, hypertension, diabetes, and low CRF compared with never smokers. Current smokers did not show increased risk factor prevalence compared with never smokers but had higher rates of low CRF. There were 1,749 deaths; mean follow-up was 12 ± 5 years. Mortality was only slightly increased in past versus never smokers (Hazard Ratio: 1.2; 95% confidence interval 1.12 to 1.38) but was much higher in current smokers (Hazard Ratio 2.4; 95% confidence interval 2.05 to 2.80). Mortality in never, past, and current smokers was inversely related to CRF level. In conclusion, past smokers showed higher rates of co-morbidities and low CRF, but mortality was only mildly increased versus never smokers, whereas current smokers carried a high mortality risk. Our data suggest that quitting smoking is beneficial despite the increased co-morbidities. Exercise may potentially mitigate the risk of co-morbidities and death in those who quit smoking.

Race/Ethnicity-Specific Associations between Smoking, Serum Leptin, and Abdominal Fat: The Multi-Ethnic Study of Atherosclerosis

Objective

Smoking is a well-known cardiovascular risk factor associated with weight loss. We aimed to evaluate the association between smoking, serum leptin levels, and abdominal fat.

Design

Cross-sectional.

Setting

Data from examinations 2 or 3 (2002-2005) of the Multi-Ethnic Study of Atherosclerosis (MESA).

Participants

1,875 asymptomatic, community-dwelling adults.

Main Outcome Measures

We used multivariable linear regression models to assess the race/ethnicity-specific associations between smoking, serum log_eleptin levels, and computed tomography ascertained abdominal fat. Results were adjusted for demographic and relevantclinical covariates.

Results

Participants (mean age 64.5±9.6 years; 50.6% women; 42.2% former, 11.4% current smokers) were White (40.1%), Hispanic (25.8%), African American (21.1%), and Chinese (13.0%). Overall, median (25th - 75th percentile) leptin levels were significantly lower among current (11.14 ng/mL; 4.13 - 26.18) and former smokers (11.68 ng/mL; 4.72 - 27.57), as compared with never smokers (15.61 ng/mL; 3.05 - 30.12) (P<.001). The difference in median leptin levels between current and never smokers were significantly higher for Hispanics (Δ9.64 ng/mL) and African Americans (Δ8.81 ng/mL) than Whites (Δ2.10 ng/mL) and Chinese (Δ4.70 ng/mL) (P<.001). After adjustment for total abdominal fat, log_e-leptin levels remained lower for former (-.14 [-.22 - -.07]) and current (-.17 [-.28 - -.05]) smokers, compared with never smokers. Results differed by race/ethnicity, with significantly lower log_e-leptin levels observed only among current and former African Americans and Hispanic smokers, compared with their never smoker counterparts. (Ps for interaction <.05).

Conclusions

Among smokers, leptin levels significantly vary by race/ethnicity. Former and current smoking are associated with lower leptin levels, although this may be restricted to Hispanics and African Americans.

Sex-Specific Link Between Emotional Vulnerability and Poor Weight Control in Cigarette Smokers

BACKGROUND

Cigarette smoking and poor weight control independently and synergistically increase risk for morbidity and mortality. However, few studies have examined the etiological role of emotion-regulatory dysfunction in the link between smoking and poor weight control, as well as the possible moderating role of sex.

METHOD

Participants (n = 577; M_age = 44.42; SD = 13.80; 52.7% female) were daily smokers who completed a single survey online through Qualtrics. Emotional vulnerability was indexed by a latent construct comprised of the subscales from the Distress Tolerance Scale (DTS) and the Anxiety Sensitivity Index-3 (ASI-3). A regression model was constructed to examine the relation between emotional vulnerability and poor weight control, measured via body mass index (BMI).

RESULTS

Emotional vulnerability was significantly and positively associated with BMI (b = .08, p = .020). The effect was moderated by sex, such that emotional vulnerability was significantly related to BMI in female smokers (b = .15, p = .002), but not in male smokers (b = .01, p = .806).

CONCLUSIONS

Emotional vulnerability appears to be a novel female-specific psychological mechanism related to poor weight control in smokers. Possible limitations are discussed.

