Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality.
Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality.
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DOI：
10.1056/nejmoa1803626
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发表时间：
2018-08-16
期刊：
影响因子：
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通讯作者：
Sun Q
中科院分区：
文献类型：
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作者：
Hu Y;Zong G;Liu G;Wang M;Rosner B;Pan A;Willett WC;Manson JE;Hu FB;Sun Q
戒烟后体重增加是否会削弱戒烟对健康的益处尚不清楚。在涉及美国男性和女性的三项队列研究中，我们确定了那些报告戒烟的人，并前瞻性地评估了吸烟状况和体重的变化。我们根据戒烟后的体重变化，估计了那些报告戒烟的人患2型糖尿病、心血管疾病死亡和任何原因死亡的风险。近期戒烟者（戒烟后2 - 6年）患2型糖尿病的风险高于当前吸烟者（风险比，1.22; 95%置信区间[CI]，1.12 - 1.32）。风险在戒烟后5 - 7年达到峰值，然后逐渐下降。2型糖尿病风险的暂时性增加与体重增加成正比，而在体重没有增加的戒烟者中，风险并没有增加（相互作用P<0.001）。相比之下，戒烟者的死亡率没有暂时增加，无论戒烟后体重变化如何。与目前吸烟者相比，心血管疾病死亡的风险比为0.69（95% CI，0.54至0.88）在最近戒烟者中，体重没有增加，0.47（95% CI，0.35 - 0.63）体重增加0.1 - 5.0 kg的受试者中，0.25（95% CI，0.15 - 0.42）体重增加5.1 - 10.0 kg的受试者中，0.33体重增加超过10.0 kg的受试者中，吸烟率为0.50（95%CI，0.46 - 0.55），长期戒烟者（戒烟后>6年）中，吸烟率为0.50（95%CI，0.18 - 0.60）。任何原因的死亡也观察到类似的关联。戒烟伴随着体重的大幅增加与2型糖尿病的短期风险增加有关，但并没有减轻戒烟对降低心血管和全因死亡率的益处。（由美国国立卫生研究院资助。
Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear. 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. 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. 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. (Funded by the National Institutes of Health.)