Cigarette Smoking and Food and Nutrient Intakes in Relation to Coronary Heart Disease

My nutrition index: a method for measuring optimal daily nutrient intake

Background

Adequate nutrition is essential for individual and population level health. However, determining adequacy of daily nutrient intake in research studies is often challenging given the unique nutritional needs of individuals. Herein, we examine construct, predictive, criterion, content, and concurrent validity of a dietary analytic tool – My Nutrition Index (MNI) for measuring nutrient intake in relation to personalized daily nutrient intake guidelines. MNI gauges adequacy of an individual’s daily nutrient intake based on his or her unique demographic and lifestyle characteristics. MNI accounts for potential adverse effects of inadequate and excess nutrient consumption.

Methods

MNI, calculated based on 34 nutrients, provides an overall index score ranging from 0 to 100, with higher scores reflecting a more nutritious diet. We calculated MNI scores for 7154 participants ages 18-65 in the National Health and Nutrition Examination Surveys (2007-2014) by using average nutrient intakes from two 24-h dietary recalls. Survey-weighted binary logistic regression models were used to assess associations between MNI scores and obesity, depression, health perceptions, and past or present cardiovascular disease.

Results

Higher MNI scores were associated with lower prevalence of self-reported cardiovascular disease (OR = 0.69, CI: 0.52, 0.92, p = 0.012), depression (OR = 0.76, CI: 0.65, 0.90, p < 0.001), and obesity (OR = 0.92, CI: 0.87, 0.99, p = 0.016), as well as more favorable health perceptions (OR = 1.24, CI: 1.13, 1.37, p < 0.001).

Conclusions

MNI provides an individualized approach for measuring adequacy/sufficiency of daily nutrient intake that can validly be employed to assess relationships between nutrition and health outcomes in research studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00497-9.

Developmental trajectories of body mass index since childhood and health-related quality of life in young adulthood: Tehran Lipid and Glucose Study

PURPOSE

The association between long-term BMI changes since childhood and health-related quality of life (HRQoL) in adulthood is still unclear. This study aimed to examine the association between identified BMI trajectories and HRQoL.

METHODS

A population-based cohort of 1938 eligible children (3-18 years) and their parents have been repeatedly followed up for 18 years. Offspring BMI trajectories were identified using group-based trajectory models. HRQoL was evaluated in offspring aged 21-36 years using SF-12V2. Using quantile regression analysis, the associations of the identified BMI trajectories and HRQoL in young adulthood were examined.

RESULTS

In males, persistent increasing overweight/obese group was negatively associated with 30th, 40th, 50th, and 60th percentiles of physical component summary (PCS) score distribution (β = - 2.60, p = 0.006; β = - 2.01, p = 0.005; β = - 1.86, p = 0.001; β = - 1.98, p = 0.009, respectively). A similar result was observed only in the 40th percentile of PCS distribution for the progressive overweight group (β = - 1.03, p = 0.022). In addition, the progressive overweight group in males showed a positive association with the upper tail of mental component summary (MCS) score distribution specifically for the 90th percentile (β = 1.15, p = 0.036). Regarding females, the current results indicated that the 90th percentile of MCS distributions was decreased in the persistent increasing overweight/obese group for females (β = - 1.83, p = 0.024). In addition, the progressive overweight group in females had a positive association with lower (30th and 40th) percentiles of PCS distribution (β = 1.29, p = 0.034, and β = 1.15, p = 0.030, respectively).

CONCLUSION

A sex-specific conditional association between developmental BMI trajectories from childhood and HRQoL in young adulthood was observed in physical and mental HRQoL.

Exercise and food supplement of vitamin C ameliorate hypertension through improvement of gut microflora in the spontaneously hypertensive rats

AIMS

Exercise and food supplement of vitamin C (VC) are beneficial to human health, especially for those who suffer from hypertension. Here we tend to explore if gut microflora is involved in the anti-hypertensive effects of exercise and VC-supplement therapies.

MATERIALS AND METHODS

With the spontaneously hypertensive rat (SHR) model, the small intestine pathology and the fecal microbiota was analyzed along with the pro- and anti-inflammatory cytokines (PICs and AICs) and reactive oxygen species (ROS) in the hypothalamus paraventricular nucleus (PVN) and intestine.

KEY FINDINGS

We found that both exercise and VC intake, individually or combined, were able to alleviate the blood pressure in the SHRs comparing to the normotensive control Wistar-kyoto (WKY) rats. The expression level of PICs in the PVN and intestine of the SHRs was down-regulated while the AICs were up-regulated after treatments, together with down-regulation of ROS in the PVN. At meantime, the gut pathology was dramatically improved in the SHRs with exercise training or VC intake. Analysis of the gut microflora revealed significant changes in their composition. Several important micro-organisms that were deficient in the SHRs were found up-regulated by the treatments, including Turicibacter and Romboutsia which are involved in the short-chain fatty acid production.