Role of the endocannabinoid system in drug addiction

Drug addiction is a chronic relapsing disorder that produces a dramaticglobal health burden worldwide. Not effective treatment of drug addiction is currently available probably due to the difficulties to find an appropriate target to manage this complex disease raising the needs for further identification of novel therapeutic approaches. The endocannabinoid system has been found to play a crucial role in the neurobiological substrate underlying drug addiction. Endocannabinoids and cannabinoid receptors are widely expressed in the main areas of the mesocorticolimbic system that participate in the initiation and maintenance of drug consumption and in the development of compulsion and loss of behavioral control occurring during drug addiction. The identification of the important role played by CB1 cannabinoid receptors in drug addiction encouraged the possible used of an early commercialized CB1 receptor antagonist for treating drug addiction. However, the incidence of serious psychiatric adverse events leaded to the sudden withdrawal from the market of this CB1 antagonist and all the research programs developed by pharmaceutical companies to obtain new CB1 antagonists were stopped. Currently, new research strategies are under development to target the endocannabinoid system for drug addiction avoiding these side effects, which include allosteric negative modulators of CB1 receptors and compounds targeting CB2 receptors. Recent studies showing the potential role of CB2 receptors in the addictive properties of different drugs of abuse have open a promising research opportunity to develop novel possible therapeutic approaches.

Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality

BACKGROUND

Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear.

METHODS

In three cohort studies involving men and women in the United States, we identified those who had reported quitting smoking and we prospectively assessed changes in smoking status and body weight. We estimated risks of type 2 diabetes, death from cardiovascular disease, and death from any cause among those who had reported quitting smoking, according to weight changes after smoking cessation.

RESULTS

The risk of type 2 diabetes was higher among recent quitters (2 to 6 years since smoking cessation) than among current smokers (hazard ratio, 1.22; 95% confidence interval [CI], 1.12 to 1.32). The risk peaked 5 to 7 years after quitting and then gradually decreased. The temporary increase in the risk of type 2 diabetes was directly proportional to weight gain, and the risk was not increased among quitters without weight gain (P<0.001 for interaction). In contrast, quitters did not have a temporary increase in mortality, regardless of weight change after quitting. As compared with current smokers, the hazard ratios for death from cardiovascular disease were 0.69 (95% CI, 0.54 to 0.88) among recent quitters without weight gain, 0.47 (95% CI, 0.35 to 0.63) among those with weight gain of 0.1 to 5.0 kg, 0.25 (95% CI, 0.15 to 0.42) among those with weight gain of 5.1 to 10.0 kg, 0.33 (95% CI, 0.18 to 0.60) among those with weight gain of more than 10.0 kg, and 0.50 (95% CI, 0.46 to 0.55) among longer-term quitters (>6 years since smoking cessation). Similar associations were observed for death from any cause.

CONCLUSIONS

Smoking cessation that was accompanied by substantial weight gain was associated with an increased short-term risk of type 2 diabetes but did not mitigate the benefits of quitting smoking on reducing cardiovascular and all-cause mortality. (Funded by the National Institutes of Health.).

Heat or Burn? Impacts of Intrauterine Tobacco Smoke and E-Cigarette Vapor Exposure on the Offspring's Health Outcome

Maternal smoking during pregnancy leads to gestational complications and organ disorders in the offspring. As nicotine replacement therapy is often ineffective for smoking cessation, pregnant women turn to alternatives such as heat-not-burn tobacco and e-cigarettes. Recently, the popularly of e-cigarettes has been increasing especially among the youth and pregnant women, mainly due to the advertisements claiming their safety. This has even led to some clinicians recommending their use during pregnancy. E-cigarettes heat e-liquid to produce an aerosol (e-vapor), delivering flavorings and nicotine to the user. However, e-vapor also contains toxins such as formaldehyde along with heavy metals and carcinogenic nitrosamines. In addition, specific flavoring compounds such as diacetyl can be toxic themselves or decompose into toxic compounds such as benzaldehydes. These compounds can induce toxicity, inflammation and oxidative stress in the mothers and can accumulate in the developing fetus, affecting intrauterine development. Recent animal studies suggest that maternal e-vapor exposure during pregnancy could cause respiratory and neurological disorders in the offspring. This review will examine the available literature to shed light on the current understanding of this problem-to-be from lessons learned in animal models.

