Relationships between cigarette smoking, body size and body shape

Prevalence and associated factors of adult overweight and obesity in Southwestern China

Background

Data on the prevalence of overweight and obesity in Southwestern China were limited. The aims of this study were to estimate the prevalence of overweight/obesity and their associated factors in this area.

Methods

A cross-sectional study was conducted from 2013 to 2014 in Chengdu and Chongqing, two megacities in Southwestern China. Data were obtained from questionnaires, physical examinations and lab tests. A total of 11,096 residents aged 35-79 years were included in the final analysis of this study.

Results

The prevalence of overweight and obesity among adults aged 35-79 years in Southwestern China were 29.7 and 4.4%, respectively. Multivariable logistic regression analysis suggested that women, non-smokers, ex-smokers, being hypertensive and diabetic were related to higher obesity prevalence, and that physically active adults and those aged 65-79 years were less likely to have obesity.

Conclusion

Obesity and overweight were prevalent in Southwestern China, especially among women, those with diabetes and/or hypertension, and those who have quitted smoking for more than 3 years.

Estimating causality between smoking and abdominal obesity by Mendelian randomization

BACKGROUND AND AIMS

Smokers tend to have a lower body weight than non-smokers, but also more abdominal fat. It remains unclear whether or not the relationship between smoking and abdominal obesity is causal. Previous Mendelian randomization (MR) studies have investigated this relationship by relying upon a single genetic variant for smoking heaviness. This approach is sensitive to pleiotropic effects and may produce imprecise causal estimates. We aimed to estimate causality between smoking and abdominal obesity using multiple genetic instruments.

DESIGN

MR study using causal analysis using summary effect estimates (CAUSE) and latent heritable confounder MR (LHC-MR) methods that instrument smoking using genome-wide data, and also two-sample MR (2SMR) methods.

SETTING

Genome-wide association studies (GWAS) summary statistics from participants of European ancestry, obtained from the GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN), Genetic Investigation of Anthropometric Traits (GIANT) Consortium and the UK Biobank.

PARTICIPANTS

We used GWAS results for smoking initiation (n = 1 232 091), life-time smoking (n = 462 690) and smoking heaviness (n = 337 334) as exposure traits, and waist-hip ratio (WHR) and waist and hip circumferences (WC and HC) (n up to 697 734), with and without adjustment for body mass index (adjBMI), as outcome traits.

MEASUREMENTS

Smoking initiation, life-time smoking, smoking heaviness, WHR, WC, HC, WHRadjBMI, WCadjBMI and HCadjBMI.

FINDINGS

Both CAUSE and LHC-MR indicated a positive causal effect of smoking initiation on WHR (0.13 [95% confidence interval (CI) = 0.10, 0.16 and 0.49 (0.41, 0.57), respectively] and WHRadjBMI (0.07 (0.03, 0.10) and 0.31 (0.26, 0.37). Similarly, they indicated a positive causal effect of life-time smoking on WHR [0.35 (0.29, 0.41) and 0.44 (0.38, 0.51)] and WHRadjBMI [0.18 (0.13, 0.24) and 0.26 (0.20, 0.31)]. In follow-up analyses, smoking particularly increased visceral fat. There was no evidence of a mediating role by cortisol or sex hormones.

CONCLUSIONS

Smoking initiation and higher life-time smoking may lead to increased abdominal fat distribution. The increase in abdominal fat due to smoking is characterized by an increase in visceral fat. Thus, efforts to prevent and cease smoking can have the added benefit of reducing abdominal fat.

Association of combined healthy lifestyle with general and abdominal obesity

Background

Data linking joint healthy lifestyle factors to general and abdominal obesity are scarce, in particular in the Middle East. The aim of this study was to examine the association of combined healthy lifestyle factors with general and abdominal obesity in a large population of Iranian adults.

Methods

This cross-sectional study was done on 3,172 Iranian adults aged ≥18 years. We constructed healthy lifestyle score using information on dietary intakes, physical activity, smoking status, and psychological distress. To evaluate components of healthy lifestyle, we applied a validated 106-item semi-quantitative Food Frequency Questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ), and other pre-tested questionnaires. General obesity was defined as having a body mass index (BMI) ≥30 kg/m2 and abdominal obesity as a waist circumference (WC) of ≥102 cm in men and ≥88 cm in women.

Results

Mean age of participants was 36.54 ± 7.97 years. General and abdominal obesity were prevalent among 8.7% and 21.5% of study participants, respectively. Linear analysis showed a significant positive relationship between healthy lifestyle score and BMI among men (β: 0.30, 95% CI: 0.05, 0.54). However, no significant association was found between healthy lifestyle and abdominal obesity in men. Among women, one score increase in healthy lifestyle score was associated with a reduction of 0.65 cm in WC. In terms of individual components of healthy lifestyle, we found that low-distressed women had lower odds of abdominal obesity compared with high-distressed women.

Conclusion

We found a significant inverse association between healthy lifestyle and WC among women. However, healthy lifestyle was positively associated with BMI among men.

Empirical dietary inflammatory index and lifestyle inflammation score relationship with obesity: A population-based cross-sectional study

The present study aimed to investigate the association between the empirical dietary inflammatory index (EDII) and lifestyle inflammatory score (LIS) with general and abdominal obesity in Iranian adults using data from the Yazd Health study (YaHS). This cross-sectional study was conducted using the information of participants of the YaHS study. The dietary assessment was conducted using a validated food frequency questionnaire (FFQ) and anthropometric measurements assessed by standard protocols. The inflammatory potential of diet and lifestyle were calculated using EDII and LIS scores. We also created a combinational index of EDII and LIS as an EDII-LIS score. General and abdominal obesity were defined based on body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) cut points, respectively. The odds ratio (OR) and 95% confidence interval (CI) of general and abdominal obesity across tertiles of EDII and LIS were estimated using logistic regression analyses, adjusted for potential confounders. A significant association was found between a higher EDII score and general obesity (OR: 1.21, 95% CI: 1.04-1.41, p trend: .016), however, there was no significant association between EDII and both definitions of abdominal obesity. Participants in the highest versus lowest tertile of LIS had higher odds of increased abdominal obesity (ORWC: 37.0, 95% CI: 28.8-47.5, p trend <.001, ORWHR: 3.30, 95% CI: 2.65-4.11, p trend <.001). In addition, there was also a direct relationship between the higher score of EDII-LIS and the increased likelihood of abdominal obesity (ORWC: 15.0, 95% CI: 12.3-18.3, p trend <.001, ORWHR: 2.68, 95% CI: 2.18-3.29, p trend <.001). Greater adherence to the EDII score was associated with a higher odds of general obesity, but not abdominal obesity. Also, individuals with a higher score of LIS and EDII-LIS are more prone to abdominal obesity.

Risk Factors for Early-Onset Versus Late-Onset Coronary Heart Disease (CHD): Systematic Review and Meta-Analysis

AIM

We aimed to systematically compare literature on prevalence of modifiable and non-modifiable risk factors for early compared to late-onset coronary heart disease (CHD).

METHODS

PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol registered in PROSPERO CRD42020173216). Study quality was assessed using the National Heart, Lung and Blood Institute tool for observational and case-control studies. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences (MD)/standardised MD (SMD) with 95% confidence intervals (CI) for categorical and continuous variables.

RESULTS

Individuals presenting with early-onset CHD (age <65 years) compared to late-onset CHD had higher mean body mass index (MD 1.07 kg/m2; 95% CI 0.31-1.83), total cholesterol (SMD 0.43; 95% CI 0.23-0.62), low-density lipoprotein (SMD 0.26; 95% CI 0.15-0.36) and triglycerides (SMD 0.50; 95% CI 0.22-0.68) with lower high-density lipoprotein-cholesterol (SMD 0.26; 95% CI -0.42--0.11). They were more likely to be smokers (OR 1.76, 95% CI 1.39-2.22) and have a positive family history of CHD (OR 2.08, 95% CI 1.74-2.48). They had lower mean systolic blood pressure (MD 4.07 mmHg; 95% CI -7.36--0.78) and were less likely to have hypertension (OR 0.47, 95% CI 0.39-0.57), diabetes mellitus (OR 0.56, 95% CI 0.51-0.61) or stroke (OR 0.31, 95% CI 0.24-0.42).

CONCLUSION

A focus on weight management and smoking cessation and aggressive management of dyslipidaemia in young adults may reduce the risk of early-onset CHD.

Association between skeletal muscle index prior to liver transplantation and 1-year mortality posttransplant

BACKGROUND

Liver transplantation is the only curative therapy for end-stage liver disease (ESLD). Sarcopenia is often defined as the loss of muscle quantity (skeletal muscle index [SMI]), but muscle attenuation (MA), a surrogate marker of muscle quality, is also decreased in ESLD. We assessed pre-liver transplant SMI and MA and their association with posttransplant mortality, complications, and length of intensive care unit (ICU) and hospital stay.

