《NEJM》:戒烟后体重增加削弱戒烟带来的健康益处? 不存在的!
众多的研究都表明戒烟可以减少重大慢性疾病的风险并能延长预期寿命,但有研究表明戒烟后戒烟者可能出现相当大的体重增加。这种体重增加可能是由于食欲增加和能量消耗减少所致,并且这种体重的增加很可能通过增加心脏代谢疾病和过早死亡的风险来减少戒烟给戒烟者所带来的健康益处。尽管如此,关于戒烟后体重增加的健康后果的证据是目前仍然是模棱两可的。而这种不一致的发现可能是由于以前的观察性研究在很大程度上依赖于戒烟的“点流行率”(即仅在一个特定的随访期评估吸烟状况),以及可能的变化。随访期间的吸烟行为通常是未知的。据报道,超过30%戒烟1年的戒烟者最终在未来十年内复发。

最近在著名杂志《新英格兰医学杂志》上刊登了一篇在美国的大型队列研究中对吸烟状况和体重进行纵向重复评估的研究,旨在根据戒烟后的体重变化评估报告戒烟者的疾病和死亡风险轨迹。研究结果发现:虽然戒烟后会伴随着体重增加,甚至在短期内2型糖尿病的患病风险增加有关,但并没有减轻戒烟对降低心血管和全因死亡率的益处


该研究参与者来自美国的3个长期随访队列,经排除后纳入了关于糖尿病研究的有162,807人,关于死亡率的研究纳入额170,723人。研究者每隔两年对研究参与者进行随访,获得戒烟情况和体重变化情况等信息,并且根据体重变化分成不同组别。根据这些信息研究者前瞻性地评估了吸烟状况和体重的变化。并且根据戒烟后的体重变化,估计了2型糖尿病患者,心血管疾病导致的死亡以及报告戒烟者死亡的风险。


研究结果显示在最近戒烟人群(戒烟后2至6年)中,2型糖尿病风险相比于当前吸烟者增高了22%(风险比1.22; 95%置信区间[CI],1.12至1.32)。并且2型糖尿病发病率在戒烟后5至7年达到顶峰,然后逐渐下降,在戒烟30年后发病率与从未吸烟者无明显差别。


在戒烟后短期内2型糖尿病风险的增加与体重增加成正比,而在那些并且没有体重增加的戒烟者的2型糖尿病的患病风险并没有增加(相互作用P <0.001)。


相比之下,不管戒烟后体重变化如何,戒烟者的死亡率都没有暂时增加。与目前的吸烟者相比,新近戒烟者在没有体重增加或体重减轻组中心血管疾病死亡的风险降低了31%(风险比 0.69;95%CI,0.54~0.88),在体重增加0.1~0.5kg组中降低了75%(风险比 0.25)在体重增加10.0 kg以上组中降低了67%(风险比 0.33;95%CI,0.18~0.60),长期戒烟组中(戒烟后> 6年)降低了50%(风险比 0.50;95%CI,0.46~0.5k)。心血管病的死亡率从戒烟始开始下降,并且在戒烟后10-15年降至低点。


因此,即使戒烟后会伴随着体重增加,但并不会减轻戒烟对降低心血管和全因死亡率的益处。同时,该项研究也提示广大正在戒烟或者即将投身戒烟的烟民们在戒烟过程中,通过控制饮食,加强运动等方式调节体重,从而进一步加强戒烟给身体带来的健康益处。

参考文献原文:

BACKGROUND

Whether weight gain after smoking cessation attenuates the health benefits of

quitting is unclear.

METHODS

In three cohort studies involving men and women in the United States, we identified

those who had reported quitting smoking and we prospectively assessed changes in smoking status and body weight. We estimated risks of type 2 diabetes, death from cardiovascular disease, and death from any cause among those who had reported quitting smoking, according to weight changes after smoking cessation.

RESULTS

The risk of type 2 diabetes was higher among recent quitters (2 to 6 years since

smoking cessation) than among current smokers (hazard ratio, 1.22; 95% confidence

interval [CI], 1.12 to 1.32). The risk peaked 5 to 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 cardiovascular

disease were 0.69 (95% CI, 0.54 to 0.88) among recent quitters without weight

gain, 0.47 (95% CI, 0.35 to 0.63) among those with weight gain of 0.1 to 5.0 kg,

0.25 (95% CI, 0.15 to 0.42) among those with weight gain of 5.1 to 10.0 kg, 0.33

(95% CI, 0.18 to 0.60) among those with weight gain of more than 10.0 kg, and

0.50 (95% CI, 0.46 to 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 cardiovascular and all-cause mortality.

参考文献:

Hu Y, Zong G, Liu G, Wang M, Rosner B, Pan A, Willett WC, Manson JE, Hu FB, Sun Q. Smoking cessation, weight change, type 2 diabetes, and mortality. N Engl J Med. 2018;379:623-632


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