Adolescent and adult nicotine exposure differentially impacts oral nicotine and oral saccharin self-administration in mice

Smokers that begin during adolescence are more likely to develop nicotine dependence than those who begin as adults. However, the factors that contribute to this remain largely unknown. Here we utilized a novel operant oral nicotine self-administration procedure in mice to assess the consequences of adolescent nicotine exposure on nicotine and saccharin (non-drug) reinforcement in adults. Animals were given non-contingent exposure to either saline or nicotine using the osmotic minipumps during both adolescence and adulthood for 2 weeks. Reinforcing efficacy for oral nicotine and saccharin was assessed using the progressive ratio schedule 2-weeks following the washout period in adults. Non-contingent nicotine exposure in adolescence drastically increased operant responding for oral nicotine but reduced responding for oral saccharin in the group re-exposed to nicotine in adulthood. Interestingly, adolescent nicotine-exposed mice that received saline exposure as adults exhibited higher preference for oral saccharin. However, breakpoints for oral nicotine in these mice remained comparable to control animals. Surprisingly, both adolescent and adult nicotine exposure increased inactive lever responding during self-administration presumably reflecting impulsive responding. Our data suggest that adolescent nicotine exposure produces an increase in reinforcement sensitivity in adulthood as reflected by increased saccharin self-administration but this sensitivity becomes biased towards nicotine self-administration when re-exposed to nicotine in adulthood. Moreover, nicotine/saccharin reinforcement could be impacted by changes in cognitive control, such as increased impulsivity. These distinct behavioral mechanisms may act in concert to facilitate maladaptive nicotine taking in smokers that initiate nicotine use during adolescence.

E-cigarettes and Weight Loss-Product Design Innovation Insights From Industry Patents

Objective

There is emerging evidence that e-cigarettes are being used by some to mitigate weight gain after quitting smoking, and being used to help control weight. This study sought to identify and describe patents related to innovations for e-cigarette devices associated and weight loss.

Methods

Relevant patents were identified using Google Patents with the core search terms: "electronic cigarette" OR "e-cigarette" OR "vaporizer" OR "vapourizer" AND "nicotine" AND "weight loss" OR "weight control" OR "obesity" OR "hunger". Patents were reviewed to identify and classify the innovation related to weight loss or weight control.

Results

Our search identified 23 unique patents that were filed between 2004 and 2015. Patent applications were sponsored by individual inventors (n = 7), tobacco companies (n = 5), e-cigarette companies (n = 8), pharmaceutical companies (n = 2) and a cannabis company (n = 1). More than half the patents (n = 12) were filed in the United States; other countries included China, Germany, South Korea, and South Africa. Strategies included using e-cigarette devices to deliver constituents to users that support weight loss through altered metabolism, reduced nutrient absorption, suppressed appetite, or supported healthy behavior change. In most cases (n = 18), the innovations detailed in the patents were intended to be used with an e-cigarette device that delivered nicotine to the user.

Conclusions

Companies from around the world, and from a range of industries are developing and patenting technologies related to e-cigarettes and weight loss. E-cigarettes may be presented to cigarette users as a possible solution to support smoking cessation and address the fear of weight gain.

Implications

This article presents evidence that a range of industries are innovating to design e-cigarettes or constituents to be used with e-cigarettes to deliver a variety of drugs beyond nicotine including weight loss drugs, laxatives, and nutritional supplements. This study may inform surveillance studies to systematically include weight loss as a possible motivation to use e-cigarettes. Further, market surveillance of e-cigarette products needs to monitor ingredients in e-liquids including constituents that have been historically used for weight loss or weight control. Regulations around e-cigarette marketing, promotion, product design including e-liquid constituents need to consider weight loss claims.