SIGNIFICANCE

Exercise training and VC intake individually can modify the gut microflora composition and improve the inflammatory state in both PVN and intestine, which contribute to their anti-hypertensive function. Combination of the two treatments enhanced their effects and worth to be considered as a non-medical aid for the hypertensive patients.

Smoking-by-genotype interaction in type 2 diabetes risk and fasting glucose

Smoking is a potentially causal behavioral risk factor for type 2 diabetes (T2D), but not all smokers develop T2D. It is unknown whether genetic factors partially explain this variation. We performed genome-environment-wide interaction studies to identify loci exhibiting potential interaction with baseline smoking status (ever vs. never) on incident T2D and fasting glucose (FG). Analyses were performed in participants of European (EA) and African ancestry (AA) separately. Discovery analyses were conducted using genotype data from the 50,000-single-nucleotide polymorphism (SNP) ITMAT-Broad-CARe (IBC) array in 5 cohorts from from the Candidate Gene Association Resource Consortium (n = 23,189). Replication was performed in up to 16 studies from the Cohorts for Heart Aging Research in Genomic Epidemiology Consortium (n = 74,584). In meta-analysis of discovery and replication estimates, 5 SNPs met at least one criterion for potential interaction with smoking on incident T2D at p<1x10-7 (adjusted for multiple hypothesis-testing with the IBC array). Two SNPs had significant joint effects in the overall model and significant main effects only in one smoking stratum: rs140637 (FBN1) in AA individuals had a significant main effect only among smokers, and rs1444261 (closest gene C2orf63) in EA individuals had a significant main effect only among nonsmokers. Three additional SNPs were identified as having potential interaction by exhibiting a significant main effects only in smokers: rs1801232 (CUBN) in AA individuals, rs12243326 (TCF7L2) in EA individuals, and rs4132670 (TCF7L2) in EA individuals. No SNP met significance for potential interaction with smoking on baseline FG. The identification of these loci provides evidence for genetic interactions with smoking exposure that may explain some of the heterogeneity in the association between smoking and T2D.

Association between Serum Vitamin C and the Blood Pressure: A Systematic Review and Meta-Analysis of Observational Studies

Background

Hypertension is regarded as a major and independent risk factor of cardiovascular diseases, and numerous studies observed an inverse correlation between vitamin C intake and blood pressure.

Aim

Our aim is to investigate the relationship between serum vitamin C and blood pressure, including the concentration differences and the correlation strength.

Method

Two independent researchers searched and screened articles from the National Library of Medicine, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP databases, and WANFANG databases. A total of 18 eligible studies were analyzed in the Reviewer Manager 5.3 software, including 14 English articles and 4 Chinese articles.

Results

In the evaluation of serum vitamin C levels, the concentration in hypertensive subjects is 15.13 μmol/L lower than the normotensive ones (mean difference = −15.13, 95% CI [-24.19, -6.06], and P = 0.001). Serum vitamin C has a significant inverse relation with both systolic blood pressure (Fisher′s Z = −0.17, 95% CI [-0.20, -0.15], P < 0.00001) and diastolic blood pressure (Fisher′s Z = −0.15, 95% CI [-0.20, -0.10], P < 0.00001).

Conclusions

People with hypertension have a relatively low serum vitamin C, and vitamin C is inversely associated with both systolic blood pressure and diastolic blood pressure.

Weight control belief and its impact on the effectiveness of tobacco control policies on quit attempts: findings from the ITC 4 Country Survey

BACKGROUND

Weight concerns are widely documented as one of the major barriers for girls and young adult women to quit smoking. Therefore, it is important to investigate whether smokers who have weight concerns respond to tobacco control policies differently than smokers who do not in terms of quit attempts, and how this difference varies by gender and country.

OBJECTIVE

This study aims to investigate, by gender and country, whether smokers who believe that smoking helps control weight are less responsive to tobacco control policies with regards to quit attempts than those who do not.

METHODS

We use longitudinal data from the International Tobacco Control Policy Evaluation Project in the USA, Canada, the UK and Australia to conduct the analysis. We first constructed a dichotomous indicator for smokers who have the weight control belief and then examined the disparity in policy responsiveness in terms of quit attempts by directly estimating the interaction terms of policies and the weight control belief indicator using generalised estimating equations.

FINDINGS

We find that weight control belief significantly attenuates the policy impact of tobacco control measures on quit attempts among US female smokers and among UK smokers. This pattern was not found among smokers in Canada and Australia.

