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Driva S, Korkontzelou A, Tonstad S, Tentolouris N, Litsiou E, Vasileiou V, Vassiliou AG, Saltagianni V, Katsaounou P. Metabolic Changes Following Smoking Cessation in Patients with Type 2 Diabetes Mellitus. Biomedicines 2024; 12:1882. [PMID: 39200346 PMCID: PMC11352061 DOI: 10.3390/biomedicines12081882] [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: 06/30/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Smoking cessation is crucial for reducing complications of type 2 diabetes mellitus (T2DM), but associated weight gain can worsen glycemic control, discouraging quitting attempts. Varenicline, a partial agonist of α4β2 nicotinic receptors, aids smoking cessation. This study examines the effects of varenicline on body weight and metabolic parameters in patients with T2DM and prediabetes. METHODS Fifty-three patients were enrolled, of which 32 successfully quit smoking after a three-month course of varenicline and were examined after an additional month with no medication. Measurements taken at baseline, 2.5 months, and 4 months included body weight, blood pressure, resting metabolic rate (RMR), glycated hemoglobin (HbA1c), fasting glucose, blood lipids, C-reactive protein (CRP), appetite-related hormones, and physical activity. RESULTS Post-treatment, there were no significant changes in body weight, blood pressure, RMR, or glycemic control. Total (CHOL) and low-density lipoprotein (LDL-C) cholesterol decreased significantly at 4 months of the study (from 168 to 156 mg/dL, p = 0.013, and from 96 to 83 mg/dL, p = 0.013, respectively). Leptin levels increased (from 11 to 13.8 ng/dL, p = 0.004), as did glucagon-like peptide-1 (GLP-1) levels (from 39.6 to 45.8 pM, p = 0.016) at 4 months of follow-up. The percentage of participants who reported moderate-intensity activity increased from 28% to 56%, while those reporting high-intensity activity increased from 19% to 22%, respectively (p = 0.039). CONCLUSIONS Our study showed that smoking cessation with varenicline in smokers with T2DM and prediabetes led to significant improvements in lipid profile, significant increase in plasma leptin and GLP-1 levels, and increased physical activity, without significant weight gain. Thus, smoking cessation without weight gain or deteriorated glycemic control is feasible for these smokers, with added benefits to lipid profiles, GLP-1 regulation, and physical activity.
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Affiliation(s)
- Stamatina Driva
- Smoking Cessation Outpatient Clinic, Respiratory Department, First Intensive Care Unit, Evangelismos General Hospital, 10676 Athens, Greece (E.L.)
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aliki Korkontzelou
- Smoking Cessation Outpatient Clinic, Respiratory Department, First Intensive Care Unit, Evangelismos General Hospital, 10676 Athens, Greece (E.L.)
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Nikolaos Tentolouris
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Eleni Litsiou
- Smoking Cessation Outpatient Clinic, Respiratory Department, First Intensive Care Unit, Evangelismos General Hospital, 10676 Athens, Greece (E.L.)
| | - Vasiliki Vasileiou
- Endocrinology Department, Diabetes Center, Alexandra Hospital, 11528 Athens, Greece
| | - Alice G. Vassiliou
- Smoking Cessation Outpatient Clinic, Respiratory Department, First Intensive Care Unit, Evangelismos General Hospital, 10676 Athens, Greece (E.L.)
| | - Vassiliki Saltagianni
- Smoking Cessation Outpatient Clinic, Respiratory Department, First Intensive Care Unit, Evangelismos General Hospital, 10676 Athens, Greece (E.L.)
| | - Paraskevi Katsaounou
- Smoking Cessation Outpatient Clinic, Respiratory Department, First Intensive Care Unit, Evangelismos General Hospital, 10676 Athens, Greece (E.L.)
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Abstract
BACKGROUND Smoking is an important risk factor for various metabolic and cardiovascular disorders, and smoking cessation reduces the risk of these conditions. However, weight gain is commonly observed when individuals quit smoking, which often leads to hesitation in pursuing smoking cessation. Weight gain increases the risk of metabolic syndrome (MS). However, previous studies that investigated the relationship between smoking cessation and MS have yielded inconsistent results. Therefore, we conducted a meta-analysis to evaluate the association between smoking cessation and MS. METHODS Medline, Embase, Cochrane Library and CINAHL databases, were comprehensively searched from inception to April 2023, to identify relevant studies examining the relationship between smoking cessation and MS, comparing such relationship to that with active smoking. The methodological quality of the selected studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. A random-effects model was used for meta-analysis. RESULTS Of 495 identified studies, 24 were reviewed. The risk of selection bias was identified in all the studies. The overall analysis of 14 studies, including data of combined results for both men and women, revealed an increased risk of MS among ex-smokers compared with that among active smokers (pooled relative risk [RR] 1.18, 95% confidence interval [CI]: 1.08-1.29). From the selected studies, 13 studies analyzing men were extracted for subgroup analysis. Among men, no significant difference in the risk of developing MS was observed between ex-smokers and smokers (pooled RR: 1.05, 95% CI: 0.95-1.17). In men, the risk of MS increased if the cessation period was ≤15 years in men (pooled RR 1.26, 95% CI: 1.01-1.56) and slightly decreased if the cessation period was > 15 years (RR 0.84, 95% CI: 0.70-1.00) in ex-smokers compared with that in current smokers. CONCLUSION An increased risk of MS was observed in the early stages of smoking cessation compared with current smoking. As the longer duration of smoking cessation, the risk of MS becomes less significant.