The Association Between Smoking Cessation Period and Metabolic Syndrome in Korean Men

The association between smoking cessation period and metabolic syndrome (MS) is currently unknown. We studied 6032 men aged >19 years who participated in the Korean National Health and Nutrition Examination Surveys between 2010 and 2012. The risk of MS according to the amount of smoking and duration of smoking cessation was examined, and adjusted for age, amount of alcohol consumed, physical activity, body mass index, income, and education levels. Compared with never-smokers, there was a significant increase in the risk of MS among current smokers >10 pack-years and former smokers with a history of pack-years >30. The odds ratio for MS increased with smoking amount in both current and former smokers. But the risk of MS in former smokers was no longer significant after 20 years of smoking cessation adjusted for past smoking amount. Thus, to prevent MS, current smokers should quit smoking early and former smokers should continue quitting.

16S rRNA Long-Read Sequencing of the Granulation Tissue from Nonsmokers and Smokers-Severe Chronic Periodontitis Patients

Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity among smokers and nonsmokers which may help in better understanding of predisposition to this chronic inflammation mediated diseases. We selected deep-seated infected granulation tissue removed during periodontal flap surgery procedures for identification and differential abundance of residential bacterial species among smokers and nonsmokers through long-read sequencing technology targeting full-length 16S rRNA gene. A total of 8 phyla were identified among which Firmicutes and Bacteroidetes were most dominating. Differential abundance analysis of OTUs through PICRUST showed significant (p>0.05) abundance of Phyla-Fusobacteria (Streptobacillus moniliformis); Phyla-Firmicutes (Streptococcus equi), and Phyla Proteobacteria (Enhydrobacter aerosaccus) in nonsmokers compared to smokers. The differential abundance of oral metagenomes in smokers showed significant enrichment of host genes modulating pathways involving primary immunodeficiency, citrate cycle, streptomycin biosynthesis, vitamin B6 metabolism, butanoate metabolism, glycine, serine, and threonine metabolism pathways. While thiamine metabolism, amino acid metabolism, homologous recombination, epithelial cell signaling, aminoacyl-tRNA biosynthesis, phosphonate/phosphinate metabolism, polycyclic aromatic hydrocarbon degradation, synthesis and degradation of ketone bodies, translation factors, Ascorbate and aldarate metabolism, and DNA replication pathways were significantly enriched in nonsmokers, modulation of these pathways in oral cavities due to differential enrichment of metagenomes in smokers may lead to an increased susceptibility to infections and/or higher formation of DNA adducts, which may increase the risk of carcinogenesis.

Helping Patients With ESRD and Earlier Stages of CKD to Quit Smoking

Among the many adverse effects of tobacco exposure is the increased risk for progression of kidney disease. Individuals with chronic kidney disease (CKD), who already face increased cardiovascular event rates compared to the general population, are at even greater risk if they smoke. Despite these risks and the increased focus on smoking cessation in the general population in recent years, national guidelines have not specifically targeted individuals with CKD. There are similarly sparse data specific to individuals with CKD regarding the safety and efficacy of evidence-based smoking cessation modalities. This review aims to identify the risks of nicotine dependence in individuals with CKD and the potential benefits of smoking cessation; discuss current strategies for smoking cessation, including behavioral and pharmacologic therapies such as varenicline; and extrapolate these interventions to the unique challenges of this population. Much of the data presented stem from evidence for the general population but are described with additional consideration in dosing of nicotine replacement therapy, as well as non-nicotine pharmacotherapy and treatment modality for individuals with CKD.

Feeding of tobacco blend or nicotine induced weight loss associated with decreased adipocyte size and increased physical activity in male mice

