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Savic-Pesic D, Chamorro N, Lopez-Rodriguez V, Daniel-Diez J, Torres Creixenti A, El Mesnaoui MI, Benavides Navas VK, Castellanos Cotte JD, Abellan Cano I, Da Costa Azevedo FA, Trenza Peñas M, Voelcker-Sala I, Villalobos F, Satue-Gracia EM, Martin-Lujan F. Validity of the Espiro Mobile Application in the Interpretation of Spirometric Patterns: An App Accuracy Study. Diagnostics (Basel) 2023; 14:29. [PMID: 38201338 PMCID: PMC10795716 DOI: 10.3390/diagnostics14010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the interpretation of spirometry results; however, as yet none are validated. We evaluated the interpretation accuracy of the Espiro app using pulmonologist interpretations as the gold standard. This is an observational descriptive study in which 118 spirometry results were interpreted by the Espiro app, two pulmonologists, two primary care physicians, and two residents of a primary care training program. We determined the interpretation accuracy of the Espiro app and the concordance of the pattern and severity interpretation between the Espiro app and each of the observers using Cohen's kappa coefficient (k). We obtained a sensitivity and specificity for the Espiro app of 97.5% (95% confidence interval (CI): 86.8-99.9%) and 94.9% (95%CI: 87.4-98.6%) with pulmonologist 1 and 100% (95%CI: 91.6-100%) and 98.7% (95%CI: 92.9-99.9%) with pulmonologist 2. The concordance for the pattern interpretation was greater than k 0.907, representing almost perfect agreement. The concordance of the severity interpretation was greater than k 0.807, representing substantial to almost perfect agreement. We concluded that the Espiro app is a valid tool for spirometry interpretation.
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Affiliation(s)
- Darinka Savic-Pesic
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Carrer de Sant Llorenç, 21, 43201 Reus, Spain
| | - Nuria Chamorro
- Pneumology Service, Hospital Universitari de Tarragona Joan XXII, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Vanesa Lopez-Rodriguez
- Pneumology Service, Hospital Universitari de Tarragona Joan XXII, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain
| | - Jordi Daniel-Diez
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Anna Torres Creixenti
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Mohamed Issam El Mesnaoui
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Viviana Katherine Benavides Navas
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Jose David Castellanos Cotte
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
| | - Iván Abellan Cano
- Primary Care Unit, Sanitat Conselleria, Generalitat Valenciana, Dpto 18, Carretera de Sax s/n, 03600 Elda, Spain
| | | | - María Trenza Peñas
- Centro de Salud Aguilas Sur, Primary Care Unit, Servicio Murciano de Salud, Calle Rey Carlos III, s/n, 30880 Aguilas, Spain
| | - Iñaki Voelcker-Sala
- College of Medicine and Public Health, Flinders University, Flinders Drive, Bedford Park, SA 5042, Australia
| | - Felipe Villalobos
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
| | - Eva-María Satue-Gracia
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- Primary Care Research Support Unit Reus-Tarragona, Institut Català de la Salut, Camí de Riudoms, 53–55, 43202 Reus, Spain
| | - Francisco Martin-Lujan
- Camp de Tarragona Primary Care Unit, Institut Català de la Salut, Doctor Mallafrè Guasch, 4, 43005 Tarragona, Spain; (D.S.-P.); (E.-M.S.-G.)