METHODS

In 169 consecutive patients with ESLD who underwent a liver transplantation between 2007 and 2014, SMI and MA were measured on computed tomography scans at time of placement on the waiting list for liver transplantation. The primary outcome of interest was 1-year posttransplant mortality. Secondary posttransplantation outcomes of interest were complications within 30 days and length of stay in the ICU > 3 days and in the hospital >3 weeks. Logistic and Cox regression analyses were performed.

RESULTS

MA was associated with 1-year posttransplant mortality rate (hazard ratio=0.656, 95% CI=0.464-0.921, P = 0.015). The highest quartile of SMI had a lower odds for the total length of stay in the hospital lasting >3 weeks (odds ratio=0.211, 95% CI=0.061-0.733, P = 0.014). MA was associated with a prolonged ICU stay; this was, however, not statistically significant after adjustment for age, sex, and Model for ESLD score.

CONCLUSION

Lower MA is associated with a longer length of ICU stay and 1-year mortality after liver transplantation, whereas low SMI was associated with a total length of hospital stay.

Relationships of Tobacco Use and Kava Consumption to Sex-Associated Variation in Body Composition and Obesity Risk in Melanesian Adults From Vanuatu

Obesity prevalence has increased in low- and middle-income countries (LMICs) over the past several decades, with generally greater occurrence among adult females compared with males. Gendered variation in health behaviors, such as substance use, may play a role in how differences in obesity, body size, and composition manifest in association with sex. This study examines sex-moderated relationships of tobacco smoking and kava consumption with body composition and obesity among 301 Ni-Vanuatu (local self-identification meaning “of Vanuatu”) adults. Data collected included self-reported frequency of substance use as well as anthropometric measurements to assess body mass, composition, and obesity. Tobacco and kava use were associated with reduced measurements of body mass and adiposity in males, and kava use was associated with some elevated measurements of body mass and hip circumference in females. Kava use was also negatively associated with obesity based on waist-to-height ratio among males. These results have implications for evaluation and future research on substance control programs in this population.

Metabolic Diseases and Risk of Head and Neck Cancer: A Cohort Study Analyzing Nationwide Population-Based Data

The aim of the study was to investigate the association between metabolic diseases and the risk of head and neck cancer (HNC) using nationwide population-based big data. This retrospective cohort study was conducted using the Korean National Health Insurance Service health checkup database. A total of 4,575,818 participants aged >40 years who received a health checkup in 2008 were enrolled, and we studied the incidence of HNC until 2019. We analyzed the risk of HNC according to the presence of metabolic diseases, such as obesity, dyslipidemia, hypertension, and diabetes. Although metabolic syndrome itself was not associated with HNC, each component of metabolic syndrome was associated with HNC. Underweight and diabetes were risk factors for HNC (HR: 1.694). High total cholesterol and high low-density lipoprotein cholesterol levels were factors that decreased the risk (HR 0.910 and 0.839). When we analyzed men and women separately, low total cholesterol level, low low-density lipoprotein cholesterol level, and hypertension were risk factors only in men. In addition, pre-obesity, obesity, and central obesity decreased the risk only in men. Each metabolic disease affects HNC in different ways. Underweight and diabetes increased the risk of HNC, whereas high total cholesterol and high low-density lipoprotein cholesterol levels decreased the risk of HNC.

Identifying the latent classes of modifiable risk behaviours among diabetic and hypertensive individuals in Northeastern India: a population-based cross-sectional study

OBJECTIVE

To identify the latent classes of modifiable risk factors among the patients with diabetes and hypertension based on the observed indicator variables: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. We hypothesised that the study population diagnosed with diabetes or hypertension is homogeneous with respect to the modifiable risk factors.

DESIGN

A cross-sectional study using a stratified random sampling method and a nationally representative large-scale survey.

SETTING AND PARTICIPANTS

Data come from the fourth round of the Indian National Family Health Survey, 2015-2016. Respondents aged 15-49 years who were diagnosed with either diabetes or hypertension or both were included. The total sample is 22 249, out of which 3284 were men and 18 965 were women.

PRIMARY AND SECONDARY OUTCOME MEASURES

The observed variables used as latent indicators are the following: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. The concomitant variables include age, gender, education, marital status and household wealth index. Latent class model was used to simultaneously identify the latent class and to determine the association between the concomitant variables and the latent classes.

RESULTS

Three latent classes were identified and labelled as class 1: 'diabetic with low-risk lifestyle' (21%), class 2: 'high-risk lifestyle' (8%) and class 3: 'hypertensive with low-risk lifestyle' (71%). Class 1 is characterised by those with a high probability of having diabetes and low probability of smoking and drinking alcohol. Class 2 is characterised by a high probability of smoking and drinking alcohol and class 3 by a high probability of having high blood pressure and low probability of smoking and drinking alcohol.

CONCLUSIONS

Co-occurrence of smoking and alcohol consumption was prevalent in men, while excess body weight and high blood pressure were prevalent in women. Policy and programmes in Northeastern India should focus on targeting multiple modifiable risk behaviours that co-occur within an individual.

Cardiovascular Risk Factors among Individuals Incarcerated in an Arizona County Jail

We aimed to estimate the prevalence of cardiovascular risk factors, including hypertension, diabetes, high cholesterol, cigarette smoking, alcohol consumption, and obesity among a sample of individuals incarcerated in an Arizona county jail and compare prevalence estimates to a matched non-institutionalized population. From 2017–2018, individuals housed at a county jail completed a cross-sectional health survey. We estimated the prevalence of hypertension, diabetes, cholesterol, overweight/obesity, cigarette smoking, binge drinking, and self-reported health among individuals incarcerated. We compared prevalence estimates of cardiovascular risk factors to a matched sample of 2017–2018 NHANES participants. Overall, 35.9%, 7.7%, and 17.8% of individuals incarcerated in jail self-reported hypertension, diabetes, and high cholesterol, respectively. Of individuals incarcerated, 59.6% were overweight or obese and 36.8% self-reported fair or poor general health. Over half of individuals incarcerated reported ever smoking cigarettes (72.3%) and binge drinking (60.7%). Compared to a matched sample of NHANES participants, individuals incarcerated in jail had a statistically higher prevalence of cigarette smoking and binge drinking. Screening of cardiovascular risk factors and providing preventive measures and interventions, such as healthy eating, physical activity, or pharmacological adherence interventions, while individuals are incarcerated may contribute to the prevention and management of cardiovascular risk factors and, eventually, cardiovascular disease.

Milk-Fat Intake and Differences in Abdominal Adiposity and BMI: Evidence Based on 13,544 Randomly-Selected Adults

The primary purpose of this investigation was to evaluate the relationship between milk-fat intake and obesity, particularly abdominal obesity, in 13,544 U.S. adults. A lesser objective was to measure the degree to which the association was influenced by multiple potential confounding variables. This cross-sectional study used data from the 2011-2016 National Health and Nutrition Examination Survey (NHANES). Quantity of milk-fat regularly consumed was the exposure variable. Sagittal abdominal diameter (SAD), a measure of abdominal obesity, and body mass index (BMI) were the outcome variables. Sagittal abdominal diameter is a strong predictor of visceral abdominal fat, when measured by computed tomography, and has been shown to predict cardiometabolic disorders better than BMI. After controlling for age, race, gender, physical activity, leisure computer use and gaming, alcohol habits, and cigarette use, significantly lower BMIs were associated with consistent non-fat and full-fat milk consumption (F = 4.1, p = 0.0063). A significantly lower SAD was associated only with regular consumption of non-fat milk (F = 5.0, p = 0.0019). No significant differences were detected between the other milk-fat groups or milk abstainers. In this nationally representative sample, only 19.6% of adults regularly consumed low-fat milk. In conclusion, consistent non-fat milk intake was predictive of lower levels of abdominal adiposity compared to consumption of higher levels of milk-fat.

Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview

The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.

Combinations of modifiable lifestyle behaviours in relation to colorectal cancer risk in Alberta's Tomorrow Project

The objective of this study was to identify distinct clusters of individuals that exhibit unique patterns of modifiable lifestyle-related behaviours and to determine how these patterns are associated with the risk of developing colorectal cancer (CRC). The study consisted of 26,460 participants and 267 CRC cases from Alberta's Tomorrow Project. Exploratory latent class analysis of risk behaviours (obesity, physical inactivity, meat consumption, smoking, alcohol consumption, and fruit and vegetable consumption) and Cox proportional hazard models were utilized. Seven unique behavioural groups were identified, where the risk of CRC was 2.34 to 2.87 times greater for high risk groups compared to the low risk group. Sex-specific models identified higher risk groups among men (Hazard Ratios [HRs]: 3.15 to 3.89) than among women (HRs: 1.99 to 2.19). Targeting groups defined by clustering of behaviours could potentially lead to more effective prevention of CRC on a population level.