Although epidemiological data and results from rodent studies support an inverse relationship between nicotine consumption and body weight, the molecular mechanisms are poorly understood. CD-1 mice were fed a basal diet or a basal diet containing low or high dose smokeless tobacco blend or high dose nicotine tartrate for 14 weeks. High dose tobacco blend and nicotine tartrate diets vs. basal diet reduced mouse body weight (16.3% and 19.7%, respectively), epididymal (67.6% and 72.5%, respectively) and brown adipose weight (42% and 38%, respectively), epididymal adipocyte size (46.4% and 41.4%, respectively), and brown adipose tissue lipid droplet abundance, with no elevation of adipose tissue inflammation. High dose tobacco blend and nicotine diets also increased mouse physical activity and decreased respiratory exchange ratio, suggesting that high dose nicotine intake induces adipose tissue triglyceride lipolysis to provide fatty acids as an energy source. Both low and high dose tobacco blend and nicotine diet feeding vs. basal diet increased plasma insulin levels (2.9, 3.6 and 4.3-fold, respectively) and improved blood glucose disposal without affecting insulin sensitivity. Feeding of the high dose tobacco blend or nicotine feeding in mice induces body weight loss likely by increasing physical activity and stimulating adipose tissue triglyceride lipolysis.

Smoking Cessation without Educational Instruction could Promote the Development of Metabolic Syndrome

AIM

Smoking cessation is particularly important for maintaining health; however, the subsequent risk of an increased body weight is of major concern. The present study investigated the influence of smoking cessation on the incidence of metabolic syndrome and its components in the Japanese general population.

METHODS

This study enrolled individuals without metabolic syndrome or a history of smoking via our annual health checkup program (n=5,702, 55.2±11.5 years). Participants were divided into three groups mentioned below and followed up with the endpoint being the development of metabolic syndrome: (1) subjects who had never smoked and did not smoke during the observation period (non-smoker); (2) those who continued smoking during the observation period (continuous smoker); and (3) those who ceased smoking during the observation period (smoking cessation).

RESULTS

During the observation period (median 1,089 days), 520 subjects developed metabolic syndrome, and Kaplan-Meier analysis showed a higher incidence of metabolic syndrome in the smoking cessation group than in the other groups. Smoking cessation was confirmed as an independent predictor of the new onset of metabolic syndrome by multivariate Cox proportional hazard analysis after adjustment. Subjects only from the smoking cessation group showed a significant deterioration in metabolic factors during the study in correlation with an increased waist circumference after smoking cessation.

CONCLUSIONS

Smoking cessation without instruction could be followed by the development of metabolic syndrome, and the incidence of metabolic syndrome might reduce the benefit obtained from smoking cessation. Therefore, further educational outreach is needed to prevent the progression of metabolic syndrome during the course of smoking cessation.

Association Between Plasma Caffeine and Other Methylxanthines and Metabolic Parameters in a Psychiatric Population Treated With Psychotropic Drugs Inducing Metabolic Disturbances

Importance: Multiple studies conducted in the general population identified an association between self-reported coffee consumption and plasma lipid levels. To date, no study assessed whether and which plasma methylxanthines (caffeine and/or its metabolites, i.e., paraxanthine, theophylline, and theobromine) are associated with plasma lipids. In psychiatric patients, an important coffee consumption is often reported and many psychotropic drugs can induce a rapid and substantial increase of plasma lipid levels. Objective: To determine whether plasma methylxanthines are associated with metabolic parameters in psychiatric patients receiving treatments known to induce metabolic disturbances. Design, Setting, and Participants: Data were obtained from a prospective study including 630 patients with metabolic parameters [i.e., body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and fasting triglycerides (TG)] monitored routinely during psychotropic treatment. Exposures: Plasma methylxanthines levels. Main Outcomes and Measures: Metabolic variables including BMI and plasma lipid levels. Results: Multivariate analyses indicated that BMI, TC, HDL-C, and non-HDL-C increased significantly with increasing total methylxanthines (p _corrected ≤ 0.05). In addition, compared to patients with plasma caffeine concentration in the lowest quartile, those with caffeine concentration in the highest quartile were twice more prone to suffer from non-HDL hypercholesterolemia (p _corrected = 0.05), five times more likely to suffer from hypertriglyceridemia (p _corrected = 0.01) and four times more susceptible to be overweight (p _corrected = 0.01). Conclusions and Relevance: This study showed that plasma caffeine and other methylxanthines are associated with worsening of metabolic parameters in patients receiving psychotropic treatments known to induce metabolic disturbances. It emphasizes that important caffeine consumption could be considered as an additional environmental risk factor for metabolic worsening in patients receiving such treatments.