- ISAC Research Group, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut IDIAP Jordi Gol, Gran Vía de Les Corts Catalanes, 591 Ático, 08007 Barcelona, Spain;
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Carrer de Sant Llorenç, 21, 43201 Reus, Spain
- Primary Care Research Support Unit Reus-Tarragona, Institut Català de la Salut, Camí de Riudoms, 53–55, 43202 Reus, Spain
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Catalin RE, Martin-Lujan F, Salamanca-Gonzalez P, Palleja-Millan M, Villalobos F, Santigosa-Ayala A, Pedret A, Valls-Zamora RM, Sola R. Mediterranean Diet and Lung Function in Adults Current Smokers: A Cross-Sectional Analysis in the MEDISTAR Project. Nutrients 2023; 15:nu15051272. [PMID: 36904270 PMCID: PMC10005310 DOI: 10.3390/nu15051272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Previous studies have shown that adherence to the Mediterranean Diet (MeDi) has a positive impact on lung function in subjects with lung disease. In subjects free of respiratory diseases, but at risk, this association is not yet well established. METHODS Based on the reference data from the MEDISTAR clinical trial (Mediterranean Diet and Smoking in Tarragona and Reus; ISRCTN 03.362.372), an observational study was conducted with 403 middle-aged smokers without lung disease, treated at 20 centres of primary care in Tarragona (Catalonia, Spain). The degree of MeDi adherence was evaluated according to a 14-item questionnaire, and adherence was defined in three groups (low, medium, and high). Lung function were assessed by forced spirometry. Logistic regression and linear regression models were used to analyse the association between adherence to the MeDi and the presence of ventilatory defects. RESULTS Globally, the pulmonary alteration prevalence (impaired FEV1 and/or FVC) was 28.8%, although it was lower in participants with medium and high adherence to the MeDi, compared to those with a low score (24.2% and 27.4% vs. 38.5%, p = 0.004). Logistic regression models showed a significant and independent association between medium and high adherence to the MeDi and the presence of altered lung patterns (OR 0.467 [95%CI 0.266, 0.820] and 0.552 [95%CI 0.313, 0.973], respectively). CONCLUSIONS MeDi adherence is inversely associated with the risk impaired lung function. These results indicate that healthy diet behaviours can be modifiable risk factors to protect lung function and reinforce the possibility of a nutritional intervention to increase adherence to MeDi, in addition to promoting smoking cessation.
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Affiliation(s)
- Roxana-Elena Catalin
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Francisco Martin-Lujan
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Departament of Medicine and Surgery, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
- Correspondence:
| | - Patricia Salamanca-Gonzalez
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Meritxell Palleja-Millan
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Departament of Medicine and Surgery, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Felipe Villalobos
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Antoni Santigosa-Ayala
- Research Support Unit Camp of Tarragona, Department of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Reus, Spain
- CENIT Research Group, Fundació Institut Universitari Per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Departament of Medicine and Surgery, Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Anna Pedret
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Rosa M. Valls-Zamora
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Rosa Sola
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Universitat Rovira i Virgili, 43201 Reus, Spain
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Salamanca-González P, Valls-Zamora RM, Pedret-Figuerola A, Sorlí-Aguilar M, Santigosa-Ayala A, Catalin RE, Pallejà-Millán M, Solà-Alberich R, Martin-Lujan F. Effectiveness of a Motivational Nutritional Intervention through Social Networks 2.0 to Increase Adherence to the Mediterranean Diet and Improve Lung Function in Active Smokers: The DIET Study, a Randomized, Controlled and Parallel Clinical Trial in Primary Care. Nutrients 2021; 13:3597. [PMID: 34684600 PMCID: PMC8538243 DOI: 10.3390/nu13103597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diet can help preserve lung function in smokers, as well as aid individuals who avoid smoking. This study aimed to evaluate the effectiveness of a nutritional intervention, using the Social Networks 2.0 tool, to increase adherence to the Mediterranean diet (MD) and improve lung function in smokers without prior respiratory disease. METHODS A randomized controlled parallel design was used. The participants were assigned to either the intervention or control group. Data from representative smokers without respiratory disease (n = 77) aged 18-70 years were analyzed. The participants completed a validated semi-quantitative food-frequency questionnaire, and their adherence to the diet was evaluated by using the questionnaire called the Mediterranean Diet Adherence Score (MEDAS, with 14 items), which considers ≥9 points to indicate high adherence. The lung function was assessed by spirometry. Associations among variables were determined by logistic regression. RESULTS A comparison of the variables at the end of the study between the control and intervention groups showed that the intervention significantly increased adherence to the MD based on the MEDAS questionnaire (0.69 (2.1) vs. 2.05 (2.03); p = 0.009). Specifically, the consumption of fruits was increased after two years in both groups; however, a more significant increase was detected in the intervention group (121 (178) vs. 12.7 (167) in the control group; p-value = 0.008). In the unadjusted analysis, the intervention only showed a statistical significant increase in the score of adherence to the MD (β: 1.36; 95% CI 0.35; 2.3; p = 0.009), and this increase was maintained after adjusting for age and sex (β: 1.15; 95% CI 0.05; 2.2; p = 0.040) and after adjusting for various sociodemographic, lifestyle and anthropometric variables (β: 1.17; 95% CI 0.02; 2.31; p = 0.046). The pulmonary function parameters improved more in the intervention group; however, no significant differences were observed between the two groups. CONCLUSIONS A nutritional intervention based on a dietetic-nutritional education program resulted in a significant increase in adherence to the MD. However, some evidence suggests that an MD dietary intervention can improve lung function, but in our study, we were not able to demonstrate this. Further research is needed to obtain more robust data and confirm a possible benefit of the program before it can be extended to general practice.