Electronic Cigarette Use and Metabolic Syndrome Development: A Critical Review

The metabolic syndrome is a combination of several metabolic disorders, such as cardiovascular disease, atherosclerosis, and type 2 diabetes. Lifestyle modifications, including quitting smoking, are recommended to reduce the risk of metabolic syndrome and its associated complications. Not much research has been conducted in the field of e-cigarettes and the risk of metabolic syndrome. Furthermore, taking into account the influence of e-cigarettes vaping on the individual components of metabolic syndrome, i.e, abdominal obesity, insulin resistance, dyslipidemia and elevated arterial blood pressure, the results are also ambiguous. This article is a review and summary of existing reports on the impact of e-cigarettes on the development of metabolic syndrome as well as its individual components. A critical review for English language articles published until 30 June 2020 was made, using a PubMed (including MEDLINE), Cochrane, CINAHL Plus, and Web of Science data. The current research indicated that e-cigarettes use does not affect the development of insulin resistance, but could influence the level of glucose and pre-diabetic state development. The lipid of profile an increase in the TG level was reported, while the influence on the level of concentration of total cholesterol, LDL fraction, and HDL fraction differed. In most cases, e-cigarettes use increased the risk of developing abdominal obesity or higher arterial blood pressure. Further research is required to provide more evidence on this topic.

Obesity and Cancer Treatment Outcomes: Interpreting the Complex Evidence

A wealth of epidemiological evidence, combined with plausible biological mechanisms, present a convincing argument for a causal relationship between excess adiposity, commonly approximated as body mass index (BMI, kg/m²), and incident cancer risk. Beyond this relationship, there are a number of challenges posed in the context of interpreting whether being overweight (BMI 25.0-29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²) adversely influences disease progression, cancer mortality and survival. Elevated BMI (≥ 25.0 kg/m²) may influence treatment selection of, for example, the approach to surgery; the choice of chemotherapy dosing; the inclusion of patients into randomised clinical trials. Furthermore, the technical challenges posed by an elevated BMI may adversely affect surgical outcomes, for example, morbidity (increasing the risk of surgical site infections), reduced lymph node harvest (and subsequent risk of under-staging and under-treatment) and increased risk of margin positivity. Suboptimal chemotherapy dosing, associated with capping chemotherapy in obese patients as an attempt to avoid excess toxicity, might be a driver of poor prognostic outcomes. By contrast, the efficacy of immune checkpoint inhibition may be enhanced in patients who are obese, although in turn, this observation might be due to reverse causality. So, a central research question is whether being overweight or obese adversely affects outcomes either directly through effects of cancer biology or whether adverse outcomes are mediated through indirect pathways. A further dimension to this complex relationship is the obesity paradox, a phenomenon where being overweight or obese is associated with improved survival where the reverse is expected. In this overview, we describe a framework for evaluating methodological problems such as selection bias, confounding and reverse causality, which may contribute to spurious interpretations. Future studies will need to focus on prospective studies with well-considered methodology in order to improve the interpretation of causality.

Metabolic differences between men and women who are long-term users of the water pipe: The Irbid WiHi project

Smoking tobacco and metabolic disorders are global epidemics associated with cardiovascular, immune, respiratory, and metabolic diseases. Cigarette smoking seems to affect metabolic disorders. However, the effect of water pipe (Wp), also called hookah, smoking duration on obesity and lipid profile is still a sparse. The present study examined the relationship of smoking Wp with body weight (Bw), body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), total cholesterol/HDLc, LDLc/HDLc, and triglycerides. Obesity, lipid profile, and smoking status were obtained from a total of 291 participants of which 147 smoked Wp. Smokers were divided into 3 groups: smoked <10 years (Wp1) (n = 72), smoked 10-20 years (Wp2) (n = 43), and smoked >20 years (Wp3) (n = 30). The ANCOVA revealed greater BMI and Bw and lipid profile measures in individuals smoking Wp vs never (P < .01). Additional analysis revealed that Bw and BMI were greater in the women (n = 11) with longer Wp smoking history (P < .05) but not the men (n = 19). In addition, Tc, LDLc, Tc/HDLc, and LDLc/HDLc levels were greater among the men smoking Wp for longer time (P < .05), but not the women. In conclusion, the study found greater obesity and lipid profile in the adults smoked Wp vs never, especially the ones smoked for longer time.

Prevalence of overweight and obesity in China: Results from a cross-sectional study of 441 thousand adults, 2012-2015

OBJECTIVES

Obesity has become a global health public problem. The study aims to examine the latest prevalence of overweight and obesity in China.

METHODS

Data came from the China Hypertension Survey (CHS), a nationally representative cross-sectional study among residents aged ≥18 years from October 2012 to December 2015. Overweight and obesity were defined as 25≤BMI<30kg/m² and BMI≥30kg/m² according to the WHO classifications, respectively.

RESULTS

The data of 441 306 participants were analyzed. The prevalence of overweight and obesity was 28.1% and 5.2% respectively. The prevalence of overweight and obesity varied considerably across provinces. The prevalence of overweight was the highest in Beijing, which was 2.8 fold of the lowest in Guangxi (40.9% vs. 14.6%). The prevalence of obesity was the highest in Tianjin, which was 9.4 fold of the lowest in Hainan (12.2% vs. 1.3%). There was a striking north-south gradient with the prevalence higher in Northeast and Northwest China and lower in Southeast China. Multivariate logistic regression analysis indicated that sex, age, education, smoking, marital status and family history of cardiovascular disease were significantly associated with overweight and obesity.

CONCLUSIONS

Overweight and obesity are highly prevalent among Chinese adults, and their prevalence varies greatly among different population subgroups and provinces. National and provincial obesity control and prevention strategies should be public health priorities in China.

Bidirectional Longitudinal Associations Between Cannabis Use and Body Mass Index Among Adolescents

Introduction: Literature on the association between cannabis use and body mass index (BMI) among adults suggests that greater cannabis use is associated with a lower BMI. However, results are mixed among adolescents, with both cross-sectional and longitudinal studies finding positive, negative, and nonsignificant associations between cannabis use and BMI. This longitudinal study aims to shed light on these associations by prospectively examining the associations between cannabis use and BMI across a 2-year window in a large sample of adolescent cannabis users. Methods: Participants were 401 adolescents ages 14-17 at baseline who were at risk for escalation in their use of cannabis. We conducted a parallel process latent growth curve model to examine associations between the cannabis use intercept, BMI intercept, cannabis use slope, and BMI slope. Results: Results showed that baseline BMI predicted a positive and significant association with cannabis use slope. In addition, there was a significant and negative correlation between the cannabis use slope and the BMI slope. These significant associations remained after controlling for relevant covariates. Conclusions: Results are consistent with the adult literature that reports a negative association between cannabis use and BMI. Future research should focus on uncovering the mechanisms that may drive the association between cannabis use and BMI.

The Association between Various Lifestyle Patterns and the Body Mass Index in Adolescents

Objective: The study aims to analyze obesogenic behavioral patterns of adolescents living in Mureş County, Romania, as well as to establish a relationship between these behaviors and their Body Mass Index (BMI), in an attempt to provide effective prevention strategies for obesity.

Material and Methods: 153 students between 9th to 12th grade, aged between 14 and 19 years old, from the Vocational and Art Highschool of Târgu Mureş were included in the study. All the candidates filled out an evaluation questionnaire of lifestyle and risky behaviors. The analyzed data were sex, age, residence, BMI and risky eating behavior defined as the consumption of carbohydrates (bread, potatoes, sweets), sodas, junk food, alcohol (wine, distilled beverages, beer), beer separately, level of physical activity (school and extra-school sports activities), sedentary behaviors (≥2 hours/day in front of a screen: personal computer-PC and television-TV), and spending ≥2 hours/day separately on the PC and on the TV.

Results: A statistically significant association was observed between BMI and consumption of fast-food, tobacco, beer, sedentary behavior and spending ≥2 hours/day in front of the PC. Moreover, there was a statistically significant difference between the BMI values of adolescents presenting all studied risk behaviors compared to those who did not.

Conclusions: Obesity among adolescents from Mureş County is influenced by lifestyle choices like fast-food, tobacco, beer, sedentary behavior and spending ≥2 hours/day in front of the PC.