An association of smoking with serum urate and gout: A health paradox

BACKGROUND

The potential effect of cigarette smoking on levels of serum urate and risk of gout has been considered by a large number of studies, either as the primary variable of interest or as a covariate.

METHODS

Here we systematically review the published evidence relating to the relationship of smoking with serum urate, hyperuricaemia, and gout.

RESULTS

Many studies have reported that smoking reduces serum urate, however, the evidence has not been conclusive with other studies pointing to the opposite or no effect. It has also been suggested that smoking reduces the risk of gout, although there is some evidence to contradict this finding.

CONCLUSION

A consensus has yet to be reached as to the effect of smoking on serum urate levels and the risk of gout.

Metabolomic Fingerprinting in Various Body Fluids of a Diet-Controlled Clinical Smoking Cessation Study Using a Validated GC-TOF-MS Metabolomics Platform

Untargeted GC-TOF-MS analysis proved to be a suitable analytical platform to determine alterations in the metabolic profile. Several metabolic pathways were found to be altered in a first clinical study comparing smokers against nonsmokers. Subsequently, we conducted a clinical diet-controlled study to investigate alterations in the metabolic profile during the course of 3 months of smoking cessation. Sixty male subjects were included in the study, and plasma, saliva, and urine samples were collected during four 24 h stationary visits: at baseline, while still smoking, after 1 week, after 1 month, and after 3 months of cessation. Additionally, subjects were monitored for their compliance by measurements of CO in exhaled breath and salivary cotinine throughout the study. GC-TOF-MS fingerprinting was applied to plasma, saliva, and urine samples derived from 39 compliant subjects. In total, 52 metabolites were found to be significantly altered including 26 in plasma, 20 in saliva, and 12 in urine, respectively. In agreement with a previous study comparing smokers and nonsmokers, the fatty acid and amino acid metabolism showed significant alterations upon 3 months of smoking cessation. Thus these results may indicate a partial recovery of metabolic pathway perturbations, even after a relatively short period of smoking cessation.

Cigarette Smoking, Diabetes, and Diabetes Complications: Call for Urgent Action

PURPOSE OF REVIEW

This review aimed to examine the latest evidence linking cigarette smoking and cessation to risk of incident diabetes and its complications.

RECENT FINDINGS

Abundant evidence has demonstrated that smoking is associated with increased risk of type 2 diabetes and cardiovascular disease among diabetic patients, while its relationship with microvascular complications is more limited to diabetic nephropathy and neuropathy in type 1 diabetes. In addition, diabetes risk remains high in the short term after smoking cessation, while it reduces gradually in the long term. Risk of cardiovascular complications also substantially decreases after quitting smoking, but results for microvascular complications are not consistent. Smoking is associated with increased risks of incident diabetes in the general population and cardiovascular complications among diabetic patients. Although the short-term post-cessation diabetes risk needs to be acknowledged, this review calls for urgent action to implement population-wide policies and individual pharmaceutical and lifestyle interventions (if evidence accumulated in future) to aid smoking cessation and prevent diabetes and its complications.

Addressing Outcomes Expectancies in Behavior Change

Individuals commonly seek help for problem health behaviors, such as excessive drinking, smoking, and weight gain. Yet, there is a high rate of recidivism in these behaviors because outcome expectancies are either too high, negative outcome expectancies are not considered, or outcome expectancies are not properly addressed. Healthcare providers are recommended to list the outcome expectancy for the problem behavior and corresponding treatment for their patient. Through the process it is important to acknowledge both the positive and negative outcomes of engaging in the problem behavior. Healthcare providers are then encouraged to have their patient identify the goals and objectives that will assist in achieving the desired outcome. By recognizing and addressing outcome expectancies, it is more likely that the patient will be less resistant to the healthcare provider's recommendations to change problematic behavior.

Associations Among Cardiometabolic Abnormalities, Obesity, and Sociobehavioral Factors in a Southern Nevada Adult Population

CONTEXT

Cardiometabolic abnormalities underlie many health risks associated with obesity.

OBJECTIVE

We determined the relationship between cardiometabolic abnormalities, sociodemographic characteristics, and modifiable risk factors among adults in Southern Nevada.

