Log in to MyACC
Smoking Cessation, Weight Gain, Diabetes, Mortality
Study Questions:
Does weight gain after smoking cessation attenuate the health benefits of quitting?
Methods:
In three longitudinal cohort studies involving men and women in the United States with baseline in 1984, 1988, and 1991 and followed every 2 years with questionnaires, the authors identified those who had reported quitting smoking and prospectively assessed changes in smoking status and body weight. Other variables included recreational activity and food frequency. They estimated relative risks of type 2 diabetes, death from cardiovascular disease (CVD), and death from any cause by physician records/next of kin, and National Death Index among those who had reported quitting smoking, according to weight changes after smoking cessation. Those with baseline cardiovascular disease (CVD), diabetes, or cancer were excluded.
Results:
A total of 162,807 participants were included in the diabetes analyses, and 170,723 were included in the mortality analyses. The risk of type 2 diabetes was higher among recent quitters (2-6 years since smoking cessation) than among current smokers (hazard ratio, 1.22; 95% confidence interval [CI], 1.12-1.32). The risk peaked 5-7 years after quitting and then gradually decreased. The temporary increase in the risk of type 2 diabetes was directly proportional to weight gain, and the risk was not increased among quitters without weight gain (p < 0.001 for interaction). In contrast, quitters did not have a temporary increase in mortality, regardless of weight change after quitting. As compared with current smokers, the hazard ratios for death from CVD were 0.69 (95% CI, 0.54-0.88) among recent quitters without weight gain, 0.47 (95% CI, 0.35-0.63) among those with weight gain of 0.1-5.0 kg, 0.25 (95% CI, 0.15-0.42) among those with weight gain of 5.1-10.0 kg, 0.33 (95% CI, 0.18-0.60) among those with weight gain of >10.0 kg, and 0.50 (95% CI, 0.46-0.55) among longer-term quitters (>6 years since smoking cessation). Similar associations were observed for death from any cause.
Conclusions:
Smoking cessation that was accompanied by substantial weight gain was associated with an increased short-term risk of type 2 diabetes, but did not mitigate the benefits of quitting smoking on reducing CV and all-cause mortality.
Perspective:
The authors suggested that preventing excessive weight gain may maximize the health benefits of smoking cessation through reducing the short-term risk of diabetes and further lowering the long-term risk of death. Their analysis provided further evidence that improving diet quality with fruits, vegetables, and grains and increasing physical activities may help quitters to achieve their weight-maintenance goals. The findings also suggest that health care practitioners provide advice based on monitoring weight gain and glycemic response to smoking cessation.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise, Smoking
Keywords: Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Diet, Exercise, Metabolic Syndrome, Primary Prevention, Risk, Smoking, Smoking Cessation, Weight Gain
< Back to Listings