The Prevalence of Smoking in 41-43-Year-Old Males and its Relation to Some Risk Factors

Aim. To evaluate the prevalence of smoking in 41-43-year-old men living in Moscow and its association with other chronic non-communicable diseases risk factors.Material and methods. People of male sex were prospectively followed up during 32 years since childhood (11-12 years). Only 301 (30%) representatives of 1005 initially enrolled people were examined after 32 years. The examination included: survey by a standard questionnaire (the passport data, the level of physical activity, bad habits – smoking, alcohol consumption); three-time blood pressure measurement; assessment of heart rate; measurement of weight and height, thickness of skin folds (over the triceps, under the scapula and on the abdomen); waist circumference.Results. Almost 50% of 41-44-year-old males smoked every day; less than a third of the study participants had never smoked. Every fifth of the smokers smoked less than 10 cigarettes per day while more than a half of them – a pack and more. The vast majority of the past smokers (85.2%) had stopped smoking at their own will and only very few (1.2%) by doctor’s advice. The intensity of smoking according to the pack/year index was >10 in almost 81.9% of the current smokers. The past smokers had abdominal obesity significantly more often than the non-smokers and the current smokers (57.5% vs 37% and 50.7%, respectively). The current smokers revealed the significantly higher risk of hypertension. The past smokers had 2.5 times higher risk of general obesity and 2.3 times higher one – of abdominal obesity as compared to the non-smokers. The intensity of smoking at the present time correlated with heart rate (HR). The past smokers (who smoked ≥20 cigarettes/day) as compared to the non-smokers had significantly higher HR, the Quetelet index, thickness of skin fold over the triceps and on the abdomen. The currents smokers revealed correlation of the status of smoking with HR, while the past smokers – with such parameters as the Quetelet index, waist circumference, thickness of skin fold under the scapula and over the triceps and no correlation with HR. The current smokers had significantly higher the 10-year risk of death as compared to thepast smokers and the non-smokers. Conclusion. Smoking is one of the most important risk factors of development of chronic non-communicable diseases. The struggle against smoking must be promoted, while close attention should be paid to people who had stopped smoking as a group of risk of cardiovascular disease onset. 

Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know

Objectives

The aim of this study was to review the impact of smoking tobacco on the musculoskeletal system, and on bone fractures in particular.

Methods

English-language publications of human and animal studies categorizing subjects into smokers and nonsmokers were sourced from MEDLINE, The Cochrane Library, and SCOPUS. This review specifically focused on the risk, surgical treatment, and prevention of fracture complications in smokers.

Results

Smokers have an increased risk of fracture and experience more complications with delayed bone healing, even if they have already stopped smoking, because some adverse effects persist for a prolonged period. Some risks can be reduced during and after surgery by local and general prevention, and smoking cessation is an important factor in lessening this risk. However, if a patient wants to stop smoking at the time of a fracture, the cessation strategies in reducing tobacco use are not easy to implement. The patient should also be warned that using e-cigarettes or other tobaccos does not appear to reduce adverse effects on health.

Conclusion

The evidence reviewed in this study shows that smoking has a negative effect in terms of the risk and treatment of fractures.

Cite this article: J. Hernigou, F. Schuind. Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone Joint Res 2019;8:255–265. DOI: 10.1302/2046-3758.86.BJR-2018-0344.R1.

International Comparison of Abdominal Fat Distribution Among Four Populations: The ERA-JUMP Study

BACKGROUND

Abdominal fat distribution varies across groups with different races or environments. Whether environmental factors, apart from racial differences, affect abdominal fat distribution is unknown.

METHODS

We compared the abdominal fat distribution of four groups; different races with similar environments (Caucasians vs. Japanese Americans), different environments with an identical race (Japanese Americans vs. Japanese), and similar races with similar environments (Japanese vs. Koreans). A population-based sample of 1212 men aged 40-49 were analyzed: 307 Caucasians and 300 Japanese Americans in the United States, 310 Japanese in Japan, and 295 Koreans in Korea. We compared the proportion of visceral adipose tissue area to total abdominal adipose tissue area (VAT%) and other factors that can affect abdominal fat distribution (smoking, alcohol use, physical activity levels, and metabolic factors).

RESULTS

VAT% was significantly higher in Japanese and Koreans than in Japanese Americans and Caucasians (50.0, 48.5, 43.2, 41.0%, respectively, P < 0.001). Even after adjustment for possible confounders, the significant VAT% difference remained in comparing groups with identical race but different environments (i.e., Japanese vs. Japanese Americans). In contrast, comparing groups with different races but similar environments (i.e., Caucasians vs. Japanese Americans), VAT% was not significantly different. Comparing groups with similar races and similar environments (i.e., Japanese vs. Koreans), VAT% did not significantly differ.

CONCLUSIONS

Environmental differences, apart from racial differences, affect the difference in abdominal fat distribution across different groups in middle-aged men.

The associations between smoking and obesity in northeast China: a quantile regression analysis

Obesity is a risk factors of chronic diseases, and smoking is associated with both chronic diseases and obesity. There were some controversies about the associations between smoking and obesity. Thus, our study aimed to explore the associations of smoking with obesity, using body mass index (BMI) and waist circumference (WC) as obesity indices in northeast China. We enrolled a sample of 16,412 participants in Jilin province aged 18-79 in this study, which were derived from a cross-sectional survey in 2012. We used quantile regression (QR) models to identify the associations of smoking with obesity in different quantiles of BMI (or WC) by genders. The differences of BMI and WC by genders were statistically significant (p < 0.05). In conclusion, compared with current non-smokers, current smokers had lower BMI but higher WC. As increasing of WC, the association of WC with smoking was getting stronger, especially in females.

Associations of nicotine dependence and fat distribution in Chinese male adults: a cross-sectional study in Lanxi, China

INTRODUCTION

Previous studies have showed association between smoking and central fat distribution. However, the impact of smoking on whole body fat distribution, particularly peripheral fat distribution remains unclear.

METHODS

Nicotine dependence was assessed in a total of 1264 male adults aged 18-80 years using the Fagerström Test for Nicotine Dependence (FTND). Smoking status was categorised as non-smokers, former and current smokers with very low, low/moderate, or high FTND scores. Body fat distribution was determined using the dual energy X-ray absorptiometry and anthropometric measurements. Multivariable linear regression models were applied to examine the adjusted associations between body fat distribution and smoking in all participants, and its association with FTND scores in the current smokers.

RESULTS

Greater waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), trunk fat percentage (%TF), android fat percentage (%AF) and android-to-gynoid fat mass ratio (AOI); but lower legs fat percentage (%LegF), limb fat percentage (%LimbF) and gynoid fat percentage (%GF) were found in current smokers with high FTND scores compared with non-smokers. In current smokers aged 60 years or older, FTND scores had positive associations with WC, WHR, WHtR, %TF, %AF and AOI, and negative associations with %LegF, %LimbF and %GF.

CONCLUSIONS

Nicotine dependence was positively associated with central fat distribution and negatively associated with peripheral fat distribution in Chinese male adults, particularly in those older or heavy smokers, and these associations were independent from body mass index, which might be due to long exposure to smoking.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Waist circumference and risk of 23 site-specific cancers: a population-based cohort study of Korean adults

BACKGROUND

Large waist circumference (WC) is a risk factor for several site-specific cancers, but a large-scale systematic investigation across all common cancers adjusted for potential confounders has not been conducted. This study aimed to evaluate the possible links between WC and common cancers.

METHODS

We prospectively examined the association between WC and the risk of cancers in a 7-year cohort study of nearly 22.9 million Korean adults. Using the claims database merged with the national health check-up data, we fitted proportional hazard models to investigate associations between WC and 23 of the most common cancers, with adjustment for potential confounders, including body mass index (BMI). We also evaluated the modification of BMI on the relationships between WC and the incidence of cancer.

RESULTS

A total of 769,871 cancer cases were identified. WC was positively associated with 18 of 23 cancers, and the effects varied substantially by site in each sex. The modification of BMI on the WC-cancer association also varied across the cancer site; in most cases it mitigated the association. For cancers of the oral cavity, larynx, oesophagus, lung, and premenopausal breast, the BMI adjustment reversed the association toward being positive (all P_trend < 0.001).

CONCLUSIONS

Central obesity, independent of general obesity, was associated with the risk of several cancers. The heterogeneity in the mediating effects of BMI suggests that different mechanisms are associated with different cancer sites. Based upon these findings, active strategies to monitor and prevent central obesity should be implemented.