DESIGN

We included 2415 participants older than 20 years from the Behavioral Risk Factor Surveillance System surveys conducted in 2011, 2013, and 2015 in Southern Nevada. Cardiometabolic abnormalities were assessed on the combined basis of blood pressure, cholesterol, and diabetes status. Logistic regression stratified by body mass index status was used to examine cardiometabolic abnormalities in different body mass index classes.

MAIN OUTCOME MEASURE

Odds ratio estimates for cardiometabolic abnormalities after accounting for sociodemographic and health behavior characteristics.

RESULTS

Cardiometabolic abnormalities followed a socioeconomic gradient, although adjustment for lifestyle variables attenuated the associative link. Non-Hispanic black (vs white) race did not elevate cardiometabolic abnormalities risk among nonobese adults, yet conferred a multivariable-adjusted odds ratio of 2.18 (95% confidence interval [CI], 1.03-4.61) among obese adults. By comparison, odds of cardiometabolic abnormalities among nonobese adults were 2.42 (95% CI, 0.99-5.92) times higher for Hispanics and 2.83 (95% CI, 1.23-6.55) times higher for other or multiracial minorities. Among obese adults, male gender (odds ratio: 1.84; 95% CI, 1.03-3.27) and former (odds ratio: 2.09; 95% CI, 1.14-3.85) smoker status were associated with cardiometabolic abnormalities independent of other covariates.

CONCLUSIONS

The present data support intervention strategies tailored to reinforce and promote positive health behaviors among disadvantaged groups. There were variable patterns of ethnic group disparities in clustered cardiometabolic abnormalities across body mass index classes. Targeted prevention approaches incorporating an explicit health equity perspective may help mitigate observed differences.

Smoking cessation improves cardiometabolic risk in overweight and obese subjects treated with varenicline and dietary counseling

BACKGROUND AND AIM

Weight gain after stopping smoking potentially counteracts improvements in cardiometabolic risks. We investigated changes in metabolic syndrome (MetS) components and homeostasis assessment model insulin resistance (HOMA-IR) in smokers given dietary counseling during their quit attempt.

METHODS AND RESULTS

Smokers (≥10 cigarettes/day) with BMI 25-40 kg/m² were randomized to a low-carbohydrate or low-fat diet and treated with a standard course of varenicline for 12 weeks. Quitters were assessed according to the Russell standard (≤5 cigarettes after the quit date) validated with expired breath carbon monoxide (CO) < 10 ppm. Of 122 randomized participants, 108 (89%) completed clinical and laboratory assessments at 12 weeks. As changes in metabolic risk factors did not differ between dietary groups, we combined the groups to compare quitters to continuing smokers. We found similar weight change among 78 validated quitters as 30 continuing smokers (-0.1 ± 3.0 kg vs 0.3 ± 3.1 kg; p = 0.7) and change in waist circumference (-2.0 ± 3.8 cm vs -0.9 ± 3.9 cm; p = 0.2). Changes in triglyceride concentrations (-0.16 ± 0.52 mmol/l vs 0.21 ± 0.95 mmol/l; p = 0.015) and diastolic blood pressure (-0.9 ± 6 mmHg vs 1.9 ± 8 mmHg; p = 0.039) were more favorable in quitters. Changes in other cardiometabolic risks and HOMA-IR did not differ between quitters and continuous smokers, nor did energy intake or resting metabolic rate.

CONCLUSION

Dyslipidemia and blood pressure improved and no early weight gain was seen in quitters, suggesting that dietary intervention can mitigate some of the effects of stopping smoking on cardiometabolic risk factors in overweight and obese smokers.

CLINICAL TRIALS REGISTRATION

NCT01069458.