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Affiliation(s)
- Patricia Salamanca-González
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain; (P.S.-G.); (R.M.V.-Z.); (A.P.-F.); (R.S.-A.)
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain; (M.S.-A.); (A.S.-A.); (R.-E.C.)
| | - Rosa Maria Valls-Zamora
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain; (P.S.-G.); (R.M.V.-Z.); (A.P.-F.); (R.S.-A.)
| | - Anna Pedret-Figuerola
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain; (P.S.-G.); (R.M.V.-Z.); (A.P.-F.); (R.S.-A.)
| | - Mar Sorlí-Aguilar
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain; (M.S.-A.); (A.S.-A.); (R.-E.C.)
| | - Antoni Santigosa-Ayala
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain; (M.S.-A.); (A.S.-A.); (R.-E.C.)
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Doctor Mallafré Guach, 4, 43007 Tarragona, Spain
- Departament de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain;
| | - Roxana-Elena Catalin
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain; (M.S.-A.); (A.S.-A.); (R.-E.C.)
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Doctor Mallafré Guach, 4, 43007 Tarragona, Spain
| | - Meritxell Pallejà-Millán
- Departament de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain;
- Research Support Unit Camp of Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Camí de Riudoms, 53-55, 43202 Reus, Spain
| | - Rosa Solà-Alberich
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain; (P.S.-G.); (R.M.V.-Z.); (A.P.-F.); (R.S.-A.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan XXIII, Doctor Mallafré Guasch, 4, 43007 Tarragona, Spain
| | - Francisco Martin-Lujan
- CENIT Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain; (M.S.-A.); (A.S.-A.); (R.-E.C.)
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Doctor Mallafré Guach, 4, 43007 Tarragona, Spain
- Departament de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, Sant Llorenç, 21, 43201 Reus, Spain;
- Research Support Unit Camp of Tarragona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Camí de Riudoms, 53-55, 43202 Reus, Spain
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Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M, Aveyard P. Interventions for preventing weight gain after smoking cessation. Cochrane Database Syst Rev 2021; 10:CD006219. [PMID: 34611902 PMCID: PMC8493442 DOI: 10.1002/14651858.cd006219.pub4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most people who stop smoking gain weight. This can discourage some people from making a quit attempt and risks offsetting some, but not all, of the health advantages of quitting. Interventions to prevent weight gain could improve health outcomes, but there is a concern that they may undermine quitting. OBJECTIVES To systematically review the effects of: (1) interventions targeting post-cessation weight gain on weight change and smoking cessation (referred to as 'Part 1') and (2) interventions designed to aid smoking cessation that plausibly affect post-cessation weight gain (referred to as 'Part 2'). SEARCH METHODS Part 1 - We searched the Cochrane Tobacco Addiction Group's Specialized Register and CENTRAL; latest search 16 October 2020. Part 2 - We searched included studies in the following 'parent' Cochrane reviews: nicotine replacement therapy (NRT), antidepressants, nicotine receptor partial agonists, e-cigarettes, and exercise interventions for smoking cessation published in Issue 10, 2020 of the Cochrane Library. We updated register searches for the review of nicotine receptor partial agonists. SELECTION CRITERIA Part 1 - trials of interventions that targeted post-cessation weight gain and had measured weight at any follow-up point or smoking cessation, or both, six or more months after quit day. Part 2 - trials included in the selected parent Cochrane reviews reporting weight change at any time point. DATA COLLECTION AND ANALYSIS Screening and data extraction followed standard Cochrane methods. Change in weight was expressed as difference in weight change from baseline to follow-up between trial arms and was reported only in people abstinent from smoking. Abstinence from smoking was expressed as a risk ratio (RR). Where appropriate, we performed meta-analysis using the inverse variance method for weight, and Mantel-Haenszel method for smoking. MAIN RESULTS Part 1: We include 37 completed studies; 21 are new to this update. We judged five studies to be at low risk of bias, 17 to be at unclear risk and the remainder at high risk. An intermittent