Prevalence and influencing factors of overweight and obesity in a Chinese rural population: the Henan Rural Cohort Study

The study aimed to estimate prevalence and influencing factors of overweight, general obesity, and abdominal obesity in rural areas of China. A total of 39034 participants aged 18 to 79 years were enrolled from the Henan Rural Cohort Study for the cross-sectional study. The age-standardized prevalence of overweight, general obesity, and abdominal obesity were 34.97%, 16.82%, and 43.71% in the general Chinese rural adults, respectively. Gender differences were: 36.04%, 18.98%, 35.37% for men, and 34.55%, 15.42%, 49.13% for women, respectively. The subgroup analysis showed the rates of overweight, general obesity, and abdominal obesity existed considerable disparities, but were universally high in all subgroups. Further, the study found that there were statistically significant U-shaped associations between the prevalence of overweight, general obesity, and abdominal obesity and age groups. In addition, the prevalence of participants with both abnormal BMI and WC were even at approximate forty percent. Aging, married/cohabiting, higher per capita monthly income, and unhealthy lifestyle were independent influencing factors of overweight, general obesity and abdominal obesity. In conclusion, overweight and obesity were severe in rural China. There is an increased need for closely monitoring high risk factors and promoting healthy lifestyle to curb the obesity epidemic among rural population.

Assessing the relationship between smoking and abdominal obesity in a National Survey of Adolescents in Brazil

Abdominal obesity is even a stronger risk factor than overall obesity for noncommunicable chronic diseases. We examined the association between smoking and abdominal obesity among adolescents. Analyses were based on 38,813 subjects aged 15-17 years from the Study of Cardiovascular Risks in Adolescents (ERICA), a Brazilian school-based national survey. Abdominal obesity was defined considering waist circumference (WC) percentiles. Statistical analyses, stratified by sex, considered the sample complex design. Poisson regression with robust variance was used to estimate smoker-to-nonsmoker abdominal obesity prevalence ratio (PR), adjusting by sociodemographic and lifestyle variables. Higher prevalence of abdominal obesity was observed among adolescents who consumed >1 cigarettes/day, comparing to nonsmokers: considering WC >80th percentile, adjusted-PR for boys was 1.27 [95%CI:1.05,1.52] and, for girls, 1.09 [95%CI:1.00,1.19]; using the 90th percentile, adjusted-PR were 2.24 [95%CI:1.70,2.94] and 1.27 [95%CI:1.12,1.46], respectively for male and female adolescents. Our findings suggest a positive association between cigarette consumption and the prevalence of abdominal obesity, for both boys and girls. Although other studies had found this association in adults, our study contributes to this discussion by assessing it in adolescents using a nationwide representative sample of medium and large municipalities.

Influence of cigarette smoking on hormone and lipid metabolism in women in late reproductive stage

BACKGROUND

The aim of the study was to analyze lipid and hormone metabolism, body mass index (BMI), and age parameters in late reproductive stage women in relation to cigarette smoking.

METHODS

The study enrolled 345 healthy late reproductive stage women living in Poland; 13.33% were smokers. The first part of the study assessed lipid metabolism (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides) and hormone metabolism (estradiol [E2], follicle-stimulating hormone [FSH], and anti-Müllerian hormone [AMH] levels) in women in the early phase of the follicular menstrual cycle. The second part of study was carried out using the diagnostic survey method, with a standardized questionnaire (Primary Care Evaluation of Mental Disorders [PRIME-MD]) and the authors' own research tools.

RESULTS

The women were aged 42.3±4.5 years (mean ± SD). The BMI (24.8±4.04 kg/m2) did not differ significantly between the groups. The women who smoked cigarettes had a statistically significantly (p<0.05) lower level of HDL as well as higher LDL and triglyceride levels (p<0.05). Differences were also shown in hormone levels: non-smoking participants had statistically significantly higher levels of E2 and FSH (p<0.05). In the group of non-smoking women, age was a predictor exerting a significant positive impact on the levels of total cholesterol, LDL, triglycerides, and AMH (p<0.05). BMI contributed to a decline in HDL and triglyceride levels. In the group of smoking women, age significantly positively influenced the level of E2, and negatively influenced AMH. BMI was associated with a significant decrease in the HDL level.

CONCLUSION

Smoking cigarettes affects the physical health of women in late reproductive stage through negative influences on lipid and hormone metabolism, among other factors. Age is an unmodifiable factor adversely affecting both lipids and hormones. Higher BMI has a negative influence on lipid metabolism in both groups of women in this study.

Cigarette Smoking and Adipose Tissue: The Emerging Role in Progression of Atherosclerosis

Smoking is an established risk factor for atherosclerosis through several underlying pathways. Moreover, in the development of atherosclerotic plaque formation, obesity, defined as excess fat mass accumulation, also plays a vital role in dyslipidemia and insulin resistance. Substantial evidence shows that cigarette smoking induces multiple pathological effects in adipose tissue, such as differentiation of adipocytes, lipolysis, and secretion properties in adipose tissue. Therefore, there is an emerging speculation in which adipose tissue abnormality induced by smoking or nicotine is likely to accelerate the progression of atherosclerosis. Herein, this review aims to investigate the possible interplay between smoking and adipose tissue dysfunction in the development of atherosclerosis.

Measured Adiposity in Relation to Head and Neck Cancer Risk in the European Prospective Investigation into Cancer and Nutrition

Background: Emerging evidence from cohort studies indicates that adiposity is associated with greater incidence of head and neck cancer. However, most studies have used self-reported anthropometry which is prone to error.Methods: Among 363,094 participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC) with measured anthropometry, there were 837 incident cases of head and neck cancer. Head and neck cancer risk was examined in relation to body mass index (BMI) [lean: <22.5 kg/m2, normal weight (reference): 22.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obese: ≥30 kg/m2], waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) using Cox proportional hazards models.Results: Among men, a BMI < 22.5 kg/m2 was associated with higher head and neck cancer risk [HR 1.62; 95% confidence interval (CI), 1.23-2.12)]; BMI was not associated with head and neck cancer among women. WC and WHR were associated with greater risk of head and neck cancer among women (WC per 5 cm: HR, 1.08; 95% CI, 1.02-1.15; WHR per 0.1 unit: HR, 1.64; 95% CI, 1.38-1.93). After stratification by smoking status, the association for WHR was present only among smokers (Pinteraction = 0.004). Among men, WC and WHR were associated with head and neck cancer only upon additional adjustment for BMI (WC per 5 cm: HR 1.16; 95% CI, 1.07-1.26; WHR per 0.1 unit: HR, 1.42; 95% CI, 1.21-1.65).Conclusions: Central adiposity, particularly among women, may have a stronger association with head and neck cancer risk than previously estimated.Impact: Strategies to reduce obesity may beneficially impact head and neck cancer incidence. Cancer Epidemiol Biomarkers Prev; 26(6); 895-904. ©2017 AACR.

European guidelines on lifestyle changes for management of hypertension : Awareness and implementation of recommendations among German and European physicians

BACKGROUND

In the 2013 European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines for the management of arterial hypertension, six lifestyle changes for treatment are recommended for the first time with class I, level of evidence A. We initiated a survey among physicians to explore their awareness and consideration of lifestyle changes in hypertension management.

METHODS

The survey included questions regarding demographics as well as awareness and implementation of the recommended lifestyle changes. It was conducted at two German and two European scientific meetings in 2015.

RESULTS

In all, 1064 (37.4% female) physicians participated (806 at the European and 258 at the German meetings). Of the six recommended lifestyle changes, self-reported awareness was highest for regular exercise (85.8%) followed by reduction of weight (66.2%). The least frequently self-reported lifestyle changes were the advice to quit smoking (47.3%) and moderation of alcohol consumption (36.3%). Similar frequencies were observed for the lifestyle changes implemented by physicians in their care of patients.

CONCLUSION

A close correlation between awareness of guideline recommendations and their implementation into clinical management was observed. European physicians place a stronger emphasis on regular exercise and weight reduction than on the other recommended lifestyle changes. Moderation of alcohol consumption is the least emphasized lifestyle change.

Smoking status and abdominal obesity among normal- and overweight/obese adults: Population-based FINRISK study

Several studies have reported direct associations of smoking with body mass index (BMI) and abdominal obesity. However, the interplay between them is poorly understood. Our first aim was to investigate the interaction between smoking status and BMI on abdominal obesity (waist circumference, WC). Our second aim was to examine how the association of smoking status with WC varies among normal and overweight/obese men and women. We examined 5833 participants from the National FINRISK 2007 Study. The interactions between smoking and BMI on WC were analyzed. Participants were categorized into eight groups according to BMI (normal weight vs. overweight/obese) and smoking status (never smoker, ex-smoker, occasional/light/moderate daily smoker, heavy daily smoker). The associations between each BMI/smoking status -group and WC were analyzed by multiple regressions, the normal-weight never smokers as the reference group. The smoking status by BMI-interaction on WC was significant for women, but not for men. Among the overweight/obese women, ex-smokers (β = 2.73; 1.99, 3.46) and heavy daily smokers (β = 4.90; 3.35, 6.44) had the highest estimates for WC when adjusted for age, BMI, alcohol consumption and physical activity. In comparison to never smoking overweight/obese women, the β-coefficients of ex-smokers and heavy daily smokers were significantly higher. Among men and normal weight women the β -coefficients did not significantly differ by smoking status. An interaction between smoking status and BMI on abdominal obesity was observed in women: overweight/obese heavy daily smokers were particularly vulnerable for abdominal obesity. This risk group should be targeted for cardiovascular disease prevention.

