Women gain weight 1 year after smoking cessation while dietary intake temporarily increases

No changes in dietary intake after quitting smoking; a prospective study in Switzerland

BACKGROUND

After quitting smoking, quitters frequently increase their weight and change their dietary intake. Still, most studies on the topic are over 20 years old and focused on few dietary markers. We analysed the changes in weight and dietary intake after quitting smoking using a large panel of dietary markers.

METHODS

Prospective study including 5064 participants, 169 of whom (3.3%) quitted during a median follow-up of 5 years. Dietary intake was assessed using a food frequency questionnaire. Participants were excluded if they lacked dietary data or reported extreme total energy intakes (TEI) < 850 or > 4000 kcal/day.

RESULTS

Data from 128 participants (43.8% women, aged 56.0 ± 10.0 years) were used. After quitting smoking, mean weight increased 2.1 ± 0.7 kg; the majority (58%) of the participants gained over 1 kg, and only 7.1% were on a diet to reduce their weight. Total protein intake increased from (median [interquartile range]) 14.4 [12.9-16.4] to 15.1 [13.4-17.9] % of total energy intake (TEI), p = 0.008, while animal protein intake increased from 9.7 [8.0-12.1] to 10.8 [8.5-13.5] %TEI, p = 0.011. Fish intake increased from 27 [17-45] to 37 [19-55] g/day, p = 0.016 and dairy intake decreased from 177 [94-288] to 150 [77-243] g/day, p = 0.009. No other changes were found. Among the 68 (53%) participants who reported time since quitting, quitting for <=1 year led to a decreased consumption of fruits, while the opposite was found for participants who quit for longer than one year. No associations were found between weight or dietary changes and time since quitting.

CONCLUSIONS

People who quit smoking tend to gain weight, do not significantly change their dietary intake, and seem to make little effort to prevent weight gain. Systematic dietary support should be provided to all smokers wishing to quit.

Diet, eating behaviour and weight gain in men and women with overweight/obesity receiving varenicline for smoking cessation

Because trying to quit smoking and not gain weight requires changes in two major behaviours simultaneously we explored eating behaviour in smokers with overweight/obesity making a quit attempt using guideline-based treatment. Participants were randomized to a carbohydrate-reduced or fat-reduced diet. The Three Factor Eating Questionnaire and Binge Eating Scale were completed by 48 of 64 participants in the low-carbohydrate and 47 of 58 in the fat-reduced group at randomization, after 6 and 14 weeks. At 6 weeks, no between group differences were seen in eating behaviour scores thus, we combined the sample for further analyses. In the combined sample, restraint increased (3.94 [95% CI 3.05, 4.83]), disinhibition (uncontrolled eating) decreased (-0.86 [95% CI-1.31, -0.41]) and binge eating decreased (-1.95 [95% CI -2.83, -1.06]), while hunger scores did not change (-0.43 [95% CI -0.89, 0.03]) after 14 weeks. In a general linear model, increase in dietary restraint (P = .012) and decrease in binge eating (P = .040) were associated with lower weight gain (model R² _adj = .147). In a smoking cessation program, dietary support regardless of diet was associated with increased dietary restraint and reduced binge eating. Because smoking cessation causes weight gain these results indicate that dietary support leads to eating behaviour changes that may prevent weight gain.

The Utilization of National Tobacco Cessation Services among Female Smokers and the Need for a Gender-Responsive Approach

Despite the steadily increasing prevalence of female smoking, gender-responsive tobacco cessation services have not been widely provided worldwide. The purpose of this study is to identify factors associated with the use of tobacco cessation services among female tobacco product users in Korea from a national perspective. We performed a logistic regression analysis using data from 663 female smokers; 11.0% of female smokers had used government-supported smoking cessation services. A logistic regression model showed a statistically significant association between the utilization of smoking cessation services and a history of pregnancy and childbirth, depression, current use of heated tobacco products and multiple tobacco products, parental smoking status and receiving advice to quit. With regard to the motivation ruler, those in their 50s reported a higher importance than those in their 20s. Weight gain concerns when quitting smoking were the lowest among the participants aged 19-29. The need to develop gender-specific smoking cessation programs is the highest among the participants aged 39-49 and the lowest among those aged 19-29. This study suggests several factors related to the utilization of national health services among female smokers. Further studies considering gender-specific needs for the development of gender-responsive tobacco cessation support are needed.

Weight Gain After Smoking Cessation and Lifestyle Strategies to Reduce it

BACKGROUND

Weight gain following smoking cessation reduces the incentive to quit, especially among women. Exercise and diet interventions may reduce postcessation weight gain, but their long-term effect has not been estimated in randomized trials.

METHODS

We estimated the long-term reduction in postcessation weight gain among women under smoking cessation alone or combined with (1) moderate-to-vigorous exercise (15, 30, 45, 60 minutes/day), and (2) exercise and diet modification (≤2 servings/week of unprocessed red meat; ≥5 servings/day of fruits and vegetables; minimal sugar-sweetened beverages, sweets and desserts, potato chips or fried potatoes, and processed red meat).