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Affiliation(s)
- Hyun Ji Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Khan FY, Ken-Dror G, Ly P, Hail HA, Deleu D, Ali M, Hussein HA, Abuzaid HO, Sharif K, Sharma P. Cigarette smoking as a risk factor for ischaemic stroke in young South Asian male migrants to Qatar: The BRAINS study. Qatar Med J 2023; 2023:23. [PMID: 38089674 PMCID: PMC10714014 DOI: 10.5339/qmj.2023.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/30/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The incidence of stroke in the Middle East is high, given its relatively young population. Smoking is a well-recognized risk factor for ischaemic stroke, and its high regional prevalence may partly account for this increased stroke risk. This research aims to determine whether young male South Asian migrants in Qatar were adversely affected by stroke depending on their smoking status. METHODS Data from the ongoing international prospective BRAINS study was analysed. Male South Asian migrants to Qatar with a history of ischaemic stroke were recruited. Multivariate regression analysis was used to estimate the effects of comorbidities, such as BMI, hypertension, diabetes, hypercholesterolemia, alcohol consumption, and ischemic heart disease, on the association of age of stroke onset and smoking status. RESULTS We identified 778 (mean age 49.5±10.2) migrant male workers of South Asian descent with ischaemic stroke in Qatar, of which 41.3% of the sample were current smokers. Compared to non-smokers, current smokers suffered a stroke 2.03 years earlier (95%CI: 0.60-3.46, P=0.005). Multivariate regression analysis demonstrated that only current smoking status was associated with an earlier age of stroke onset (β=2.03, SE=0.74, P=0.006). CONCLUSION Smoking is associated with at least a two-year earlier onset of ischaemic stroke in male South Asian migrants to the Middle East. Our study has important implications for the public health management of migrants in host countries.
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Affiliation(s)
| | - Gie Ken-Dror
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), United Kingdom https://orcid.org/0000-0003-3641-7441
| | - Paul Ly
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), United Kingdom https://orcid.org/0000-0003-3641-7441
| | | | - Dirk Deleu
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Musab Ali
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), United Kingdom https://orcid.org/0000-0003-3641-7441
- Imperial College Healthcare NHS Trust, London UK
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4
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Han S, Jeong S, Ahn JC, Cho Y, Choi S, Park SJ, Kim KH, Lee G, Son JS, Park SM. Association of post-smoking cessation changes in fasting serum glucose with changes in predicted fatty liver score. Sci Rep 2023; 13:10300. [PMID: 37365204 DOI: 10.1038/s41598-023-37194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/17/2023] [Indexed: 06/28/2023] Open
Abstract
Major post-cessation metabolic changes include weight gain and hyperglycemia. However, the association of post-cessation change in fasting serum glucose (FSG) with risk of fatty liver remains unclear. A total of 111,106 participants aged 40 and above who underwent health screening at least once in two examination periods were extracted from the Korean National Health Insurance Service-National Sample Cohort. Fatty liver status was evaluated using the Korean National Health and Nutrition Examination Survey nonalcoholic fatty liver disease (K-NAFLD) score. Linear and logistic regression were used to calculate the adjusted mean (aMean) and adjusted odds ratio (aOR) with 95% confidence intervals. Compared to stable (aMean 0.10; 95% CI 0.03-0.18) and decline (aMean - 0.60; 95% CI - 0.71 to 0.49) groups, FSG elevation (aMean 1.28; 95% CI 1.16-1.39) was associated with higher K-NAFLD score even within different body mass index change groups. Risk of fatty liver was significantly reduced among participants with stable (aOR 0.38; 95% CI 0.31-0.45) and declined (aOR 0.17; 95% CI 0.13-0.22) FSG levels after smoking cessation compared to FSG elevation group. This study suggests that quitters with elevated FSG are associated with higher NAFLD risk and may benefit from careful monitoring of FSG levels and management of other cardiovascular risk factors.
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Affiliation(s)
- Saemi Han
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Joseph C Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Yoosun Cho
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Gyeongsil Lee
- KS Health Link Inst. and Life Clinic, Seoul, South Korea
| | - Joung Sik Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea.
- Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
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Driva S, Korkontzelou A, Tonstad S, Tentolouris N, Katsaounou P. The Effect of Smoking Cessation on Body Weight and Other Metabolic Parameters with Focus on People with Type 2 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013222. [PMID: 36293800 PMCID: PMC9603007 DOI: 10.3390/ijerph192013222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 06/01/2023]
Abstract
Smokers with diabetes mellitus substantially lower their risks of microvascular and macrovascular diabetic complications, in particular cardiovascular disease, by quitting smoking. However, subsequent post-smoking-cessation weight gain may attenuate some of the beneficial effects of smoking cessation and discourage attempts to quit. Weight gain can temporarily exacerbate diabetes and deteriorate glycemic control and metabolic profile. The molecular mechanisms by which quitting smoking leads to weight gain are largely associated with the removal of nicotine's effects on the central nervous system. This review addresses mechanisms of post-smoking-cessation weight gain, by reviewing the effects of nicotine on appetite, food intake, eating behaviour, energy expenditure, fat oxidation and appetite-regulating peptides. We also highlight correlations between post-cessation weight gain and risk of type 2 diabetes, consequences of weight gain in people with type 2 diabetes and the role of pharmacotherapies, which combine treatment of nicotine addiction and promotion of weight control.
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Affiliation(s)
- Stamatina Driva
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aliki Korkontzelou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- First Department of Critical Care, Evangelismos General Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, 0424 Oslo, Norway
| | - Nikolaos Tentolouris
- Diabetes Centre, First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Paraskevi Katsaounou
- First Department of Critical Care, Evangelismos General Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
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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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Stein JH, Smith SS, Hansen KM, Korcarz CE, Piper ME, Fiore MC, Baker TB. Longitudinal effects of smoking cessation on carotid artery atherosclerosis in contemporary smokers: The Wisconsin Smokers Health Study. Atherosclerosis 2020; 315:62-67. [PMID: 33227549 DOI: 10.1016/j.atherosclerosis.2020.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS We quantified the effects of smoking and smoking cessation on carotid artery atherosclerosis and wall thickness in two unique cohorts of smokers making a quit attempt. METHODS Our primary analysis included 726 smokers making a quit attempt in a randomized clinical trial with long-term follow-up. Our secondary analysis included 889 smokers making a quit attempt in a subsequent trial. Participants underwent carotid artery ultrasonography at baseline and up to 3 subsequent visits. Primary outcomes were changes in carotid plaque score and intima media-thickness (IMT). We calculated a smoking burden score (SBS) that reflected the number of visits in which participants reported smoking after the quit attempt. Multivariable regression examined relations between SBS and carotid artery outcomes with adjustments for cardiovascular disease risk factors. RESULTS In the primary analysis, participants were mean (standard deviation) 46.1 (10.3) years old (57.9% female) and smoked 21.1 (8.9) cigarettes per day (CPD). After a median of 7 years, lower SBS predicted less increase in carotid plaque score (Chi-squared = 13.0, p = 0.012). SBS independently predicted change in carotid plaque score (p = 0.007; SBS 0 vs 4) as did baseline CPD (p = 0.024) and age (p<0.0001). SBS did not affect carotid IMT change. In the secondary analysis, increasing SBS was associated with increased likelihood of new plaques over 3 years among participants that smoked ≥15 CPD, (Chi-squared = 6.51, p = 0.011). CONCLUSIONS Smoking cessation is associated with less progression of carotid plaque, but not IMT. Salutary associations of smoking cessation with carotid plaque progression are related to degree of abstinence.
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Affiliation(s)
- James H Stein
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA.
| | - Stevens S Smith
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA
| | - Kristin M Hansen
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA
| | - Claudia E Korcarz
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA
| | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA
| | - Michael C Fiore
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA
| | - Timothy B Baker
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, CSC-H4/520, Madison, WI, 53792, USA
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Johnson AL, Kaye J, Baker TB, Fiore MC, Cook JW, Piper ME. Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors. Drug Alcohol Depend 2020; 207:107796. [PMID: 31864163 PMCID: PMC7076564 DOI: 10.1016/j.drugalcdep.2019.107796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined. METHODS Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit. RESULTS Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence. CONCLUSIONS Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.