Lifetime cigarette smoking is associated with abdominal obesity in a community-based sample of Japanese men: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA)

Studies from Western countries suggest that smokers tend to display greater abdominal obesity than non-smokers, despite showing lower weight. Whether this holds true in a leaner population requires clarification. Using indices of abdominal obesity including visceral adipose tissue, we examined whether lifetime cigarette smoking is associated with unfavorable fat distribution among Japanese men. From 2006 to 2008, we conducted a cross-sectional investigation of a community-based sample of Japanese men at 40-64 years old, free of cardiovascular diseases and cancer. Areas of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated using computed tomography. We divided participants into four groups: never-smokers; and tertiles of pack-years of smoking among ever-smokers. Using multivariable linear regression, we calculated adjusted means of obesity indices (VAT, SAT, VAT-SAT ratio [VSR], and waist-hip ratio [WHR]) for each group, and mean differences between consecutive groups. We analyzed 513 men (median age, 58.2 years; current smokers, 40.1%). Two-thirds showed body mass index (BMI) < 25 kg/m(2) (median, 23.5 kg/m(2)). Overall, greater lifetime smoking group was associated with greater WHR and VSR. On average, one higher smoking group was associated with 0.005 higher WHR (95% CI, 0.001-0.008; P = 0.005) and 0.041 greater VSR (95% CI, 0.009-0.073; P = 0.012) after adjustment for potential confounders, including BMI. In this sample of relatively lean Japanese men, greater lifetime smoking was associated with a metabolically more adverse fat distribution. Although smoking is commonly associated with lower BMI, minimizing the amount of lifetime smoking should be advocated.

Cigarette use, comorbidities, and prognosis in a prospective head and neck squamous cell carcinoma population

BACKGROUND

To better understand the associations between a history of tobacco use and survival outcomes, cigarette use was prospectively surveyed in 687 previously untreated patients with cancer of the oral cavity (n = 271), oropharynx (n = 257), larynx (n = 135), or hypopharynx (n = 24).

METHODS

Kaplan-Meier and Cox models explored the associations of tobacco use intensity (packs/day), duration (years of use), and timing before diagnosis with overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).

RESULTS

Cigarette use duration, timing, and intensity were significant predictors for all outcomes in univariate analysis. Never smoking and pack-years were not significantly associated with outcomes after adjustment for prognostic factors, such as stage, comorbidities, and human papillomavirus (HPV) status, which were strongly associated with clinical outcomes.

CONCLUSION

The findings confirm the association between smoking history and survival and the importance of clinical variables in evaluating smoking as a prognostic factor. Timing, intensity, and duration of cigarette use should be considered with other prognostic factors when considering risk stratification for treatment planning. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1810-1820, 2016.

Body image emotions, perceptions, and cognitions distinguish physically active and inactive smokers

Objectives

To determine if body image emotions (body-related shame and guilt, weight-related stress), perceptions (self-perceived overweight), or cognitions (trying to change weight) differ between adolescents characterized by smoking and physical activity (PA) behavior.

Methods

Data for this cross-sectional analysis were collected in 2010–11 and were available for 1017 participants (mean (SD) age = 16.8 (0.5) years). Participants were categorized according to smoking and PA status into four groups: inactive smokers, inactive non-smokers, active smokers and active non-smokers. Associations between body image emotions, perceptions and cognitions, and group membership were estimated in multinomial logistic regression.

Results

Participants who reported body-related shame were less likely (OR (95% CI) = 0.52 (0.29–0.94)) to be in the active smoker group than the inactive smoker group; those who reported body-related guilt and those trying to gain weight were more likely (2.14 (1.32–3.48) and 2.49 (1.22–5.08), respectively) to be in the active smoker group than the inactive smoker group; those who were stressed about weight and those perceiving themselves as overweight were less likely to be in the active non-smoker group than the inactive smoker group (0.79 (0.64–0.97) and 0.41 (0.19–0.89), respectively).

Conclusion

Body image emotions and cognitions differentiated the active smoker group from the other three groups.

•

We examined body image in physically active adolescent smokers.

•

Body-related shame and guilt were related to being a physically active smoker.

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Trying to gain weight was also associated with being a physically active smoker.

•

Body image emotions and cognitions differentiate physically active smokers.

The Associations Between Smoking Habits and Serum Triglyceride or Hemoglobin A1c Levels Differ According to Visceral Fat Accumulation

BACKGROUND

Whether smokers and former smokers have worse lipid profiles or glucose levels than non-smokers remains unclear.

METHODS

The subjects were 1152 Japanese males aged 42 to 81 years. The subjects were divided according to their smoking habits (nonsmokers, former smokers, and current smokers) and their visceral fat area (VFA) (<100 cm(2) and ≥100 cm(2)).

RESULTS

The serum triglyceride (TG) levels of 835 males were assessed. In the VFA ≥100 cm(2) group, a significantly greater proportion of current smokers (47.3%) exhibited TG levels of ≥150 mg/dL compared with former smokers (36.4%) and non-smokers (18.8%). The difference in TG level distribution between former smokers and non-smokers was also significant. However, among the subjects with VFA of <100 cm(2), the TG levels of the three smoking habit groups did not differ. The serum hemoglobin A1c (HbA1c) levels of 877 males were also assessed. In the VFA <100 cm(2) group, significantly higher proportions of current smokers (17.9%) and former smokers (14.9%) demonstrated HbA1c levels of ≥5.6% compared with non-smokers (6.3%). In contrast, in the VFA ≥100 cm(2) group, significantly fewer former smokers displayed HbA1c levels of ≥5.6% compared with non-smokers and current smokers. Furthermore, the interaction between smoking habits and VFA was associated with the subjects' TG and HbA1c concentrations, and the associations of TG and HbA1c concentrations and smoking habits varied according to VFA.

CONCLUSIONS

Both smoking habits and VFA exhibited associations with TG and HbA1c concentrations. The associations between smoking habits and these parameters differed according to VFA.

Lower body mass index is associated with a higher risk of giant cell arteritis: a systematic review and meta-analysis

OBJECTIVE

To characterize the possible association between body mass index (BMI) and risk of giant cell arteritis (GCA).

METHODS

We conducted a systematic review of observational studies (case-control or cohort study) that (I) reported BMI of patients with GCA prior to the diagnosis of GCA compared with subjects without GCA and (II) provided relative risk (RR), odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI) from its regression analysis. Meta-analysis of the included studies was then performed to estimate the pooled effect using generic variance method of DerSimonian and Laird.

RESULTS

Three studies encompassing 141 patients with GCA and 85,736 controls met our eligibility criteria and were included in the data analyses. We demonstrated a statistically significant inverse relationship between BMI and risk of subsequent development of GCA as the risk increased by 8% when BMI was reduced by 1.0 kg/m(2) (pooled OR of 0.92/kg/m(2); 95% CI, 0.88-0.96).

CONCLUSIONS

Our study demonstrated a statistically significant inverse relationship between BMI and risk of subsequent development GCA. The pathophysiologic link behind this negative correlation is not well-characterized and further investigation is required.

Prevalence, associated factors and heritabilities of metabolic syndrome and its individual components in African Americans: the Jackson Heart Study

OBJECTIVE

Both environmental and genetic factors play important roles in the development of metabolic syndrome (MetS). Studies about its associated factors and genetic contribution in African Americans (AA) are sparse. Our aim was to report the prevalence, associated factors and heritability estimates of MetS and its components in AA men and women.

PARTICIPANTS AND SETTING

Data of this cross-sectional study come from a large community-based Jackson Heart Study (JHS). We analysed a total of 5227 participants, of whom 1636 from 281 families were part of a family study subset of JHS.

METHODS

Participants were classified as having MetS according to the Adult Treatment Panel III criteria. Multiple logistic regression analysis was performed to isolate independently associated factors of MetS (n=5227). Heritability was estimated from the family study subset using variance component methods (n=1636).

RESULTS

About 27% of men and 40% of women had MetS. For men, associated factors with having MetS were older age, lower physical activity, higher body mass index, and higher homocysteine and adiponectin levels (p<0.05 for all). For women, in addition to all these, lower education, current smoking and higher stress were also significant (p<0.05 for all). After adjusting for covariates, the heritability of MetS was 32% (p<0.001). Heritability ranged from 14 to 45% among its individual components. Relatively higher heritability was estimated for waist circumference (45%), high density lipoprotein-cholesterol (43%) and triglycerides (42%). Heritability of systolic blood pressure (BP), diastolic BP and fasting blood glucose was 16%, 15% and 14%, respectively.