RESULTS

Among 10,087 eligible smokers in the Nurses' Health Study and 9,271 in the Nurses' Health Study II, the estimated 10-year mean weights under smoking cessation were 75.0 (95% CI = 74.7, 75.5) kg and 79.0 (78.2, 79.6) kg, respectively. Pooling both cohorts, the estimated postcessation mean weight gain was 4.9 (7.3, 2.6) kg lower under a hypothetical strategy of exercising at least 30 minutes/day and diet modification, and 5.9 (8.0, 3.8) kg lower under exercising at least 60 minutes/day and diet modification, compared with smoking cessation without exercising.

CONCLUSIONS

In this study, substantial weight gain occurred in women after smoking cessation, but we estimate that exercise and dietary modifications could have averted most of it.

Activation of PPARγ Attenuates the Expression of Physical and Affective Nicotine Withdrawal Symptoms through Mechanisms Involving Amygdala and Hippocampus Neurotransmission

An isoform of peroxisome proliferator-activated receptors (PPARs), PPARγ, is the receptor for the thiazolidinedione class of anti-diabetic medications including pioglitazone. Neuroanatomical data indicate PPARγ localization in brain areas involved in drug addiction. Preclinical and clinical data have shown that pioglitazone reduces alcohol and opioid self-administration, relapse to drug seeking, and plays a role in emotional responses. Here, we investigated the behavioral effect of PPARγ manipulation on nicotine withdrawal in male Wistar rats and in male mice with neuron-specific PPARγ deletion (PPARγ^(-/-)) and their littermate wild-type (PPARγ^(+/+)) controls. Real-time quantitative RT-PCR and RNAscope in situ hybridization assays were used for assessing the levels of expression and cell-type localization of PPARγ during nicotine withdrawal. Brain site-specific microinjections of the PPARγ agonist pioglitazone were performed to explore the role of this system on nicotine withdrawal at a neurocircuitry level. Results showed that activation of PPARγ by pioglitazone abolished the expression of somatic and affective nicotine withdrawal signs in rats and in (PPARγ^(+/+)) mice. This effect was blocked by the PPARγ antagonist GW9662. During early withdrawal and protracted abstinence, the expression of PPARγ increased in GABAergic and glutamatergic cells of the amygdala and hippocampus, respectively. Hippocampal microinjections of pioglitazone reduced the expression of the physical signs of withdrawal, whereas excessive anxiety associated with protracted abstinence was prevented by pioglitazone microinjection into the amygdala. Our results demonstrate the implication of the neuronal PPARγ in nicotine withdrawal and indicates that activation of PPARγ may offer an interesting strategy for smoking cessation.SIGNIFICANCE STATEMENT Smoking cessation leads the occurrence of physical and affective withdrawal symptoms representing a major burden to quit tobacco use. Here, we show that activation of PPARγ prevents the expression of both somatic and affective signs of nicotine withdrawal. At molecular levels results show that PPARγ expression increases in GABAergic cells in the hippocampus and in GABA- and glutamate-positive cells in the basolateral amygdala. Hippocampal microinjections of pioglitazone reduce the insurgence of the physical withdrawal signs, whereas anxiety linked to protracted abstinence is attenuated by pioglitazone injected into the amygdala. Our results demonstrate the implication of neuronal PPARγ in nicotine withdrawal and suggest that PPARγ agonism may represent a promising treatment to aid smoking cessation.

Stress and Addiction: When a Robust Stress Response Indicates Resiliency

OBJECTIVE

Stress reactivity research has traditionally focused on the idea that exaggerated responses to stress may have adverse effects on health. Accumulating evidence suggests that attenuated responses to stress and delayed recovery may also be problematic.

METHODS

This review focuses on the role of the stress response of the hypothalamic-pituitary-adrenocortical axis, the endogenous opioid system, and the cardiovascular system in hypertension, pain perception, and addictive behaviors. Results from multiple methods of assessment and stress paradigms conducted in our laboratory over the past two decades are integrated with research from other investigators and with existing theories.

RESULTS

Research indicates that exaggerated biological and physiological responses to stress and attenuated pain perception are associated with hypertension and risk for cardiovascular diseases. This research complements work linking reduced stress responses with enhanced pain sensitivity and discomfort. Multiple studies have also demonstrated that an attenuated stress response is linked to exacerbation of withdrawal symptoms and relapse in nicotine addiction. Evidence indicates important moderators (i.e., sex, personality traits, and early life adversity) and hypothalamic-pituitary-adrenocortical- and endogenous opioid system-related mechanisms in the altered response to stress. I integrate these findings in a conceptual model emphasizing that robust stress responses in the context of addiction and relapse should be considered as a marker of resiliency.

CONCLUSIONS

A blunted stress response may indicate long-term physiological dysregulation that could usher harmful consequences for cardiovascular disease, pain perception, and addictive disorders. The impact of dysregulation is influenced by multiple individual and situational factors that should be considered in evaluating the clinical significance of stress response dysregulation.

Worsening Dietary and Physical Activity Behaviors Do Not Readily Explain Why Smokers Gain Weight After Cessation: A Cohort Study in Young Adults

Introduction

The relationship between smoking cessation and weight gain is well established but the underlying mechanisms remain poorly understood. We aimed to determine whether postcessation weight gain was mediated by changing health behaviors.

Methods

A total of 281 smokers self-reported their demographic, smoking, and lifestyle characteristics in 2004-2006 (aged 26-36) and 2009-2011 (aged 31-41). Behaviors considered as potential mediators of weight gain were changes in consumption of breakfast, discretionary foods (servings/d), fruit and vegetables (servings/d), alcohol (g/d), takeaway food (times/wk), Diet Guideline Index score, leisure time physical activity (PA, min/wk), total PA (min/wk), time spent sitting (min/d), and TV viewing (h/d).