CONCLUSIONS

Although our results vary by gender and country, the findings suggest that weight concerns do alter policy responsiveness in quit attempts in certain populations. Policy makers should take this into account and alleviate weight concerns to enhance the effectiveness of existing tobacco control policies on promoting quitting smoking.

Consequences of smoking for body weight, body fat distribution, and insulin resistance

Our aim was to critically evaluate the relations among smoking, body weight, body fat distribution, and insulin resistance as reported in the literature. In the short term, nicotine increases energy expenditure and could reduce appetite, which may explain why smokers tend to have lower body weight than do nonsmokers and why smoking cessation is frequently followed by weight gain. In contrast, heavy smokers tend to have greater body weight than do light smokers or nonsmokers, which likely reflects a clustering of risky behaviors (eg, low degree of physical activity, poor diet, and smoking) that is conducive to weight gain. Other factors, such as weight cycling, could also be involved. In addition, smoking increases insulin resistance and is associated with central fat accumulation. As a result, smoking increases the risk of metabolic syndrome and diabetes, and these factors increase risk of cardiovascular disease. In the context of the worldwide obesity epidemic and a high prevalence of smoking, the greater risk of (central) obesity and insulin resistance among smokers is a matter of major concern.

Clustering of risk behaviors with cigarette consumption: A population-based survey

OBJECTIVE

This study assessed clustering of multiple risk behaviors (i.e., low leisure-time physical activity, low fruits/vegetables intake, and high alcohol consumption) with level of cigarette consumption.

METHODS

Data from the 2002 Swiss Health Survey, a population-based cross-sectional telephone survey assessing health and self-reported risk behaviors, were used. 18,005 subjects (8052 men and 9953 women) aged 25 years old or more participated.

RESULTS

Smokers more frequently had low leisure time physical activity, low fruits/vegetables intake, and high alcohol consumption than non- and ex-smokers. Frequency of each risk behavior increased steadily with cigarette consumption. Clustering of risk behaviors increased with cigarette consumption in both men and women. For men, the odds ratios of multiple (> or =2) risk behaviors other than smoking, adjusted for age, nationality, and educational level, were 1.14 (95% confidence interval: 0.97, 1.33) for ex-smokers, 1.24 (0.93, 1.64) for light smokers (1-9 cigarettes/day), 1.72 (1.36, 2.17) for moderate smokers (10-19 cigarettes/day), and 3.07 (2.59, 3.64) for heavy smokers (> or =20 cigarettes/day) versus non-smokers. Similar odds ratios were found for women for corresponding groups, i.e., 1.01 (0.86, 1.19), 1.26 (1.00, 1.58), 1.62 (1.33, 1.98), and 2.75 (2.30, 3.29).

CONCLUSIONS

Counseling and intervention with smokers should take into account the strong clustering of risk behaviors with level of cigarette consumption.

RELATIONSHIP BETWEEN SMOKING HABITS AND SERUM OXYGEN RADICAL ABSORBANCE CAPACITY AND DIETARY INTAKE IN JAPANESE ADULTS

1. The present study was undertaken to investigate the effect of smoking habits on dietary intake, serum oxygen radical absorbance capacity (ORAC) and lifestyle in Japanese adults. 2. Lifestyle factors were recorded by questionnaire and dietary intake was measured by a single 24 h food recall. Blood was collected under fasting conditions for analysis. 3. Smokers had lower intakes of vitamin C, fruits and dark green and yellow vegetables (DGYV), higher consumption of alcohol, lower physical activity and lower ORAC values than non-smokers. Body mass index (BMI), serum total cholesterol (TC) and triacylglycerol (TG) increased, whereas high-density lipoprotein-cholesterol (HDL-C) decreased with an increase in the amount smoked, but there were no significant differences between smokers and non-smokers. 4. It is considered that high cancer and cardiovascular risks among smokers are also reinforced by undesirable lifestyle factors other than smoking.

Haptoglobin 2-2 phenotype is associated with decreased ferroxidase activity in smokers

BACKGROUND

Cigarette smoking and the inheritance of Hp 2-2 phenotype have been separately linked to cardiovascular disease. In this study, the combined effects of smoking and the presence of Hp 2-2 type on predisposition to cardiovascular disease were investigated.

METHODS

Fasting blood specimens were collected from 489 Jordanian males (228 smokers and 261 nonsmokers). Haptoglobin phenotype was determined by electrophoresis, and lipid profile and ferroxidase activity were determined by spectrophotometric methods.