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Affiliation(s)
- Adrienne L. Johnson
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705,Correspondence concerning this article should be addressed to Megan E. Piper, Ph.D., Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI, 53711; Tel: 608-265-5472; Fax: 608-265-3102;
| | - Jesse Kaye
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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Schmidt KMT, Hansen KM, Johnson AL, Gepner AD, Korcarz CE, Fiore MC, Baker TB, Piper ME, Stein JH. Longitudinal Effects of Cigarette Smoking and Smoking Cessation on Aortic Wave Reflections, Pulse Wave Velocity, and Carotid Artery Distensibility. J Am Heart Assoc 2019; 8:e013939. [PMID: 31795823 PMCID: PMC6951052 DOI: 10.1161/jaha.119.013939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
Background We evaluated the effects of smoking and smoking cessation on aortic wave reflections (augmentation index), aortic pulse wave velocity, and carotid artery distensibility and stiffness (distensibility coefficient, Young's elastic modulus). Methods and Results Current smokers underwent carotid, radial, and femoral artery tonometry and carotid ultrasound at baseline and 3 years after a quit attempt. Baseline associations of smoking heaviness markers (exhaled carbon monoxide and cigarettes smoked/d) and effects of smoking cessation at year 3 on changes in arterial measures were assessed using multivariable linear regression models. The 1417 smokers (54% female) were mean (SD) 49.3 (11.6) years old and smoked 17.2 (8.3) cigarettes/d (exhaled carbon monoxide 14.7 [8.2] parts per million). Arterial measures were associated more strongly with age, blood pressure (BP), and waist circumference than with smoking heaviness markers. Augmentation index was associated independently with carbon monoxide (P=0.004). Pulse wave velocity, distensibility coefficient, and Young's elastic modulus had small, inconsistent associations with smoking heaviness markers. At year 3, augmentation index improved with smoking cessation (P=0.006) despite more weight gain (2.54 vs 0.36 kg, P<0.001) and insulin resistance (P=0.001) among abstainers, but distensibility coefficient decreased (P=0.004). Changes in arterial measures were related more strongly to changes in BP than smoking cessation. Conclusions Arterial wave reflection and stiffness measures were associated more strongly with age, BP, and waist circumference than smoking heaviness. Smoking cessation was associated with weight gain and increased insulin resistance. Changes in arterial measures were predicted by changes in BP, highlighting the need to address weight gain and BP changes during a quit attempt.
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Affiliation(s)
| | - Kristin M. Hansen
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | | | - Adam D. Gepner
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | | | - Michael C. Fiore
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | - Timothy B. Baker
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | - Megan E. Piper
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | - James H. Stein
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
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10
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Oktay AA, Akturk HK, Esenboğa K, Javed F, Polin NM, Jahangir E. Pathophysiology and Prevention of Heart Disease in Diabetes Mellitus. Curr Probl Cardiol 2018; 43:68-110. [DOI: 10.1016/j.cpcardiol.2017.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Ding R, Huang T, Han J. Diet/lifestyle and risk of diabetes and glycemic traits: a Mendelian randomization study. Lipids Health Dis 2018; 17:18. [PMID: 29375034 PMCID: PMC5787924 DOI: 10.1186/s12944-018-0666-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Observational studies have demonstrated diet/lifestyle play roles in development of type 2 diabetes (T2DM); however, it remains unclear whether these relationships are causal. METHODS A two-sample MR approach was used to examine the causal effect of diet/lifestyle upon risk of T2DM and glycemic traits. RESULTS The protein intake-increasing allele C of FTO was significant associated with higher risk of T2DM (Beta ± SE = 0.104 ± 0.014, P = 4.40 × 10- 11), higher level of HOMA-IR (Beta ± SE = 0.016 ± 0.004, P = 9.55 × 10- 5), HOMA-B (Beta ± SE = 0.008 ± 0.003, P = 0.020). Using MR analyses, increased protein intake was causally associated with an increased risk of T2DM (Beta ± SE = 0.806 ± 0.260, P = 0.002). In addition, smoking cessation was causally associated with increased levels of glycemic traits such as HOMA-IR (Beta ± SE = 0.165 ± 0.072, P = 0.021), fasting insulin (Beta ± SE = 0.132 ± 0.066, P = 0.047) and fasting glucose (Beta ± SE = 0.132 ± 0.064, P = 0.039). CONCLUSIONS These results provide evidence supporting a causal role for higher protein intake and smoking cession in T2DM. Our study provides further rationale for individuals at risk for diabetes to keep healthy lifestyle.
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Affiliation(s)
- Renyu Ding
- Department of Intensive Care Medicine, The First Hospital of China Medical University, Liaoning, 110001, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
| | - Jiali Han
- Department of Otolaryngology, The First Hospital of China Medical University, Liaoning, 110001, China.
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12
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Effect of post-cessation hyperglycemia on cardiovascular disease and mortality among middle-aged men: an eight-year longitudinal study. Sci Rep 2017; 7:16085. [PMID: 29167541 PMCID: PMC5700198 DOI: 10.1038/s41598-017-16378-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022] Open
Abstract
Smoking cessation reduces the risk of cardiovascular disease (CVD), but also elevates fasting serum glucose (FSG) levels. The effect of post-cessation hyperglycemia on cardiovascular disease is unknown. The study population consisted of 127,066 men without type 2 diabetes from the Korean National Health Insurance System – Health Screening Cohort database. Change in smoking habits and FSG was determined by the difference in smoking status and FSG levels from the first (2002 and 2003) and second (2004 and 2005) health examinations. Continual smokers, quitters, ex-smokers, and never smokers were stratified according to FSG elevation. The study participants were followed-up for CVD and CVD-related death from 2006 to 2013. Compared to continual smokers, quitters had decreased risk of CVD among those without FSG elevation (hazard ratio, HR, 0.76, 95% confidence interval, CI, 0.66–0.86) and with FSG elevation (HR 0.83, 95% CI 0.72–0.96). Similarly, quitters had a tendency towards reduced risk of CVD-related death among those without FSG elevation (HR 0.74, 95% CI 0.51–1.09) and with FSG elevation (HR 0.68, 95% CI 0.46–1.03). Post-cessation hyperglycemia did not attenuate the beneficiary risk-reducing effects of quitting on CVD and CVD-related death.