Results

In total, 124 smokers quit smoking during 5 years follow-up. After adjustment for age, sex, baseline body mass index, education, and follow-up length, smoking cessation was associated with average excess weight gain of 2.09kg (95% CI = 0.35-3.83). Compared with continuing smokers, quitters reported a higher Diet Guideline Index score and less consumption of alcohol at baseline and follow-up (all p < .05). In addition, there was a tendency towards healthier dietary and PA behaviors over 5 years among quitters than continuing smokers except for time spent sitting, although these differences did not reach statistical significance. Adjustment for changes in these behaviors made little difference to the magnitude of postcessation weight gain (β: 2.32kg, 95% CI = 0.54-4.10).

Conclusions

The weight gain associated with smoking cessation was not explained by worsening dietary and PA behaviors. Future research is needed to elucidate the complex mechanisms and particularly ways it may be prevented.

Implications

Fear of weight gain often discourages smokers from trying to quit but guidance on ways to most effectively avoid weight gain is lacking. It is important to identify what causes postcessation weight gain and the ways it may be prevented. The current study explored the effects of several changing dietary and PA behaviors on the relationship between smoking cessation and weight gain in 281 young Australian smokers. We found that quitters tended to adopt healthier dietary and PA behaviors than continuing smokers, so these behaviors did not readily explain the postcessation weight gain. Further investigations of other potential mechanisms are needed.

Association Between Subjective Obesity Status and Smoking Behavior Among Normal-Weight Women

Smoking and obesity are chief causes of mortality, morbidity, and medical expenditure. However, few studies have investigated the linkage between subjective obesity status and smoking behavior. This study examines whether females in a normal body mass index range who perceive themselves as obese are more likely to smoke than those who do not perceive themselves as obese. Stratifying by age-group, I employed the propensity score matching analysis to control for selection bias. Although body mass index is lower for younger females aged 20 to 39, they are more likely than elder females to consider themselves as obese. Based on a logistic regression, my findings show that younger females who perceive themselves as obese are 21.2% more likely to smoke than females who do not perceive themselves as obese. The positive relationship between perceived obesity status and smoking behavior is also found in the propensity score matching analysis. However, the disparity in smoking prevalence is not detected between elder females who perceive themselves as obese and those who do not. Public education that fosters accurate perception of body shape is imperative in inducing healthy lifestyles and improving social welfare.

Can We Selectively Reduce Appetite for Energy-Dense Foods? An Overview of Pharmacological Strategies for Modification of Food Preference Behavior

Excessive intake of food, especially palatable and energy-dense carbohydrates and fats, is largely responsible for the growing incidence of obesity worldwide. Although there are a number of candidate antiobesity drugs, only a few of them have been proven able to inhibit appetite for palatable foods without the concurrent reduction in regular food consumption. In this review, we discuss the interrelationships between homeostatic and hedonic food intake control mechanisms in promoting overeating with palatable foods and assess the potential usefulness of systemically administered pharmaceuticals that impinge on the endogenous cannabinoid, opioid, aminergic, cholinergic, and peptidergic systems in the modification of food preference behavior. Also, certain dietary supplements with the potency to reduce specifically palatable food intake are presented. Based on human and animal studies, we indicate the most promising therapies and agents that influence the effectiveness of appetite-modifying drugs. It should be stressed, however, that most of the data included in our review come from preclinical studies; therefore, further investigations aimed at confirming the effectiveness and safety of the aforementioned medications in the treatment of obese humans are necessary.

Obesity and Smoking: can we Kill Two Birds with one Tax?

The debate on tobacco and fat taxes often treats smoking and eating as independent behaviors. However, the available evidence shows that they are interdependent, which implies that policies against smoking or obesity may have larger scope than expected. To address this issue, we propose a dynamic rational model where eating, smoking, and physical exercise are simultaneous choices that jointly affect body weight and addiction to smoking. Focusing on direct and cross-price effects, we study the impact of tobacco and food taxes, and we show that in both cases a single policy tool can reduce both smoking and body weight. Copyright © 2015 John Wiley & Sons, Ltd.

Association between Smoking Status and Obesity in a Nationwide Survey of Japanese Adults

OBJECTIVE

A positive association between the number of cigarettes smoked per day and obesity has been reported, whereas how other smoking-related indices, such as pack-years and duration of smoking, are related with obesity has been less investigated. We analyzed the age-adjusted cross-sectional association between smoking and obesity in a general Japanese population.

METHODS

We used data from a nationwide epidemiological study of Japanese adults (N = 23,106). We compared the prevalence of obesity (defined as body mass index ≥ 25kg/m2) among groups classified by smoking behavior, pack-years, number of cigarettes per day, duration of smoking, and duration and time of smoking cessation.

RESULTS

In men, current smokers had a lower odds ratio (OR) for obesity of 0.80 (95% confidence interval (CI): 0.72-0.88) compared to non-smokers, whereas past smokers had a higher OR of 1.23 (95% CI: 1.09-1.37) compared to current smokers. In women, there were no differences in obesity between the three groups classified by smoking behavior. However, in both sexes, the prevalence of obesity tended to increase with pack-years and the number of cigarettes per day, but not with duration of smoking in current and past smokers. Further, in male smokers, the risks for obesity were markedly higher in short-term heavy smokers compared with long-term light smokers, even with the same number of pack-years. Regarding the impact of smoking cessation, female past smokers who quit smoking at an age > 55-years had an elevated OR of 1.60 (95% CI:1.05-2.38) for obesity.