RESULTS

The results show that, irrespective of Hp type, total- and LDL-cholesterol levels were significantly higher in smokers compared with nonsmokers, while levels of HDL-cholesterol and ferroxidase activity were lower in smokers. There was no significant difference between the three Hp types in nonsmokers regarding the lipid profile and ferroxidase activity. In the smokers group, however, serum ferroxidase activity was significantly lower in individuals with Hp 2-2 type compared with that in Hp 1-1 and Hp 2-1 smoker individuals. Smokers with the Hp 2-2 type have significantly higher levels of total- and LDL-cholesterol and lower HDL-cholesterol levels compared with that in nonsmokers expressing the same Hp type.

CONCLUSION

These findings demonstrate that smokers with Hp 2-2 phenotype have a decreased antioxidant capacity suggesting that smoking coupled with the inheritance of an Hp-2-2 type predispose to more oxidative stress and cardiovascular disease.

Associations between health-related behaviors: a 7-year follow-up of adults

BACKGROUND

The study examines pairwise associations between smoking, alcohol use, physical activity, dietary behavior and body mass index using long-term follow-up data of Finnish adults.

METHODS

Respondents to large nationwide health behavior surveys conducted in 1989/1990 were recontacted in 1997. First, we examined whether each health behavior predicted other behaviors 7 years later. Second, we examined whether changes in each health behavior were accompanied by changes in other behaviors.

RESULTS

Smoking at baseline predicted all other health behaviors except body mass index in men. On the other hand, other behaviors tended to predict smoking. Physical inactivity and unhealthy diet were predictive of each other in men. Those with an unhealthy diet at baseline were less likely to be high alcohol users in the follow-up. Baseline body mass index did not predict any of the other behaviors. Concurrent changes in health behaviors involved either smoking or body mass index. Changes in diet and alcohol use were differently related to changes in body mass index in men than in women.

CONCLUSIONS

Overall, smoking seemed to play a central role in the associations between health behaviors. Smoking was predictive of most other health behaviors. Concurrent changes in health behaviors related either to smoking or to body weight. The associations between health behaviors were fairly similar for men and women, but the variation in the associations between body mass index and some other health behaviors suggests gender differences in the behavioral response to body weight.

Acrolein-induced cytotoxicity in cultured human bronchial epithelial cells. Modulation by alpha-tocopherol and ascorbic acid

Acrolein is a highly reactive unsaturated hazardous air pollutant of human health concern, particularly as a component of cigarette smoke. In this study, the mechanisms of acrolein-induced cytotoxicity in human bronchial epithelial cells (HBE1) and the modulating effects of antioxidants were examined. Our results show that acrolein induces a cell death pathway in human bronchial epithelial cells, which retain key features of apoptosis, as indicated by phosphatidylserine (PS) externalization and DNA fragmentation. Acrolein-induced apoptosis was associated with depletion of cellular GSH and intracellular generation of oxidants. Supplementation of cells with either alpha-tocopherol or ascorbic acid was found to strongly inhibit acrolein-induced apoptosis and to prevent the increase in the generation of intracellular oxidants, although GSH depletion was unaffected. Moreover, recovery of cellular GSH levels after acrolein exposure was enhanced following either alpha-tocopherol or ascorbic acid supplementation. The intracellular generation of oxidants following acrolein exposure seems to be an important event triggering the apoptotic response in this model system.

Does the association between smoking status and selected healthy foods depend on gender? A population-based study of 54 417 middle-aged Danes

OBJECTIVE

Smoking serves different functions for men and women. Thus, we wanted to investigate the association between smoking behaviour and intakes of selected healthy foods in men and women with special focus on differences and similarities between the two genders.

DESIGN

In 1993-1997, a random sample of 80 996 men and 79 729 women aged 50-64 y was invited to participate in the study 'Diet, Cancer and Health'. In all, 27 179 men and 29 876 women attended a health examination and completed a 192-item food-frequency questionnaire (FFQ). The association between smoking status and low, median and high intakes of selected foods was examined among 25 821 men and 28 596 women.

SETTING

The greater Copenhagen and Aarhus area, Denmark.

RESULTS

For both men and women, smoking status group was associated with diet, such that increasing level of smoking status ranging from never smokers over ex-smokers to currently heavy smokers was associated with a lower intake of the healthy foods: fresh fruit, cooked vegetables, raw vegetables/salad, and olive oil. For wine, increasing level of smoking status category was associated with a higher fraction of abstainers and heavy drinkers. The difference between the extreme smoking status categories was larger than the difference between men and women within smoking status categories such that never smoking men in general had a higher intake of healthy foods than heavy smoking women. Correction for age, educational level, and body mass index (BMI) did not affect the results.