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13
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Heggen E, Svendsen M, Tonstad S. Smoking cessation improves cardiometabolic risk in overweight and obese subjects treated with varenicline and dietary counseling. Nutr Metab Cardiovasc Dis 2017; 27:335-341. [PMID: 28216282 DOI: 10.1016/j.numecd.2016.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/18/2016] [Accepted: 12/29/2016] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- E Heggen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway.
| | - M Svendsen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | - S Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
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Kar D, Gillies C, Zaccardi F, Webb D, Seidu S, Tesfaye S, Davies M, Khunti K. Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol 2016; 15:158. [PMID: 27881170 PMCID: PMC5121966 DOI: 10.1186/s12933-016-0475-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/10/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smoking is associated with increased macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular perturbations, it also seems to influence the cardiometabolic parameters, which may partly explain the accelerated rate of vascular complications in smokers with diabetes. While smoking cessation is advocated as a universal component of the management of diabetes, there is some anecdotal evidence that HbA1c could increase following smoking cessation. The aim of this review is to explore the relationship between smoking and its cessation on cardiometabolic parameters in diabetes. METHODS Searches were conducted on Medline, EMBASE and CINAHL up to March 2016. After screening 6866 studies (Additional file 1), 14 observational studies with a total of 98,978 participants' with either type 1 or type 2 diabetes were selected for review. Narrative synthesis and meta-analyses were carried out to explore the relationship between smoking and its cessation. RESULTS Meta-analysis showed that the pooled mean difference of HbA1c between non-smokers and smokers was -0.61% (95% CI -0.88 to -0.33, p < 0.0001). The difference in LDL cholesterol between non-smokers and smokers was -0.11 mmol/l (95% CI -0.21 to -0.01, p = 0.04). The difference in HDL cholesterol between non-smokers and smokers was 0.12 mmol/l (95% CI 0.08-0.15, p < 0.001). However, there was no statistically significant difference in blood pressure between the two groups. The difference in HbA1c between quitters and continued smokers was not statistically significant -0.10% (95% CI -0.42 to 0.21, p = 0.53). However, a narrative synthesis revealed that over a period of 10 years, the HbA1c was comparable between non-smokers and quitters. CONCLUSION Non-smokers have a statistically significant lower HbA1c and more favourable lipid profile compared to smokers. Smoking cessation does not lead to an increase in HbA1c in long-term and may reduce vascular complications in diabetes by its favourable impact on lipid profile.
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Affiliation(s)
- Debasish Kar
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK. .,Derbyshire Community Health Services NHS Foundation Trust, Castle Street Medical Centre, Castle Street, Bolsover, Chesterfield, Derbyshire, UK.
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - David Webb
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Solomon Tesfaye
- Academic Unit of Diabetes and Endocrinology, University of Sheffield, Sheffield, UK
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK
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15
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Jain P, Danaei G, Robins JM, Manson JE, Hernán MA. Smoking cessation and long-term weight gain in the Framingham Heart Study: an application of the parametric g-formula for a continuous outcome. Eur J Epidemiol 2016; 31:1223-1229. [PMID: 27704230 DOI: 10.1007/s10654-016-0200-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022]
Abstract
Weight gain after smoking cessation can lessen the health benefits of, and reduce the incentives for, quitting smoking. Randomized clinical trials of smoking cessation have estimated this weight gain only over short periods of follow-up. We provide an estimate of long-term post-cessation weight gain in the Framingham Heart Study, a prospective observational study. We identified 2001 smokers free of diabetes, cancer, and cardiovascular disease in 1952. Using the parametric g-formula we estimated mean weight in 1972 if all smokers had quit at baseline versus if all had continued smoking. Our estimates were adjusted for demographic, socio-economic, and clinical factors at baseline and during follow-up. The estimated mean weight (95 % CI) at 20 years if all smokers had quit smoking was 75.2 kg (73.5, 76.6), compared with 70.2 kg (68.7, 71.8) if they had smoked 20 cigarettes/day and 73.4 kg (71.9, 74.6) if they had smoked 5 cigarettes/day (i.e., an estimated mean weight gain of 5.1 kg (3.1, 6.6) and 1.8 kg (0.8, 2.8), respectively). Smokers who were overweight or obese at baseline had a greater post-cessation weight gain on average. Our estimates suggest that smoking cessation can result in increases in body weight over 20 years. While the benefits of smoking cessation outweigh the risks due to post-cessation weight gain, our results highlight the need for long-term weight management interventions in combination with smoking cessation.