CONCLUSIONS

In a general Japanese population, obesity is progressively associated with pack-years and number of cigarettes per day, but not with the duration of smoking. When investigating the association between obesity and cigarette smoking, the daily smoking burden and the duration of smoking require to be independently considered.

Smoking relapse and weight gain prevention program for postmenopausal weight-concerned women: A pilot study

OBJECTIVE

Postmenopausal women have substantial concerns about weight gain when quitting smoking, which may contribute smoking relapse. There is a need for smoking cessation and weight gain prevention programs effective in this population.

METHODS

Two formats of a smoking cessation/weight gain prevention follow-up intervention in postmenopausal weight concerned women were compared: a minimally-tailored group format and a highly tailored, multidisciplinary individual format. Effects on sustained abstinence and postcessation weight gain were assessed. Postmenopausal smokers received 6 sessions of behavioral counseling over a 2-week period, 8weeks of the nicotine transdermal patch, and subsequent random assignment to receive follow-up relapse prevention sessions at 1, 3, 8, and 16weeks postcessation in either group or individual format.

RESULTS

The sample (N=98) was 67% Caucasian and 33% African-American. Age: m=52.3 (7.8) years, follicle stimulating hormone: m=42.6 (25.7), body mass index (BMI): m=27.4 (6.2), daily smoking rate: m=20.3 (11.5), for m=29.4 (10.7) years, Fagerström Test for Nicotine Dependence (FTND): m=6.4 (2.1), and carbon monoxide: m=23.8 (13.0) ppm. Abstinence rates in the group condition were significantly higher at 8weeks posttreatment. Group format significantly predicted abstinence rates at 8 and 16weeks posttreatment, even while controlling for age, race, BMI, CPD, years smoking, FTND, and weight concern. Weight concern predicted postcessation weight gain at 8 and 16weeks posttreatment.

CONCLUSIONS

Results indicate that smoking cessation programs for postmenopausal women may best be delivered in a group format and that postcessation weight concerns be dealt with prior to a quit date.

Effect modification by gender and smoking status on the association between obesity and atopic sensitization in Chinese adults: a hospital-based case-control study

BACKGROUND

There is an ongoing debate on the potential association between obesity and atopy. However, no previous studies have investigated whether this relationship depends on sex and smoking status in Chinese adults.

METHODS

In this hospital-based, case-control study, we recruited 1150 atopic cases aged 18 years or older and 1245 healthy control participants during April 2009 and December 2012 in Harbin, China. We conducted structured questionnaire interviews, anthropometry measurements and serum allergen-specific immunoglobulin E (IgE) testing. Univariate and multivariate logistic regression models were used to explore the relationship between obesity and atopy risk stratified by sex and smoking status.

RESULTS

There was an association between obesity and an increased risk of atopic sensitization after adjusting for age, educational, family history, smoking and alcohol consumption (OR: 2.61, 3.25; 95% CI: 1.57-4.33,1.91-5.56 in males and females, respectively). The association between BMI and allergic sensitization depended on smoking status. In both genders, the association of obesity with atopic sensitization risk was stronger in non-smokers than in current smokers. In males, ORs of atopic sensitization for obesity were 3.15 (95% CI, 1.46-6.68) for non-smokers and 2.22 (95% CI, 1.10-4.48) for current smokers. The corresponding ORs in females were 3.51 (95% CI, 1.98-6.24) and 2.22 (95% CI, 0.46-10.68) for non-smokers and current smokers, respectively. After excluding those subjects who with pre-existing allergic conditions, the same relationship still remained.

CONCLUSIONS

Obesity is positively and significantly associated with the risk of atopy in both men and women as well in both smokers and non-smokers in China. In addition, the relationship between obesity and atopic sensitization is stronger in non-smokers than in current smokers.

Smoking Habits and Neuropeptides: Adiponectin, Brain-derived Neurotrophic Factor, and Leptin Levels

This study aimed to identify changes in the level of neuropeptides among current smokers, former smokers, and individuals who had never smoked, and how smoking habits affect obesity and metabolic syndrome (MetS). Neuropeptide levels, anthropometric parameters, and metabolic syndrome diagnostic indices were determined among male workers; 117 of these had never smoked, whereas 58 and 198 were former and current smokers, respectively. The total sample comprised 373 male workers. The results obtained from anthropometric measurements showed that current smokers attained significantly lower body weight, body mass index, waist circumference, and abdominal fat thickness values than former smokers and those who had never smoked. Current smokers’ eating habits proved worse than those of non-smokers and individuals who had never smoked. The level of brain-derived neurotrophic factor (BDNF) in the neuropeptides in the case of former smokers was 23.6 ± 9.2 pg/ml, higher than that of current smokers (20.4 ± 6.1) and individuals who had never smoked (22.4 ± 5.8) (F = 6.520, p = 0.002). The level of adiponectin among former smokers was somewhat lower than that of current smokers, whereas leptin levels were higher among former smokers than current smokers; these results were not statistically significant. A relationship was found between adiponectin and triglyceride among non-smokers (odds ratio = 0.660, β value = −0.416, p < 0.01) and smokers (odds ratio = 0.827, β value = −0.190, p < 0.05). Further, waist circumference among non-smokers (odds ratio = 1.622, β value = 0.483, p < 0.001) and smokers (odds ratio = 1.895, β value = 0.639, p < 0.001) was associated with leptin. It was concluded that cigarette smoking leads to an imbalance of energy expenditure and appetite by changing the concentration of neuropeptides such as adiponectin, BDNF, leptin, and hsCRP, and influences food intake, body weight, the body mass index, blood pressure, and abdominal fat, which are risk factors for MetS and cardiovascular disease.