CONCLUSION

In this middle-aged population, intake of healthy foods were associated with smoking behaviour with a dose-response type of relationship. The overall pattern was similar for men and women.

Autoantibody against oxidized low-density lipoproteins may be enhanced by cigarette smoking

A total of 59 healthy male subjects (32 smokers and 27 nonsmokers) who had no reported systemic disease and did not take alcohol and vitamin supplementation were included. The levels of autoantibody to oxidized low-density lipoproteins (ox-LDL) in smokers and age-matched nonsmokers were compared. The plasma levels of antioxidants that can affect the formation of ox-LDL were also measured, and correlation analyses between anti ox-LDL IgG and plasma antioxidants, controlling for age and body mass index (BMI), were performed. Plasma alpha-tocopherol and uric acid concentrations of nonsmokers (2.78+/-1.09 microg/mg total lipid and 6.96+/-1.69 mg/dl, respectively) were significantly higher than those of smokers (1.68+/-0.48 microg/mg total lipid and 6.15+/-1.14 mg/dl, respectively) (P<0.05). Although plasma ascorbate and retinol levels were not significantly different between smokers and nonsmokers, smokers older than 45 years old had significantly lower plasma ascorbate levels (0.32+/-0.17 mg/dl) than age-matched nonsmokers (0. 53+/-0.14 mg/dl) (P=0.036). Higher level of plasma anti ox-LDL IgG was noted in the group of smokers compared with nonsmokers (515+/-409 mU/ml vs. 407+/-268 mU/ml, respectively) under the statistic method of Chi-Square test (P=0.049). A significant negative correlation was found between plasma anti ox-LDL IgG and alpha-tocopherol in the combined population as well as in the smoker group (r=-0.26, p=0.047; r=-0.48, p=0.006; respectively). However, there was no correlation between plasma anti ox-LDL IgG and the levels of other antioxidants. These results suggest that reduced concentrations of alpha-tocopherol are associated with cigarette smoking. The significantly negative correlation between plasma anti ox-LDL IgG and alpha-tocopherol in the entire study population as well as in the smoker group suggests that plasma alpha-tocopherol may be partially effective if not totally at protecting LDL from oxidative damage caused by cigarette smoking and dietary supplementation with alpha-tocopherol may provide a protective effect against LDL oxidation, especially in smokers.

The Health Education Authority's health and lifestyle survey 1993: who are the low fruit and vegetable consumers?

STUDY OBJECTIVE

Firstly, to determine the demographic and behavioural characteristics of low fruit and vegetable consumers. Secondly, to investigate whether knowledge and attitudes are barriers to consumption of fruit and vegetables.

DESIGN

Cross sectional survey: an interviewer administrated questionnaire was used to assess the demographic, knowledge, attitude, and behavioural characteristics of the respondents.

SETTING

England.

PARTICIPANTS

Random sample of 5553 men and women aged between 16 and 74 years. Response rate 70%.

MAIN RESULTS

The main demographic characteristics of the respondents identified as low consumers of fruit and vegetables (less than daily consumption of either fruit or vegetables) were age, sex, and smoking status. The adjusted odds ratios were 2.59 for those aged 16-24 years compared with those aged 45-74 years, 2.17 for men compared with women, and 1.77 for current smokers compared with never smokers. The most important knowledge and attitude statements after adjusting for the demographic variables were disagreeing with the statement "healthy foods are enjoyable" (odds ratio 1.90) and agreeing with the statement "I don't really care what I eat" (odds ratio 1.76). The impact of knowledge seemed less important than attitudes about a healthy diet in characterising a low fruit and vegetable consumer.

CONCLUSIONS

These findings are relevant to future strategies for improving intake of fruit and vegetables, but demonstrate the complexity of interventions required, and the dangers inherent in assuming simplistic relations between psychosocial factors and behaviour.

Smoking, diet, and health behaviors among lead-exposed blue-collar workers

The objectives of the study were to compare dietary intake by smoking levels in blue-collar Israeli workers occupationally exposed to lead and thus identify additional areas for health-enhancing intervention in addition to smoking cessation. One hundred and eighty-seven male industrial employees who were exposed to lead through their work were screened at the worksite to evaluate health status and dietary intake. Smokers had higher intakes of fat, cholesterol, calcium, riboflavin, and vitamin E per day. They were consuming more meat and high-fat dairy products. Dose-response relationships were shown for fat and energy intake by smoking level. Thus, smoking is associated with other adverse health behaviors. When conducting epidemiologic or occupational studies, analyses should include adjustment for the fact that the lifestyles of smokers may also be unhealthy in other ways.

High-dose vitamin supplements for cigarette smokers: caution is indicated

Results from human intervention studies indicate that smokers should avoid using high-dose dietary beta-carotene supplements. In addition, problems may exist for smokers with high-dose vitamin E supplements.