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Affiliation(s)
- Priyanka Jain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Goodarz Danaei
- Departments of Epidemiology and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James M Robins
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health and Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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16
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Bush T, Lovejoy JC, Deprey M, Carpenter KM. The effect of tobacco cessation on weight gain, obesity, and diabetes risk. Obesity (Silver Spring) 2016; 24:1834-41. [PMID: 27569117 PMCID: PMC5004778 DOI: 10.1002/oby.21582] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/21/2016] [Accepted: 05/17/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Most smokers gain weight after quitting, and some develop new onset obesity and type 2 diabetes. The purpose of this paper is to synthesize the current science investigating the consequences of tobacco cessation on body weight and diabetes, as well as intervention strategies that minimize or prevent weight gain while still allowing for successful tobacco cessation. METHODS Systematic reviews and relevant studies that were published since prior reviews were selected. RESULTS Smoking cessation can cause excessive weight gain in some individuals and can be associated with clinically significant outcomes such as diabetes or obesity onset. Interventions that combine smoking cessation and weight control can be effective for improving cessation and minimizing weight gain but need to be tested in specific populations. CONCLUSIONS Despite the health benefits of quitting tobacco, post-cessation weight gain and new onset obesity and diabetes are a significant concern. Promising interventions may need to be more widely applied to reduce the consequences of both obesity and tobacco use.
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18
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Regional Variability of Lifestyle Factors and Hypertension with Prediabetes and Newly Diagnosed Type 2 Diabetes Mellitus: The Population-Based KORA-F4 and SHIP-TREND Studies in Germany. PLoS One 2016; 11:e0156736. [PMID: 27275745 PMCID: PMC4898825 DOI: 10.1371/journal.pone.0156736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/26/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Type 2 diabetes mellitus (T2D) shows regional differences in Germany. The purpose of the project was to compare the prevalence of prediabetes and undiagnosed T2D in two regions in Germany, the Northeast and the South, and to evaluate their associations with regional variations in lifestyle factors and hypertension. Methods Data from the KORA-F4 study (South Germany, 2006–2008) and the SHIP-TREND study (Northeast Germany, 2008–2012) were used. Participants aged 35–79 years without T2D with an overnight fasting of more than 8 hours and an oral glucose tolerance test were included: KORA-F4: n = 2,616 and SHIP-TREND: n = 1,968. Results The prevalence of prediabetes/newly diagnosed T2D was especially high in men (about 60%) and women (about 50%) in the Northeast, followed by men (about 50%) and women (about 30%) in the South. Lifestyle factors associated with T2D varied between the regions: more participants in the Northeast were active smokers and the percentages of people with overweight or obesity were greater than in their southern counterparts. However, these differences could not explain the striking disparity in prediabetes/newly diagnosed T2D. The frequency of hypertension was also distinctly higher in the Northeast than in the South and clearly associated with prediabetes/newly diagnosed T2D. Especially in men living in the Northeast, screening individuals with blood pressure ≥ 140/90mmHg might reveal up to 70% of those with prediabetes/newly diagnosed T2D. Conclusions Knowledge about regional variability in T2D and related risk factors is important for the planning of diabetes prevention programs. In our analyses, common lifestyle factors did not nearly explain these variations between the northern SHIP-TREND and the southern KORA-F4 studies. Further examinations of regional socioeconomic, political, environmental and other aspects are needed. Meanwhile, targeted diabetes prevention strategies with a special focus on men living in the northern parts of Germany are reasonable.