Effects of smoking cessation on β-cell function, insulin sensitivity, body weight, and appetite

OBJECTIVE

To stop smoking is commonly associated with significant weight gain, but the mechanisms for this are poorly understood. We assessed the effects of smoking cessation on body weight, insulin sensitivity, β-cell function, and appetite.

SUBJECTS AND METHODS

Twenty-seven long-term smokers (n=27; nine females/18 males, 28±1 years, 22.9±0.6 kg/m(2)) attending an ambulatory smoking cessation program in a community hospital in Vienna, Austria were examined at baseline (Visit A; still smoking) and after a minimum of 3 months of smoking abstinence (Visit B; n=14); relapsed smokers were not followed up. Participants underwent 3-h oral glucose tolerance tests and body composition measurements at each study visit. Fasting (QUICKI) and dynamic (oral glucose insulin sensitivity (OGIS)) insulin sensitivity and β-cell secretion (insulinogenic index 140 (IGI40)) were calculated. Food intake was quantified with a free choice buffet. Fasting plasma concentrations of neuropeptide-Y (NPY), peptide-YY (PYY), glucagon-like peptide 1 (GLP1), leptin, ghrelin, and visfatin were measured.

RESULTS

AFTER 3 MONTHS' SMOKING ABSTINENCE, BODY WEIGHT, AND FAT MASS WERE INCREASED (+4 AND +22% RESPECTIVELY, P0.05) AND FASTING INSULIN SENSITIVITY DETERIORATED (QUICKI: post, 0.37±0.02 vs baseline, 0.41±0.2; P<0.05), while OGIS remained unchanged throughout. IGI40 increased by 31% after >3 months' smoking abstinence (P<0.01). Carbohydrate ingestion increased after stopping smoking (P<0.05). NPY fasting levels were increased after >3 months (P<0.05), PYY, GLP1, leptin, ghrelin, and visfatin were unchanged.

CONCLUSION

Smoking cessation is associated with transient metabolic changes including increased β-cell secretion in response to glucose and fasting insulin resistance. These alterations may be associated with or contribute to the body weight gain after smoking cessation.

Factors associated with weight changes in successful quitters participating in a smoking cessation program

OBJECTIVE

To identify possible predictors of post-cessation weight gain in smoking abstainers.

PATIENTS AND METHODS

A sample of 607 successful abstainers seen at the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2005 and 2010, was included in this analysis. This sample was followed up for 1year and included 47.9% women (N=291) with the mean age of 48years (18-85).

FINDINGS

Post-cessation weight gain occurred in 88.6% of the 607 abstainers. The mean weight gain after one year post-quit was 5.1kg (95% confidence interval 4.7-5.5kg). Baseline characteristics associated with increased weight gain included a higher baseline smoking rate (p<0.001), more severe cigarette dependence (p=0.003), less physical activity (p=0.008), and a report of increased appetite on the baseline assessment of withdrawal symptoms (p<0.001).

CONCLUSIONS

Smokers who are more dependent and have minimal physical activity are at increased risk for post-cessation weight gain. For these smokers, incorporating interventions targeting the weight issue into tobacco dependence treatment is recommended. Further research should be done to identify reasons for this important quitting complication.

Effect of smoking cessation on gestational and postpartum weight gain and neonatal birth weight

OBJECTIVE

To examine the association among smoking cessation, gestational and postpartum weight gain, and neonatal birth weight.

METHODS

We analyzed prospectively collected data from 1,774 women with term singleton pregnancies. Smoking status during pregnancy was categorized as nonsmokers, smokers, and quitters; and smoking status 1 year postpartum as nonsmokers, smokers, relapsed quitters, and sustained quitters. The association between smoking status and gestational weight gain, weight gain 1 year postpartum, and neonatal birth weight was tested by linear regression analysis, and the association between smoking status and neonatal birth weight less than the 10th percentile for gestational age and sex was tested by multivariable logistic regression analysis.

RESULTS

Gestational weight gain at 16 weeks of gestation was comparable for nonsmokers, smokers, and quitters. The adjusted mean gestational weight gain at 37 weeks of gestation was 2.0 kg (95% confidence interval [CI] 1.5-2.6) higher in quitters compared with nonsmokers. The rate of neonatal birth weight less than the 10th percentile was 21.7% among smokers, 8.0% among quitters, and 7.4% among nonsmokers. The adjusted odds ratio (OR) for birth weight less than 10th percentile was 3.6 (95% CI 2.5-5.2) in neonates born to smokers; the risk was similar for quitters (OR 1.0, 95% CI 0.6-1.6). One year after delivery, sustained quitters had a 2.4-kg (95% CI 1.6-3.1) higher adjusted postpartum weight gain than nonsmokers.