Connection of Nicotine to Diet-Induced Obesity and Non-Alcoholic Fatty Liver Disease: Cellular and Mechanistic Insights

Non-alcoholic fatty liver disease (NAFLD) poses a serious health hazard affecting 20-40% of adults in the general population in the USA and over 70% of the obese and extremely obese people. In addition to obesity, nicotine is recognized as a risk factor for NAFLD, and it has been reported that nicotine can exaggerate obesity-induced hepatic steatosis. The development of NAFLD has serious clinical complications because of its potential progression from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular carcinoma. Multiple mechanisms can be involved in nicotine plus high-fat diet-induced (HFD) hepatic steatosis. Emerging evidence now suggests that nicotine exacerbates hepatic steatosis triggered by HFD, through increased oxidative stress and hepatocellular apoptosis, decreased phosphorylation (inactivation) of adenosine-5-monophosphate-activated protein kinase and, in turn, up-regulation of sterol response-element binding protein 1-c, fatty acid synthase, and activation of acetyl-coenzyme A-carboxylase, leading to increased hepatic lipogenesis. There is also growing evidence that chronic endoplasmic reticulum stress through regulation of several pathways leading to oxidative stress, inflammation, perturbed hepatic lipid homeostasis, apoptosis, and autophagy can induce hepatic steatosis and its progression to NASH. Evidence also suggests a central role of the gut microbiota in obesity and its related disorders, including NAFLD. This review explores the contribution of nicotine and obesity to the development of NAFLD and its molecular underpinning.

Determinants of long-term weight change among middle-aged Swedish women

OBJECTIVE

To describe the determinants of 12-year weight change among middle-aged women in Sweden.

METHODS

In 1991/1992, 49,259 women across Sweden were recruited into a cohort. In 2003, 34,402 (73%) completed follow-up. Lifestyle and health characteristics including weight were collected, and 12-year weight change and substantial weight gain (≥+5.0 kg) were calculated; association between baseline characteristics and odds ratios (OR) with 95% confidence intervals (CI) of substantial weight gain were estimated.

RESULTS

During the 12-year follow-up, 81% of women experienced weight gain. Being above average weight (64.5 kg) at baseline (OR =1.20, 95% CI: 1.14-1.26) and smoking 1 to 9 (OR = 1.10, 95% CI: 1.01-1.20), 10 to 19 (OR = 1.30, 95% CI: 1.21-1.39), or ≥20 cigarettes daily (OR = 1.17, 95% CI: 1.04-1.32) increased a woman's odds of experiencing substantial weight gain (influenced by smoking cessation). In contrast, risk of substantial weight gain was reduced among women 45 to 50 years of age (OR = 0.79, 95% CI: 0.73-0.85), women reporting high alcohol consumption (OR = 0.90, 95% CI: 0.83-0.98), and those with medium (OR = 0.93, 95% CI: 0.87-1.00) or high (OR 0.83, 95% CI: 0.77-0.90) physical activity levels.

CONCLUSIONS

The majority of women experienced weight gain during middle age. Population-specific determinants of weight gain should guide obesity prevention efforts.

Clinical management of chronic obstructive pulmonary disease patients with muscle dysfunction

Muscle dysfunction is frequently observed in chronic obstructive pulmonary disease (COPD) patients, contributing to their exercise limitation and a worsening prognosis. The main factor leading to limb muscle dysfunction is deconditioning, whereas respiratory muscle dysfunction is mostly the result of pulmonary hyperinflation. However, both limb and respiratory muscles are also influenced by other negative factors, including smoking, systemic inflammation, nutritional abnormalities, exacerbations and some drugs. Limb muscle weakness is generally diagnosed through voluntary isometric maneuvers such as handgrip or quadriceps muscle contraction (dynamometry); while respiratory muscle loss of strength is usually recognized through a decrease in maximal static pressures measured at the mouth. Both types of measurements have validated reference values. Respiratory muscle strength can also be evaluated determining esophageal, gastric and transdiaphragmatic maximal pressures although there is a lack of widely accepted reference equations. Non-volitional maneuvers, obtained through electrical or magnetic stimulation, can be employed in patients unable to cooperate. Muscle endurance can also be assessed, generally using repeated submaximal maneuvers until exhaustion, but no validated reference values are available yet. The treatment of muscle dysfunction is multidimensional and includes improvement in lifestyle habits (smoking abstinence, healthy diet and a good level of physical activity, preferably outside), nutritional measures (diet supplements and occasionally, anabolic drugs), and different modalities of general and muscle training.