very low calorie diet (VLCD) comprising full meal replacement provided free of charge and accompanied by intensive dietitian support significantly reduced weight gain at end of treatment compared with education on how to avoid weight gain (mean difference (MD) -3.70 kg, 95% confidence interval (CI) -4.82 to -2.58; 1 study, 121 participants), but there was no evidence of benefit at 12 months (MD -1.30 kg, 95% CI -3.49 to 0.89; 1 study, 62 participants). The VLCD increased the chances of abstinence at 12 months (RR 1.73, 95% CI 1.10 to 2.73; 1 study, 287 participants). However, a second study found that no-one completed the VLCD intervention or achieved abstinence. Interventions aimed at increasing acceptance of weight gain reported mixed effects at end of treatment, 6 months and 12 months with confidence intervals including both increases and decreases in weight gain compared with no advice or health education. Due to high heterogeneity, we did not combine the data. These interventions increased quit rates at 6 months (RR 1.42, 95% CI 1.03 to 1.96; 4 studies, 619 participants; I2 = 21%), but there was no evidence at 12 months (RR 1.25, 95% CI 0.76 to 2.06; 2 studies, 496 participants; I2 = 26%). Some pharmacological interventions tested for limiting post-cessation weight gain (PCWG) reduced weight gain at the end of treatment (dexfenfluramine, phenylpropanolamine, naltrexone). The effects of ephedrine and caffeine combined, lorcaserin, and chromium were too imprecise to give useful estimates of treatment effects. There was very low-certainty evidence that personalized weight management support reduced weight gain at end of treatment (MD -1.11 kg, 95% CI -1.93 to -0.29; 3 studies, 121 participants; I2 = 0%), but no evidence in the longer-term 12 months (MD -0.44 kg, 95% CI -2.34 to 1.46; 4 studies, 530 participants; I2 = 41%). There was low to very low-certainty evidence that detailed weight management education without personalized assessment, planning and feedback did not reduce weight gain and may have reduced smoking cessation rates (12 months: MD -0.21 kg, 95% CI -2.28 to 1.86; 2 studies, 61 participants; I2 = 0%; RR for smoking cessation 0.66, 95% CI 0.48 to 0.90; 2 studies, 522 participants; I2 = 0%). Part 2: We include 83 completed studies, 27 of which are new to this update. There was low certainty that exercise interventions led to minimal or no weight reduction compared with standard care at end of treatment (MD -0.25 kg, 95% CI -0.78 to 0.29; 4 studies, 404 participants; I2 = 0%). However, weight was reduced at 12 months (MD -2.07 kg, 95% CI -3.78 to -0.36; 3 studies, 182 participants; I2 = 0%). Both bupropion and fluoxetine limited weight gain at end of treatment (bupropion MD -1.01 kg, 95% CI -1.35 to -0.67; 10 studies, 1098 participants; I2 = 3%); (fluoxetine MD -1.01 kg, 95% CI -1.49 to -0.53; 2 studies, 144 participants; I2 = 38%; low- and very low-certainty evidence, respectively). There was no evidence of benefit at 12 months for bupropion, but estimates were imprecise (bupropion MD -0.26 kg, 95% CI -1.31 to 0.78; 7 studies, 471 participants; I2 = 0%). No studies of fluoxetine provided data at 12 months. There was moderate-certainty that NRT reduced weight at end of treatment (MD -0.52 kg, 95% CI -0.99 to -0.05; 21 studies, 2784 participants; I2 = 81%) and moderate-certainty that the effect may be similar at 12 months (MD -0.37 kg, 95% CI -0.86 to 0.11; 17 studies, 1463 participants; I2 = 0%), although the estimates are too imprecise to assess long-term benefit. There was mixed evidence of the effect of varenicline on weight, with high-certainty evidence that weight change was very modestly lower at the end of treatment (MD -0.23 kg, 95% CI -0.53 to 0.06; 14 studies, 2566 participants; I2 = 32%); a low-certainty estimate gave an imprecise estimate of higher weight at 12 months (MD 1.05 kg, 95% CI -0.58 to 2.69; 3 studies, 237 participants; I2 = 0%). AUTHORS' CONCLUSIONS Overall, there is no intervention for which there is moderate certainty of a clinically useful effect on long-term weight gain. There is also no moderate- or high-certainty evidence that interventions designed to limit weight gain reduce the chances of people achieving abstinence from smoking.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amanda Farley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Laura L Jones
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Laura Kudlek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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