CONCLUSION

Smoking cessation is associated with gestational as well as postpartum weight gain. However, smoking cessation is associated with a substantially lower rate of neonatal birth weight less than the 10th percentile.

LEVEL OF EVIDENCE

II.

Tobacco addiction and the dysregulation of brain stress systems

Tobacco is a highly addictive drug and is one of the most widely abused drugs in the world. The first part of this review explores the role of stressors and stress-associated psychiatric disorders in the initiation of smoking, the maintenance of smoking, and relapse after a period of abstinence. The reviewed studies indicate that stressors facilitate the initiation of smoking, decrease the motivation to quit, and increase the risk for relapse. Furthermore, people with depression or an anxiety disorder are more likely to smoke than people without these disorders. The second part of this review describes animal studies that investigated the role of brain stress systems in nicotine addiction. These studies indicate that corticotropin-releasing factor, Neuropeptide Y, the hypocretins, and norepinephrine play a pivotal role in nicotine addiction. In conclusion, the reviewed studies indicate that smoking briefly decreases subjective stress levels but also leads to a further dysregulation of brain stress systems. Drugs that decrease the activity of brain stress systems may diminish nicotine withdrawal and improve smoking cessation rates.

Associations between weight change over 8 years and baseline body mass index in a cohort of continuing and quitting smokers

AIM

To examine the association between weight change and baseline body mass index (BMI) over 8 years in a cohort of continuing and quitting smokers.

DESIGN

Prospective cohort.

SETTING

Oxfordshire general practices nicotine patch/placebo trial with 8-year follow-up.

PARTICIPANTS

Eighty-five participants were biochemically proven abstinent at 3, 6, 12 months and 8 years (abstainers). A total of 613 smoked throughout the 8 years (smokers), 26 quit for a whole year but were smoking again by 8 years (relapsed); 116 smoked for the first year but were abstinent at 8 years (late abstainers).

MEASUREMENTS

Weight and BMI was measured at baseline and at 8 years. Regression models were used to examine weight gain by smoking status and the association of BMI at the time of quitting.

FINDINGS

Abstainers gained 8.79kg [standard deviation (SD) 6.36; 95% confidence interval (CI) 7.42, 10.17]. Smokers gained 2.24 kg (SD 6.65; 95% CI 1.7, 2.77). Relapsed smokers gained 3.28 kg (SD 7.16; 95% CI 0.328, 6.24). Late abstainers gained 8.33 kg (SD 8.04; 95% CI 6.85, 9.81). The association between baseline BMI and weight change was modified by smoking status. In smokers there was a negative linear association of BMI, while in abstainers a J-shaped curve fitted best. These models estimated weight change over 8 years in abstainers of +9.8 kg, +7.8kg, +10.2kg, +19.4kg and in smokers of +3.9kg, +2.6kg, 1.0kg and -0.8kg, where BMI was 18, 23, 29 and 36, respectively.

CONCLUSION

Obese smokers gain most weight on quitting smoking, while obese continuing smokers are likely to remain stable or lose weight. Obese quitters have the greatest need for interventions to ameliorate weight gain.

Rising cigarette prices and rising obesity: coincidence or unintended consequence?

Economists have begun to debate if the rise in cigarette prices in the U.S. in recent decades has contributed to the nation's rise in obesity, reaching conclusions that are surprisingly sensitive to specification. I show that allowing for the effect to occur gradually over several years leads to the conclusion that a rise in cigarette prices is actually associated with a long-run reduction in body mass index and obesity. This result is robust to the different methodologies used in the literature. I also provide evidence that indirect effects on exercise and food consumption may explain the counterintuitive result.

Associations between body mass index and substance use disorders differ by gender: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Alcohol, illicit drugs, and nicotine can affect appetite and body weight, but few epidemiologic studies have examined relationships between body mass index (BMI) and substance use disorders. This study used logistic regression to examine effects of BMI and gender on risk for DSM-IV substance use disorders in a sample of 40 364 adults. Overweight and obesity were associated with increased risk for lifetime alcohol abuse and dependence in men but not women. Overweight and obesity were associated with decreased risk for past-year alcohol abuse in women. BMI was not associated with illicit drug use disorders. Overweight and obese men were at decreased risk for both lifetime and past-year nicotine dependence. Overweight women were at increased risk for lifetime nicotine dependence, and obese women were at decreased risk for past-year nicotine dependence. Further research is needed to identify reasons for observed gender differences in relationships between BMI and substance use disorders.

Sequential Treatment for Nicotine Dependence and Postcessation Weight Concern in a Female Diagnosed with Paranoid Schizophrenia

Despite declines in smoking prevalence, some populations represent significant challenges to tobacco cessation programs, including smokers with psychiatric comorbidity and/or weight concerns. Few studies have found effective interventions for tobacco cessation or addressed the prevalence of smoking-related concerns in psychiatric populations. The side effects of many psychotropic medications, decreased participation in physical activity, and weight gain following cessation suggest that postcessation weight concerns and actual weight gain may be significant barriers to cessation as well. Therefore, serial interventions, rather than simultaneous ones, seem well suited to address these issues. This case study represents the piloting of serial cessation and postcessation weight gain prevention interventions in a female diagnosed with paranoid schizophrenia. Results suggested that the serial implementation of cognitive-behavioral interventions can be effective in promoting tobacco cessation in individuals with co-occurring disorders.