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Baker TB, Piper ME, Stein JH, Smith SS, Bolt DM, Fraser DL, Fiore MC. Effects of Nicotine Patch vs Varenicline vs Combination Nicotine Replacement Therapy on Smoking Cessation at 26 Weeks: A Randomized Clinical Trial. JAMA 2016; 315:371-9. [PMID: 26813210 PMCID: PMC4824537 DOI: 10.1001/jama.2015.19284] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Smoking cessation medications are routinely used in health care; it is vital to identify medications that most effectively treat this leading cause of preventable mortality. OBJECTIVE To compare the efficacies of varenicline, combination nicotine replacement therapy (C-NRT), and the nicotine patch for 26-week quit rates. DESIGN, SETTING, AND PARTICIPANTS Three-group randomized intention-to-treat clinical trial occurring from May 2012 to November 2015 among smokers recruited in the Madison, Wisconsin, and Milwaukee, Wisconsin, communities; 65.5% of smokers offered the study (2687/4102) refused participation prior to randomization. INTERVENTIONS Participants were randomized to one of three 12-week open-label smoking cessation pharmacotherapy groups: (1) nicotine patch only (n = 241); (2) varenicline only (including 1 prequit week; n = 424); and (3) C-NRT (nicotine patch + nicotine lozenge; n = 421). Six counseling sessions were offered. MAIN OUTCOMES AND MEASURES The primary outcome was carbon monoxide-confirmed self-reported 7-day point-prevalence abstinence at 26 weeks. Secondary outcomes were carbon monoxide-confirmed self-reported initial abstinence, prolonged abstinence at 26 weeks, and point-prevalence abstinence at weeks 4, 12, and 52. RESULTS Among 1086 smokers randomized (52% women; 67% white; mean age, 48 years; mean of 17 cigarettes smoked per day), 917 (84%) provided 12-month follow-up data. Treatments did not differ on any abstinence outcome measure at 26 or 52 weeks, including point-prevalence abstinence at 26 weeks (nicotine patch, 22.8% [55/241]; varenicline, 23.6% [100/424]; and C-NRT, 26.8% [113/421]) or at 52 weeks (nicotine patch, 20.8% [50/241]; varenicline, 19.1% [81/424]; and C-NRT, 20.2% [85/421]). At 26 weeks, the risk differences for abstinence were, for patch vs varenicline, -0.76% (95% CI, -7.4% to 5.9%); for patch vs C-NRT, -4.0% (95% CI, -10.8% to 2.8%); and for varenicline vs C-NRT, -3.3% (95% CI, -9.1% to 2.6%). All medications were well tolerated, but varenicline produced more frequent adverse events than did the nicotine patch for vivid dreams, insomnia, nausea, constipation, sleepiness, and indigestion. CONCLUSIONS AND RELEVANCE Among adults motivated to quit smoking, 12 weeks of open-label treatment with nicotine patch, varenicline, or C-NRT produced no significant differences in biochemically confirmed rates of smoking abstinence at 26 weeks. The results raise questions about the relative effectiveness of intense smoking pharmacotherapies. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01553084.
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Affiliation(s)
- Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - James H. Stein
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Cardiovascular Medicine, 600 Highland Avenue, Madison, WI 53792
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin-Madison, Educational Psychology, 1025 West Johnson Street, Madison, WI 53706
| | - David L. Fraser
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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Yu S, Sun Z, Zheng L, Guo X, Yang H, Sun Y. Prevalence of Diabetes and Impaired Fasting Glucose in Hypertensive Adults in Rural China: Far from Leveling-Off. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:14764-79. [PMID: 26610531 PMCID: PMC4661678 DOI: 10.3390/ijerph121114764] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 01/19/2023]
Abstract
In recent years data from many investigations has shown a leveling–off trend in diabetes incidence. In order to explain the diabetes epidemic in rural China during the past ten years, we conducted a survey from July 2012 to August 2013. Data from comprehensive questionnaires, physical examinations, and blood tests were obtained from 5919 residents with hypertension, aged ≥ 35 years. Diabetes and impaired fasting glucose (IFG) were defined according to the American Diabetes Association (ADA) criteria. The overall prevalence of diabetes and IFG were 15.3% (13.6% in men, 16.8% in women) and 40.7% (44.1% in men, 34.7% in women) in the hypertensive rural Chinese population. The prevalence of previously diagnosed diabetes was 6.5% (4.6% in men, 8.4% in women). The prevalence of undiagnosed diabetes was 8.7% (9.0% in men, 8.5% in women). Multivariate logistic regression revealed that increasing age, drinking, overweight or obesity, systolic blood pressure, low HDL-C, high total cholesterol and triglycerides increased the risk of diabetes (p < 0.05). Diabetes is thus still prevalent in rural areas of China and is manifesting an accelerating trend. It remains an important public health problem in China, especially in rural areas and routine assessment for the early detection and treatment of diabetes should be emphasized.
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Affiliation(s)
- Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Zhaoqing Sun
- Department of Cardiology, Shenjing Hospital of China Medical University, Shenyang 110001, China.
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shenjing Hospital of China Medical University, Shenyang 110001, China.
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang 110001, China.