Lifestyle and dietary differences in smokers and non-smokers from an Italian employee population

In a sample of 200 subjects, representative of a population of 1936 civil servants, we tested differences in life style, dietary habits and distribution of risk factors for CHD between smokers and nonsmokers. The two groups (79 smokers) and (121 non-smokers) did not differ significantly by age or sex. The percentage of sedentary subjects, of hypercholesterolaemics and of hypertensives was found to be particularly high among smokers: 67%, 33% and 30% respectively (vs 59%, 27% and 19% in non-smokers). More smokers were obese (11% vs 5%) but mean BMI was the same in smokers/non-smokers but showed a higher fat mass; the association of CHD risk factors indicates only one significant correlation (P < 0.05) between obesity and hypertension. In male smokers, higher values of LDL and triglycerides and lower intake of energy, vitamins C and A are observed and these values are significantly different than those for non-smokers. In women HDL values are higher in non-smokers whereas, in female smokers, the food cholesterol intake is particularly high 271 +/- 295 mg. There are also correlations both for the anthropometric and clinical parameters and for energy and nutrients, indicating that the lifestyle of smokers is less healthy than that of non-smokers. Smokers cat vegetables and fruits less frequently and consume more alcohol than non-smokers, who prefer sweet foods.

Lipaemia and lipoproteinaemia in a Spanish male nonsmoker population consuming sunflower oil

The aim of this study was to assess the prevalence of altered levels of serum lipids, lipoproteins and apolipoprotein (Apo) B in very active, 20 to 65 year-old, Spanish male nonsmokers who consumed sunflower oil. Among the 169 participants, total serum cholesterol (TC), triglycerides (TG), LDL-C, and TC/HDL-C were found to be age-dependent variables. A detailed study over a 12-day period showed that this population displayed a Mediterranean dietary pattern, with the exception of the substitution of sunflower for olive oil Saturated, monounsaturated and polyunsaturated fatty acids represented 9.9%, 12.7% and 8.8% of the total amount of energy, respectively. The cholesterol-saturated fat index of the average diet was 19.2 per 1000 kcal, whereas the Keys index of the diet was 27.1. Daily intakes of fibre, ascorbic acid and vitamin E were 25.1 g, 89.6 mg and 28.3 mg, respectively. The calcium/magnesium ratio of the average diet was 1.54. The low percentage of individuals with high TC levels (5.4% with TC > or = 6.49 mmol/L), high TG levels (3.7% with TG > or = 2.25 mmol/L), high Apo B levels (3.0% with > or = 1.5 g/L), low levels of HDL-C (0.7% with < or = 0.91 mmol/L), high LDL-C levels (1.4% with > or = 4.94 mmol/L or a high TC/HDL-C ratio (2.8% with > or = 5.0) suggest a reasonable protection against coronary heart disease in this Spanish population.

Destruction of tocopherols, carotenoids, and retinol in human plasma by cigarette smoke

The mechanisms by which exposure to cigarette smoke dramatically increase the incidence and severity of atherosclerosis and the incidence of lung cancer, chronic obstructive airways disease, and emphysema are incompletely understood. Epidemiologic evidence has suggested a modifying role for antioxidant micronutrients, including tocopherols and carotenoids, in these disease processes. It has been suggested that oxidants in cigarette smoke could be involved. We exposed freshly obtained human plasma to the gas phase of cigarette smoke to assess its effects on tocopherols, carotenoids, and retinol. Exposure to cigarette smoke led to the depletion of most of the lipophilic antioxidants in 20 mL human plasma. The order of disappearance was lycopene > alpha-tocopherol > trans-beta-carotene++ > (lutein + zeaxanthin) = cryptoxanthin > gamma-tocopherol = retinol. However, despite a substantial loss of alpha-tocopherol, there was very little peroxidative damage to lipids, and no detectable change in the content of polyunsaturated fatty acid-rich cholesterol esters. We conclude that a wide spectrum of lipophilic micronutrients undergo degradation when exposed to gas-phase cigarette smoke. The relevance of these in vitro findings to possible cigarette smoke-induced depletions of respiratory tract lipophilic antioxidants remains to be clarified.