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.

Predictors of pretreatment attrition from smoking cessation among pre- and postmenopausal, weight-concerned women

The present study sought to determine whether postcessation weight gain concerns influenced pretreatment attrition differently for pre- versus postmenopausal women smokers. Participants were pre- and postmenopausal women smokers drawn from two clinical trials for smoking cessation and weight gain prevention [the Smoking Treatment/Obesity Prevention (STOP) studies]. Predictors of attrition from baseline assessment visits prior to entering smoking cessation treatment were identified among these women. Pretreatment attrition was significantly higher among the premenopausal women. The premenopausal women had significantly higher weight concern but lower restraint and disinhibition than the postmenopausal women. Weight concern explained variance in treatment attrition from the programs, while controlling for variables such as Body Mass Index (BMI), smoking rate, number of years smoking, nicotine dependence level, dietary restraint, disinhibition, and hunger, such that the higher the weight concern, the more likely women were to drop out of treatment programs prior to a quitting attempt.

Smoking status, cigarettes per day, and their relationship to overweight and obesity among former and current smokers in a national adult general population sample

BACKGROUND

Weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The goal was to analyze overweight and obesity depending on smoking status and number of cigarettes per day (cpd) among former and current smokers.

METHODS

The sample included 7124 residents of Germany aged 18-79 y from a national health examination survey (participation rate: 61.4%). Body weight and height were objectively measured; smoking status and cpd were assessed by a questionnaire administered in a health examination center.

RESULTS

The number of cpd was positively related to being overweight and more so to obesity among former smoking men, but not women. The results were adjusted for age, school education, exercise and alcohol consumption. Men who formerly had smoked more than 30 cpd had an adjusted odds ratio (OR) of 5.0 for obesity compared to men who had never smoked.

CONCLUSION

With an increasing number of cpd more psychological and physiological processes of compensation of nicotine supply after smoking cessation may be expected. Male smokers should be provided with information on how to prevent weight gain after smoking cessation. To foster smoking cessation, female smokers should be informed that women who stop smoking manage to have no increase in the rates of overweight or obesity when considered at the general population level.

The role of corticotropin-releasing factor-like peptides in cannabis, nicotine, and alcohol dependence

The corticotropin-releasing factor (CRF)-like peptides, which include the mammalian peptides CRF, urocortin 1, urocortin 2, and urocortin 3, play an important role in orchestrating behavioral and physiological responses that may increase an organism's chance of survival when confronted with internal or external stressors. There is, however, evidence that a chronic overactivity of brain CRF systems under basal conditions may play a role in the etiology and maintenance of psychiatric disorders such as depression and anxiety disorders. In addition, there is evidence of a role for CRF-like peptides in acute and protracted drug abstinence syndromes and relapse to drug-taking behavior. This review focuses on the role of CRF-like peptides in the negative affective state associated with acute and protracted withdrawal from three widely abused drugs, cannabis, nicotine, and alcohol. In addition, we discuss the high comorbidity between stress-associated psychiatric disorders and drug dependence. A better understanding of the brain stress systems that may underlie psychiatric disorders, acute and protracted drug withdrawal, and relapse to drug-taking behavior may help in the development of new and improved pharmacotherapies for these widespread psychiatric disorders.

Change in serum lipids and body mass index by age, sex, and smoking status: the Tromsø study 1986-1995

PURPOSE

The steady increase in body weight is becoming a major health problem in western societies. How body weight increase influences established disease risk factors is the focus of our study.

METHODS

We assessed the association between 8-year change in body weight and serum lipids in a population-based study comprising 15,624 men and women aged 20 to 61 years at baseline in 1986. Comparisons between different strata of age, sex, initial weight, and categories of smoking status change were also addressed.

RESULTS

Significant associations between body mass index (BMI) change and change in high density lipoprotein (HDL) cholesterol, total cholesterol, and triglycerides were observed in all 10-year age groups both in men and women. The weakest associations were observed in persons older than 50 years of age and the associations were also weaker in women than in men. In quartile groups of baseline BMI, a significant linear trend was observed for HDL cholesterol in men and for total cholesterol in both men and women. The associations were less adverse for persons in a higher quartile group of baseline BMI. The association between BMI change and serum lipid change was strongest for persons who were consistent smokers or non-smokers at each survey.

CONCLUSIONS

We conclude that an increase in BMI has been shown to be associated with adverse changes in serum lipids. The associations were weaker in women than in men.

Food groups as predictors for short-term weight changes in men and women of the EPIC-Potsdam cohort

This study examined the effect of food group intake on subsequent 2-y weight change. Food-frequency questionnaire-based food intake data of 17,369 nonsmoking subjects of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort were examined in their relation to a subsequent weight change. Dietary data, collected from 1994 to 1998, were grouped into 24 food groups. Weight change per year follow-up was the outcome of interest; large weight gain was defined as > or =2 kg; small weight gain as > or =1 kg to <2 kg; large weight loss as < or = -2 kg; small weight loss as < or = -1 kg to > -2 kg and weight maintenance as +/- 1 kg. For each food group, a separate polytomous logistic regression model with stable weight as the reference group was constructed, controlling for age, body mass index, previous weight change, and behavioral and lifestyle factors. Odds ratios (OR) and 95% confidence intervals (CI) estimated the increase in risk associated with each 100 g/d increment in food group intake. In women, consumption of high energy, high fat food groups significantly predicted large weight gain, e.g., fats (OR = 1.75; 95% CI, 1.01-3.06), sauces (OR = 2.12; 95% CI, 1.17-3.82) and meat (OR = 1.36; 95% CI, 1.04-1.79), and the consumption of cereals predicted large weight loss (OR = 1.43; 95% CI, 1.09-1.88). In men, intake of high energy, high sugar foods, i.e., sweets, was significantly predictive of large weight gain (OR = 1.48; 95% CI, 1.03-2.13). Our data show that a diet rich in high fat and high energy foods predicts short-term weight gain even if controlled for many potential confounding factors.