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Heggen E, Svendsen M, Klemsdal TO, Tonstad S. Low Carbohydrate and Moderately Fat-Reduced Diets Similarly Affected Early Weight Gain in Varenicline-Treated Overweight or Obese Smokers. Nicotine Tob Res 2015; 18:1440-8. [PMID: 26242289 DOI: 10.1093/ntr/ntv164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Weight gain is common when stopping smoking. This study compared the effect of advising smokers to follow a diet low in carbohydrates versus a usual fat-reduced diet on weight gain and nicotine withdrawal. METHODS In a randomized clinical trial, 122 men and women smokers with body mass index 25-40kg/m(2) were assigned low-carbohydrate versus moderately fat-reduced diets. Within a week thereafter all participants started treatment with a 12-week course of varenicline 10 days prior to the target quit date. Brief dietary and motivational counseling was given at all visits. Self-reported abstinence was validated. RESULTS Protein intake in the low-carbohydrate versus fat-reduced diets was 26.4% of total energy versus 20.0%, fat 38.2% versus 30.1%, and carbohydrates 29.0% versus 41.7% (all P < .001). Mean weight changes for the low-carbohydrate versus fat-reduced groups were -1.2 (SD 2.2) versus -0.5 (SD 2.0) kg, -0.2 (SD 3.3) versus 0.5 (SD 2.6) kg, and 2.2 (SD 4.5) versus 2.1 (SD 3.9) kg at 4, 12, and 24 weeks after the target quit date, respectively (not statistically significant). Smoking abstinence rates did not differ between diets. In the combined groups, point prevalence abstinence rates were 71.0% at 12 weeks and 46.3% at 24 weeks. The Minnesota Nicotine Withdrawal Symptoms score was lower in the fat-reduced group compared with the low-carbohydrate group at weeks 4 and 12. CONCLUSIONS In overweight or obese smokers using varenicline a low-carbohydrate diet was no better than a fat-reduced diet in reducing weight gain but may result in more severe nicotine withdrawal symptoms. Compared to previous studies, cessation rates with varenicline were not impaired by dietary counseling. IMPLICATIONS The study implies that a popular low-carbohydrate diet does not result in greater weight loss than a moderately fat-reduced diet in overweight and obese smokers who are attempting to quit smoking with the aid of varenicline. Dietary counseling combined with varenicline treatment did not appear to unfavorably influence quit rates compared to previous studies in smokers not selected for overweight or obesity. Notably, the withdrawal symptoms score was lower in the fat-reduced dietary group than the low-carbohydrate group, suggesting a venue for further study.
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Affiliation(s)
- Eli Heggen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Mette Svendsen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Ole Klemsdal
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Serena Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Scherr A, Seifert B, Kuster M, Meyer A, Fagerstroem KO, Tamm M, Stolz D. Predictors of marked weight gain in a population of health care and industrial workers following smoking cessation. BMC Public Health 2015; 15:520. [PMID: 26025035 PMCID: PMC4448294 DOI: 10.1186/s12889-015-1854-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/19/2015] [Indexed: 01/28/2023] Open
Abstract
Background Concerns about postcessational weight gain might hamper rather than encourage smokers to quit smoking. Methods We conducted a comprehensive multi-institutional smoking cessation program for health care and industrial workers (n = 654) employed at University Hospital Basel (Switzerland) and two local health industry companies (Novartis International AG, F. Hoffmann-La Roche AG). The program contained counselling with an option of pharmacological support. Changes in body weight were observed during 24 months of follow-up. Factors associated with longitudinal weight gain (>5 % of baseline weight) were identified by cox-regression analysis. Results In 51 % of permanent quitters no significant changes of mean body weight were observed after 12 (0.52 kg, SD ±2.87 kg) and 24 months (0.40 kg, SD ± 2.99 kg). Marked weight gain following smoking cessation was characterized by a wide margin of changes. In more than a half of former smokers (58 %) weight increases were moderate (<5 kg), whereas excessive increases (>10 kg) were seen in only 10 % of quitters. Lower baseline BMI (HR 0.60, 95 % CI 0.40- 0.80, p = 0.03), daily consumption of less than ten cigarettes (HR 0.53, 95 % CI 0.27- 0.63, p = 0.04) and ischemic cardiopathy (HR 0.21, 95 % CI 0.07-0.62; p < 0.01) were associated with a lower risk for weight gain. Employees with lower educational levels (HR 2.60, 95 % CI 1.60-5.50, p < 0.01), diabetes mellitus (HR 3.05, 95 % CI 2.20-8.06, p = 0.02) and those smoking to reduce boredom in life (HR 1.68, 95 % CI 1.21-2.33, p < 0.01) were at highest risk. Conclusion Marked postcessational weight gain occurs less often than expected, but remains difficult to be predicted. Our findings might be helpful to alleviate weight concerns in the average smoker willing to quit.
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Affiliation(s)
- Andreas Scherr
- Clinic of Pneumology and Pulmonary Research, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | - Bruno Seifert
- Industrial Health Service, F. Hoffman- La Roche AG,, Basel, Switzerland.
| | - Martin Kuster
- Industrial Health Service, Novartis International AG, Basel, Switzerland.
| | - Anja Meyer
- Clinic of Pneumology and Pulmonary Research, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | | | - Michael Tamm
- Clinic of Pneumology and Pulmonary Research, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | - Daiana Stolz
- Clinic of Pneumology and Pulmonary Research, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
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Abstract
Nicotine dependence is a chronic, relapsing disorder with complex biological mechanisms underlying the motivational basis for this behavior. Although more than 70 % of current smokers express a desire to quit, most relapse within one year, underscoring the need for novel treatments. A key focus of translational research models addressing nicotine dependence has been on cross-validation of human and animal models in order to improve the predictive value of medication screening paradigms. In this chapter, we review several lines of research highlighting the utility of cross-validation models in elucidating the biological underpinnings of nicotine reward and reinforcement, identifying factors which may influence individual response to treatment, and facilitating rapid translation of findings to practice.
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