Role of oxidants/antioxidants in smoking-induced lung diseases

An imbalance between oxidants and antioxidants has been considered in the pathogenesis of smoking-induced lung diseases, such as chronic obstructive pulmonary disease (COPD), particularly emphysema. Recent evidence indicates that increased neutrophil sequestration and activation occurs in the pulmonary microvasculature in smokers and in patients with COPD, with the potential to release reactive oxygen species (ROS). ROS generated by airspace phagocytes or inhaled directly from the environment also increase the oxidant burden and may contribute to the epithelial damage. Although much research has focused on the protease/antiprotease theory of the pathogenesis of emphysema, less attention has been paid to the role of ROS in this condition. The injurious effects of the increased oxidant burden in smokers and in patients with COPD are opposed by the lung antioxidant defences. Hence, determining the mechanisms regulating the antioxidant responses is critical to our understanding of the role of oxidants in the pathogenesis of smoking-induced lung disease and to devising future strategies for antioxidant therapy. In this article we have reviewed the evidence for the presence of an oxidant/antioxidant imbalance in smoking-induced lung disease and its relevance to therapy in these conditions.

Dietary antioxidants and cigarette smoke-induced biomolecular damage: a complex interaction

Epidemiologic evidence suggests that cigarette smoking is a major risk factor for chronic obstructive pulmonary diseases such as chronic bronchitis and emphysema, for carcinogenesis, and for cardiovascular disease. However, the precise mechanisms of these effects are incompletely understood. The gas phase of cigarette smoke contains abundant free radicals including nitric oxide. Hence, cigarette smoke may induce some of its damaging effects by free radical mechanisms. We report that exposure of plasma, a model for respiratory tract lining fluids, to gas-phase cigarette smoke causes depletion of antioxidants, including ascorbate, urate, ubiquinol-10, and alpha-tocopherol, and a variety of carotenoids, including beta-carotene. Gas-phase cigarette smoke induced some lipid peroxidation, as measured by cholesteryl linoleate hydroperoxide (18:2OOH) formation. Ascorbate was effective in preventing 18:2OOH formation. In contrast to the low concentrations of lipid hydroperoxides measured (< 1 mumol/L), protein carbonyl formation, a measure of protein modification, increased by approximately 400 mumol/L after nine puffs of cigarette smoke. Reduced glutathione inhibited protein carbonyl formation, whereas other plasma antioxidants, including ascorbate, were ineffective. alpha, beta-Unsaturated aldehydes (acrolein and crotonaldehyde) in cigarette smoke may react with protein -SH and -NH2 groups by a Michael addition reaction that results in a protein-bound aldehyde functional group. Gas-phase cigarette smoke is capable of converting tyrosine to 3-nitrotyrosine and dityrosine, indicating free radical mechanisms of protein damage by nitrogen oxides. Aldehydes and nitrogen oxides in cigarette smoke may be significant contributors to biomolecular damage, and endogenous antioxidants can attenuate some of these adverse effects.

Attitudinal dimensions of food choice and nutrient intake

A diet low in fat and rich in fibre has been recommended to optimize general health and in particular cardiovascular health. Health attitudes to fat and fibre were studied in relation to food and nutrient intake and sociocultural and lifestyle factors amongst the general population of Northern Ireland. The study population comprised 592 adults aged 16-64 years; health attitudes to fat and fibre were assessed by questionnaire (based on a social psychological model, which adjusted for taste and convenience factors). Dietary intake was estimated using the weighed inventory technique. Fat-phobic and fibre-philic attitudes were more prevalent in women than men. Fat-phobic attitudes in women were inversely related to intake of fat through a reduced intake of chips, butter and sausages. In contrast, men's fat-phobic attitudes were not strongly correlated with fat intake; consumption of chips and sausages was negatively associated with fat-phobic attitudes, but cake/biscuit, buns/pastries and milk consumption was positively associated with fat-phobic attitudes. Fibre-philic attitudes were positively associated with dietary fibre intake; intakes of potatoes, vegetables, wholemeal bread and breakfast cereal were positively associated with fibre-philic attitudes. There were clear sociocultural and lifestyle differences in relation to dietary attitude. These findings have implications for campaigns designed to effect population dietary change.

Dietary change after smoking cessation: a prospective study

A population sample of 375 men and women cigarette smokers were recruited to take part in a prospective study of smoking cessation to test the hypothesis that stopping smoking is associated with an increased consumption of the essential fatty acid linoleic acid, which explains the concomitant reduction in risk of coronary heart disease. Diet was assessed using a 10 d weighed record in 301 smokers at baseline, 153 at 4-month follow-up, of whom twenty-six had quit smoking, and 122 at 1-year follow-up, of whom twenty had quit. Compared with continuing smokers, those who had quit at the 4-month follow-up (mean 10 and 13 weeks for men and women respectively) had statistically significant increases in body weight (5%), energy intake (13%), total dietary fat (24%), all specific types of dietary fat (26% polyunsaturated fat, 26% linoleic acid, 30% eicosapentaenoic acid, 23% monounsaturated fat and 22% saturated fat) and vitamin E intake (19%). The foods which appeared to contribute to increases in energy and fat intakes at the 4-month follow-up were vegetable oils and polyunsaturated margarines, processed meats and meat pies. By follow-up at 1 year (mean time since quitting 31 and 41 weeks for men and women respectively) there were no detectable differences in energy and total fat intakes. However, intakes of eicosapentaenoic acid and pteroylglutamate (folate) were statistically significantly higher in the quitters compared with the continuing smokers (37% for eicosapentaenoic acid and 16% for folate). We conclude that the short-term increase in dietary intake of linoleic acid, which is not sustained by 1 year, cannot explain the reduction in risk of coronary disease following smoking cessation.