Regulation of feeding-associated peptides and receptors by nicotine

Although numerous epidemiological studies have provided convincing evidence for the inverse association between tobacco smoking and body weight, the molecular mechanisms underlying this relationship are not well-understood. Nicotine, as a potent secretagogue, could be expected to influence the levels and expression of many classes of neurotransmitters, as well as of cell-membrane constituents linked to neurotransmission, including signal transducers and related effectors. A potentially major group of candidate molecules that could be involved in feeding-related actions of nicotine are the numerous neuropeptides and peptide hormones shown in the past two decades to regulate food intake and energy expenditure. These could include neuropeptide Y (NPY), orexins, leptins, and uncoupling proteins (UCPs). Some of these peptides were already shown to respond to nicotine treatment in terms of regulation of levels and of activity at the level of cell-membrane receptors. The primary objective of this review is to summarize our current understanding of the regulatory effects of nicotine on the food intake and energy expenditure as related to the expression levels of leptin, NPY, orexin, uncoupling proteins, and of NPY and orexin receptors.

Hypothesis for temporal displacement of metabolic and neuronal accommodation in smoking addiction

Using the overlapping criteria of (1) current smoking status and (2) homeostatic accommodation of smoking, the categories of nonsmoker, beginning smoker, smoker, and quitting smoker are structured into a cyclic representation of smoking addiction. This cyclic representation reveals that elimination of homeostatic accommodation of smoking is a critical success factor to the process of becoming a nonsmoker, while the act of stopping smoking is necessary yet insufficient to the success of that process. Homeostatic accommodation is described as having two components: metabolic and neuronal. A hypothesis for temporal displacement of metabolic and neuronal accommodation is presented to explain the behavior of "chippers" (occasional smokers) and adolescent smokers. Recommendations are made for research on the rates of development and dissipation of metabolic and neuronal accommodation of smoking, and for the development of a bimodal therapy that addresses both metabolic and neuronal accommodation and reduces relapse for quitting smokers.

Smoking cessation and body mass index of occupationally active men: the Israeli CORDIS Study

OBJECTIVES

This study estimated weight gain after smoking cessation and identified factors attenuating this gain.

METHODS

We conducted a prospective follow-up of 1209 male factory workers for 2 to 4 years. The independent variables were smoking habits. age, sports activity, education, alcohol consumption, ethnicity, duration of follow-up, and body mass index (BMI, kg/m2) at entry. The dependent variable was increase in BMI during follow-up.

RESULTS

The mean age-adjusted BMI at entry into the study was 26.6 kg/m2 among past smokers and 25.4 kg/m2 among current smokers. There were no differences in BMI between those who quit less than 3 years before entry and those who quit more than 6 years before entry. During follow-up, the average increase in BMI was 0.07 kg/m2 among never smokers, 0.19 kg/m2 among smokers who had stopped smoking before entry, 0.24 kg/m2 among current smokers, and 0.99 kg/m2 among those who stopped smoking after entry. Cessation of smoking after entry predicted an increased gain in BMI; older age, a higher BMI at entry, sports activity, and alcohol consumption attenuated this gain.

CONCLUSIONS

The increased rate of weight gain after smoking cessation is transient. However, the weight gained is retained for at least 6 years.

An exploratory study of recreational drug use and nutrition-related behaviors and attitudes among adolescents

This study examined drug use and eating behaviors among adolescents. The data were collected by phone interviews from 401 northern Nevadan students in grades seven to twelve. Students were divided for comparison into three groups according to their involvement with drugs: Abstainers, conventional users, and high-risk users. Analyses indicated that high-risk users less frequently ate lunch, meals at home, and with their families, and ate more often at convenience stores, fast food restaurants, and with friends. In addition, female high-risk users had significantly more negative perceptions regarding their food choices than the other female groups, and were more concerned with dieting than their high-risk using male peers. Male and female high-risk users believed that their drug use affected their eating habits. Implications for prevention programming and future research are discussed.

Effects of three doses of transdermal nicotine on post-cessation eating, hunger and weight

Smokers were randomly assigned to 0, 7, 14 or 21 mg doses of transdermal nicotine and had their eating and weight followed for 6 weeks. Among the 66 subjects who were abstinent for all 6 weeks, caloric, carbohydrate and fat intake, hunger, and weight increased in those on placebo, but alcohol, caffeine and protein intake did not. Nicotine patch decreased caloric, carbohydrate and fat intake in a dose-related manner, showed a trend for weight and showed no effect for hunger. Neither abstinence from smoking nor nicotine therapy shifted the percent of calories from sweets or carbohydrates. We conclude nicotine replacement reduces post-cessation increases in eating but does not have a specific effect on sweet intake.