CONCLUSIONS

Stress and low education were associated with having MetS in AA women, but not in men. Higher heritability estimates for lipids and waist circumference support the hypothesis of lipid metabolism playing a central role in the development of MetS and encourage additional efforts to identify the underlying susceptibility genes for this syndrome in AA.

Heavier smoking may lead to a relative increase in waist circumference: evidence for a causal relationship from a Mendelian randomisation meta-analysis. The CARTA consortium

OBJECTIVES

To investigate, using a Mendelian randomisation approach, whether heavier smoking is associated with a range of regional adiposity phenotypes, in particular those related to abdominal adiposity.

DESIGN

Mendelian randomisation meta-analyses using a genetic variant (rs16969968/rs1051730 in the CHRNA5-CHRNA3-CHRNB4 gene region) as a proxy for smoking heaviness, of the associations of smoking heaviness with a range of adiposity phenotypes.

PARTICIPANTS

148,731 current, former and never-smokers of European ancestry aged ≥ 16 years from 29 studies in the consortium for Causal Analysis Research in Tobacco and Alcohol (CARTA).

PRIMARY OUTCOME MEASURES

Waist and hip circumferences, and waist-hip ratio.

RESULTS

The data included up to 66,809 never-smokers, 43,009 former smokers and 38,913 current daily cigarette smokers. Among current smokers, for each extra minor allele, the geometric mean was lower for waist circumference by -0.40% (95% CI -0.57% to -0.22%), with effects on hip circumference, waist-hip ratio and body mass index (BMI) being -0.31% (95% CI -0.42% to -0.19), -0.08% (-0.19% to 0.03%) and -0.74% (-0.96% to -0.51%), respectively. In contrast, among never-smokers, these effects were higher by 0.23% (0.09% to 0.36%), 0.17% (0.08% to 0.26%), 0.07% (-0.01% to 0.15%) and 0.35% (0.18% to 0.52%), respectively. When adjusting the three central adiposity measures for BMI, the effects among current smokers changed direction and were higher by 0.14% (0.05% to 0.22%) for waist circumference, 0.02% (-0.05% to 0.08%) for hip circumference and 0.10% (0.02% to 0.19%) for waist-hip ratio, for each extra minor allele.

CONCLUSIONS

For a given BMI, a gene variant associated with increased cigarette consumption was associated with increased waist circumference. Smoking in an effort to control weight may lead to accumulation of central adiposity.

Adiposity and cancer risk: new mechanistic insights from epidemiology

Excess body adiposity, commonly expressed as body mass index (BMI), is a risk factor for many common adult cancers. Over the past decade, epidemiological data have shown that adiposity-cancer risk associations are specific for gender, site, geographical population, histological subtype and molecular phenotype. The biological mechanisms underpinning these associations are incompletely understood but need to take account of the specificities observed in epidemiology to better inform future prevention strategies.

The risk and burden of smoking related heart disease mortality among young people in the United States

PURPOSE

Although cigarette smoking remains the most common risk factor for heart disease among the young, few studies have explored the relationship of smoking with heart disease mortality risk among young people. This prospective study assesses the risk and burden of all heart disease (HD) and coronary heart disease (CHD) mortality associated with smoking among younger adults from a nationally representative sample of the United States.

METHOD

National Health Interview Survey respondents' data from 1997-2004 were linked to their death records through 2006. The analyses were restricted to individuals 18 to 44 years of age during follow up (n = 121,284). Cox proportional hazard ratios (HR) were estimated with adjustment for sample weights and design effects. Attributable fractions (AF) of smoking were calculated.

RESULTS

After controlling for age, race, body mass index, history of hypertension and diabetes, and leisure time physical activity, current smoking related CHD mortality HR was 14.6 [95 % confidence interval or CI, 3.3-64.9] for females and 3.6 [95 % CI, 1.2-10.4] for males. The HR for all HD mortality was 3.1 [95 % CI, 1.3-7.6] for females and 2.4 [95 % CI, 1.2-4.7] for males. The AF of smoking for CHD deaths for female and male were 0.58 and 0.54 respectively. The AF of all HD mortality was 0.31 for male and 0.32 for female. The mean estimates of all HD deaths attributable to smoking during 1997-2006 among this age group were 52,214, of which 45,147 were CHD deaths.

CONCLUSION

Even after adjustment for multiple risk factors and without addressing passive smoking, our result showed a strong relationship between smoking and HD and CHD mortality among young adults that is likely causal.

Smoking is associated with more abdominal fat in morbidly obese patients

INTRODUCTION

While the association between cigarette smoking and abdominal fat has been well studied in normal and overweight patients, data regarding the influence of tobacco use in patients with morbid obesity remain scarce. The aim of this study is to evaluate body fat distribution in morbidly obese smokers.

METHODS

We employed a cross-sectional study and grouped severely obese patients (body mass index [BMI] >40 kg/m2 or >35 kg/m2 with comorbidities) according to their smoking habits (smokers or non-smokers). We next compared the anthropometrical measurements and body composition data (measured by electric bioimpedance) of both groups. We analyzed the effect of smoking on body composition variables using univariate and multiple linear regression (MLR); differences are presented as regression coefficients (b) and their respective 95% confidence intervals.

RESULTS

We included 536 morbidly obese individuals, 453 (84.5%) non-smokers and 83 (15.5%) smokers. Male smokers had a higher BMI (b=3.28 kg/m2, p=0.036), larger waist circumference (b=6.07 cm, p=0.041) and higher percentage of body fat (b=2.33%, p=0.050) than non-smokers. These differences remained significant even after controlling for confounding factors. For females, the only significant finding in MLR was a greater muscle mass among smokers (b=1.34kg, p=0.028). No associations were found between tobacco load measured in pack-years and anthropometric measures or body composition.

DISCUSSION

Positive associations between smoking and BMI, and waist circumference and percentage of body fat, were found among male morbidly obese patients, but not among females. To the best of our knowledge, this study is the first investigation of these aspects in morbidly obese subjects. We speculate that our findings may indicate that the coexistence of morbid obesity and smoking helps to explain the more serious medical conditions, particularly cardiovascular diseases and neoplasms, seen in these patients.

High tobacco consumption lowers body weight: a Mendelian randomization study of the Copenhagen General Population Study

BACKGROUND

Conflicting evidence has been found regarding the association between high tobacco consumption and body weight among smokers. We tested the hypothesis that high tobacco consumption is causally associated with low body weight.

METHODS

We conducted a Mendelian randomization study with a genetic variant in CHRNA3 (rs1051730) as proxy for high tobacco consumption. The cohort consisted of 80,342 participants from the Copenhagen General Population Study, with details on body weight, smoking habits and CHRNA3 genotype, including 15,220 current smokers.

RESULTS

In observational analyses, high tobacco consumption was associated with high body weight, body mass index, waist circumference, hip circumference and waist-hip ratio. In multivariable adjusted models a 1-cigarette/day higher tobacco consumption was associated with 0.05 kg (95% confidence interval 0.02; 0.08) higher body weight, 0.02 kg/m(2) (0.01; 0.02) higher body mass index, 0.10 cm (0.07; 0.12) higher waist circumference and 0.02 cm (0.001; 0.03) higher hip circumference. In contrast, the per-allele increase inCHRNA3 rs1051730 associated with high tobacco consumption was associated with 0.59 kg (0.96; 0.22) lower body weight, 0.23 kg/m(2) (0.33; 0.13) lower body mass index, 0.32 cm (0.74; 0.003) lower waist circumference and 0.45 cm (0.66; 0.24) lower hip circumference. No association was found between tobacco consumption and waist-hip ratio in genetic analysis, or among CHRNA3 genotype and any of the outcome variables in former or never smokers.

CONCLUSIONS

High tobacco consumption causes lower body weight among current smokers. However, smoking does not seem to affect body shape or fat distribution causally. The lack of association between CHRNA3 genotype and body weight among former smokers and never smokers favours smoking as the causal factor for the observed associations.