Relationship between smoking and antioxidant nutrient status

The present study was designed to investigate the relationship between smoking and antioxidant nutrient intake and status. Smoker (n 44) and non-smoker (n 44) male students attending Dhaka University, aged between 22 and 28 years and living in a University Hall of Residence, were selected for the present study. Mean age, body weight, BMI and blood pressure were similar for both the smokers and non-smokers. Mean energy, protein and fat intakes were similar for both groups. Smokers had lower intakes of dietary vitamin C, carotenes and Zn but only the difference in Zn intake was statistically significant. There was no significant difference between smokers and non-smokers for either serum vitamin A (retinol) or vitamin E (alpha-tocopherol) level. The plasma vitamin C level of smokers was significantly lower than that of non-smokers (P = 0.0004). Smokers had significantly lower serum Cu (P = 0.04) and higher serum Zn levels (P = 0.003). Further, a significant dose-response relationship between smoking and vitamin C status was observed. Linear-regression analysis showed a significantly positive correlation between dietary intake and plasma vitamin C values in non-smokers (r 0.50; P = 0.0005). On the contrary, no such association was observed in smokers. These findings suggest that smoking may cause an imbalance in antioxidant nutrient intake and status.

Interactions between people's diet and their smoking habits: the dietary and nutritional survey of British adults

OBJECTIVE

To compare diet, nutrient intakes, and biochemical measures between smokers and non-smokers.

DESIGN

Analysis of data collected in cross sectional survey conducted in 1986 and 1987. Subjects were recruited from electoral wards in England, Wales, and Scotland to reflect the regional distribution of the population.

SUBJECTS

2197 subjects (70% of those asked) aged between 16 and 64 undertook dietary assessment. Of these, 1842 subjects were considered to have kept a record typical of their usual dietary intake and had given data on smoking, and their results were analysed: 1224 non-smokers (631 men), 359 light smokers (166 men), and 259 heavy smokers (153 men).

MAIN OUTCOME MEASURES

Differences in dietary, nutrient, and biochemical measures between nonsmokers and smokers.

RESULTS

Smokers ate more white bread, sugar, cooked meat dishes, butter, and whole milk and less wholemeal bread, high fibre breakfast cereals, fruit, and carrots. Smokers had lower intakes of polyunsaturated fat, protein, carbohydrate, fibre, iron, carotene, and ascorbic acid. Adjusting for other covariates did not substantially alter the pattern of intakes. At the same dietary intake of carotenoids smokers were more likely to have lower circulating serum beta carotene concentrations than non-smokers.

CONCLUSIONS

The diet and nutrient intakes and circulating levels of nutrients of smokers were different from those of non-smokers. Smokers were more likely to have an imbalance between the dietary intake of antioxidant nutrients and the metabolic demand for antioxidant protection. This imbalance is likely to make smokers more susceptible to oxidative damage. Smokers are at increased risk of chronic disease because their diets are different and because smoking creates an altered pattern of demand for specific nutrients. The diets of smokers not only fail to meet the unusual requirements for specific nutrients to satisfy the altered pattern of demand but are likely to exacerbate the damage caused by smoking.

Cigarette smoking, polyunsaturated fats, and coronary heart disease

The relation between smoking habit and diet was investigated in 910 men and women. Diet was assessed by a self-administered food frequency questionnaire. After adjustment for age, sex, and occupational group, smokers had a substantially higher saturated fat (SFA) intake and much lower polyunsaturated fat (PUFA), principally due to a lower linoleic acid (LA) intake, resulting in a lower P:S ratio compared with never smokers, and these dietary differences remained after adjustment for alcohol consumption, BMI, and energy intake. Smokers also had different food choices obtaining more PUFA from saturated fat products such as dairy foods, lard, and ordinary margarine, and less from concentrated sources such as PUFA margarines and vegetable oils than nonsmokers. The food choices of cigarette smokers leading to a higher SFA and lower PUFA intakes may partly explain their increased risk of coronary heart disease.