Macrophage elastase suppresses white adipose tissue expansion with cigarette smoking

Macrophage elastase (MMP12) is a key mediator of cigarette smoke (CS)-induced emphysema, yet its role in other smoking related pathologies remains unclear. The weight suppressing effects of smoking are a major hindrance to cessation efforts, and MMP12 is known to suppress the vascularization on which adipose tissue growth depends by catalyzing the formation of antiangiogenic peptides endostatin and angiostatin. The goal of this study was to determine the role of MMP12 in adipose tissue growth and smoking-related suppression of weight gain. Whole body weights and white adipose depots from wild-type and Mmp12-deficient mice were collected during early postnatal development and after chronic CS exposure. Adipose tissue specimens were analyzed for angiogenic and adipocytic markers and for content of the antiangiogenic peptides endostatin and angiostatin. Cultured 3T3-L1 adipocytes were treated with adipose tissue homogenate to examine its effects on vascular endothelial growth factor (VEGF) expression and secretion. MMP12 content and activity were increased in the adipose tissue of wild-type mice at 2 weeks of age, leading to elevated endostatin production, inhibition of VEGF secretion, and decreased adipose tissue vascularity. By 8 weeks of age, adipose MMP12 levels subsided, and the protein was no longer detectable. However, chronic CS exposure led to macrophage accumulation and restored adipose MMP12 activity, thereby suppressing adipose tissue mass and vascularity. Our results reveal a novel systemic role for MMP12 in postnatal adipose tissue expansion and smoking-associated weight loss by suppressing vascularity within the white adipose tissue depots.

Abdominal vs. overall obesity among women in a nutrition transition context: geographic and socio-economic patterns of abdominal-only obesity in Tunisia

Background

Most assessments of the burden of obesity in nutrition transition contexts rely on body mass index (BMI) only, even though abdominal adiposity might be specifically predictive of adverse health outcomes. In Tunisia, a typical country of the Middle East and North Africa (MENA) region, where the burden of obesity is especially high among women, we compared female abdominal vs. overall obesity and its geographic and socio-economic cofactors, both at population and within-subject levels.

Methods

The cross-sectional study used a stratified, three-level, clustered sample of 35- to 70-year-old women (n = 2,964). Overall obesity was BMI = weight/height² ≥ 30 kg/m² and abdominal obesity waist circumference ≥ 88 cm. We quantified the burden of obesity for overall and abdominal obesity separately and their association with place of residence (urban/rural, the seven regions that compose Tunisia), plus physiological and socio-economic cofactors by logistic regression. We studied the within-subject concordance of the two obesities and estimated the prevalence of subject-level “abdominal-only” obesity (AO) and “overall-only” obesity (OO) and assessed relationships with the cofactors by multinomial logistic regression.

Results

Abdominal obesity was much more prevalent (60.4% [57.7-63.0]) than overall obesity (37.0% [34.5-39.6]), due to a high proportion of AO status (25.0% [22.8-27.1]), while the proportion of OO was small (1.6% [1.1-2.2]). We found mostly similar associations between abdominal and overall obesity and all the cofactors except that the regional variability of abdominal obesity was much larger than that of overall obesity. There were no adjusted associations of AO status with urban/rural area of residence (P = 0.21), education (P = 0.97) or household welfare level (P = 0.94) and only non-menopausal women (P = 0.093), lower parity women (P = 0.061) or worker/employees (P = 0.038) were somewhat less likely to be AO. However, there was a large residual adjusted regional variability of AO status (from 16.6% to 34.1%, adjusted P < 0.0001), possibly of genetic, epigenetic, or developmental origins.

Conclusion

Measures of abdominal adiposity need to be included in population-level appraisals of the burden of obesity, especially among women in the MENA region. The causes of the highly prevalent abdominal-only obesity status among women require further investigation.

Effects of HIV Infection on Body Composition Changes Among Men of Different Racial/Ethnic Origins

PURPOSE

To compare racial/ethnic differences and effects of HIV on body composition among antiretroviral (ART)-naïve HIV seropositive (HIV+) men to a representative sample of HIV seronegative (HIV-) men. We hypothesized that the effect of HIV infection will be uniform across all racial/ethnic groups.

METHOD

A cross-sectional analysis was performed comparing HIV- (NHANES 1999-2002) and ART-naïve HIV+ men (CPCRA 061). Regional subcutaneous fat area was estimated by skinfold caliper. Total body fat (TBF), fat-free mass (FFM), and body fat index (BFI) were derived by Durnin-Womersley formula (TBF-DW, FFM-DW, BFI [TBF-DW/height(2)]). Bioelectric impedance analyses (BIA) was used to assess TBF-BIA, FFM-BIA, and body cell mass (BCM). Multivariate regression modeling adjusted for age, smoking, and hepatitis C for each measurement was performed.

RESULTS

HIV+ men (n = 321) were older and more likely to be smokers than HIV- men (n = 1,996). The HIV- men were heavier in weight (+17.8 kg, p < .001) and had higher BMI (+4.3 kg/m(2), p < .001), BCM (+2.4 kg, p = .02), FFM (+5.9 kg, p < .001), TBF-DW (+5.95 kg, p < .001), BFI (+1.6 kg/m(2), p < .001), and regional fat mass than the HIV+ men. In the multivariate model, there were significant percentage differences between HIV- and HIV+ African American men for all body composition measurements (weight +15.3%; BMI +14.5%; BCM +5.2%; TBF-DW +15%; BFI 13.9%; FFM-DW 7.9%) and all circumference and skinfold measurements; all ps < .05. For Caucasian men, the following differences were significant between HIV- and HIV+: weight +14.4%; BMI +14.0%; BCM +6.0%; TBF-DW +17.7%; BFI 17.1%; FFM-DW 8.7%; and all circumference and skinfold measurements. Similarly, among Latino men the following differences were significant: weight +10.1%; BMI +12.3%; FFM-DW +7.7%; and arm, waist, and thigh circumferences and mid-arm skinfold fat area. The interaction terms for race/ethnicity were not significant across the three racial groups for weight, BMI, BCM, TBF-BIA, and BFI.

CONCLUSION

Compared to HIV uninfected men, among HIV-infected ART-naïve men there was a significant effect of HIV infection itself on body composition among all racial/ethnic groups.

Associations of obesity with socioeconomic and lifestyle factors in middle-aged and elderly men: European Male Aging Study (EMAS)

BACKGROUND

Social and lifestyle influences on age-related changes in body morphology are complex because lifestyle and physiological response to social stress can affect body fat differently.

OBJECTIVE

In this study, we examined the associations of socioeconomic status (SES) and lifestyle factors with BMI and waist circumference (WC) in middle-aged and elderly European men.

DESIGN AND SETTING

A cross-sectional study of 3319 men aged 40-79 years recruited from eight European centres.

OUTCOMES

We estimated relative risk ratios (RRRs) of overweight/obesity associated with unfavourable SES and lifestyles.

RESULTS

The prevalence of BMI ≥ 30 kg/m(2) or WC ≥ 102 cm rose linearly with age, except in the eighth decade when high BMI, but not high WC, declined. Among men aged 40-59 years, compared with non-smokers or most active men, centre and BMI-adjusted RRRs for having a WC between 94 and 101.9 cm increased by 1.6-fold in current smokers, 2.7-fold in least active men and maximal at 2.8-fold in least active men who smoked. Similar patterns but greater RRRs were observed for men with WC ≥ 102 cm, notably 8.4-fold greater in least active men who smoked. Compared with men in employment, those who were not in employment had increased risk of having a high WC by 1.4-fold in the 40-65 years group and by 1.3-fold in the 40-75 years group. These relationships were weaker among elderly men.

CONCLUSION

Unfavourable SES and lifestyles associate with increased risk of obesity, especially in middle-aged men. The combination of inactivity and smoking was the strongest predictor of high WC, providing a focus for health promotion and prevention at an early age.

Body mass index and the risk of giant cell arteritis: results from a prospective study

OBJECTIVE

The aim of this study was to examine potential risk factors for GCA in a nested case-control study based on two prospective health surveys.

METHODS

We used two population-based health surveys, the Malmö Preventive Medicine Program (MPMP) and the Malmö Diet Cancer Study (MDCS). Individuals who developed GCA after inclusion were identified by linking the MPMP and MDCS databases to several patient administrative registers. A structured review of the medical records of all identified cases was performed. Four controls for every confirmed case, matched for sex, year of birth and year of screening, were selected from the corresponding databases. Potential predictors of GCA were examined in conditional logistic regression models.

RESULTS

Eighty-three patients (70% women, 64% biopsy positive, mean age at diagnosis 71 years) had a confirmed diagnosis of GCA after inclusion in the MPMP or MDCS. A higher BMI was associated with a significantly reduced risk of subsequent development of GCA [odds ratio (OR) 0.91/kg/m(2) (95% CI 0.84, 0.98)]. Smoking was not a risk factor for GCA overall [OR 1.36 (95% CI 0.77, 2.57)], although there was a trend towards an increased risk in female smokers [OR 2.14 (95% CI 0.97, 4.68)]. In multivariate analysis, adjusted for smoking and level of formal education, the inverse association between BMI and GCA remained significant (P = 0.027).

CONCLUSION

In this study, GCA was predicted by a lower BMI at baseline. Potential explanations include an effect of reduced adipose tissue on hormonal pathways regulating inflammation.