SMOKING WITHDRAWL EFFECTS ON ENERGY BALANCE

吸烟者的体重比不吸烟者轻，戒烟后通常会增加5-10磅，但尼古丁影响体重的机制仍不清楚。 75名吸烟者将被随机分配到三组之一（根据限制饮食评分分层）：42 mg尼古丁替代品、21 mg尼古丁替代品或安慰剂。 受试者将接受为期8周的透皮治疗和为期16周的强化小组咨询。 将在戒烟前的过夜（12小时）热量测定中以及戒烟后1、4、8和16周的24小时热量测定中评估静息代谢率（RMR）、对食物的热反应、戒断评分、3天饮食记录、尼古丁/可替宁水平和活动。 如果42 mg尼古丁剂量足以维持戒烟前设定点，则在戒烟后1周和4周，42 mg组的RMR应高于其他组，热量摄入应低于其他组。到第16周，21 mg组的体重应超过42 mg组。 RMR下降应与戒断严重程度增加密切相关，饮食方式受限的受试者应表现出热量摄入、体重和RMR下降的最大增加。 除了对两种理论（调节与效应）提供强有力的检验外，这项研究还具有重大的临床意义。 它可能有助于识别那些体重增加风险最大的吸烟者，并提出管理与戒烟相关的体重增加的最佳策略。 由于对体重增加的恐惧阻止了许多吸烟者试图戒烟，这些信息可能会提供显着的健康益处。

Smokers weigh less than nonsmokers, and typically gain 5-10 pounds upon quitting smoking, yet the mechanisms by which nicotine influences body weight remain unclear. Seventy-five smokers will be randomly assigned to one of three groups (stratified on the basis of a restrained eating score): 42 mg nicotine replacement, 21 mg nicotine replacement, or placebo. Subjects will receive transdermal therapy for eight weeks and intensive group counseling for sixteen weeks. Resting metabolic rate (RMR), thermic response to food, withdrawal ratings, three-day dietary records, nicotine/cotinine levels, and activity will be assessed in an overnight (twelve hour) calorimetry session prior to smoking cessation, and in 24-hour calorimetry sessions one, four, eight and sixteen weeks post-cessation. If the 42 mg nicotine dose is sufficient to maintain pre-smoking cessation set-point, at one and four weeks post-quit the 42 mg group should have a higher RMR and lower caloric intake than the other groups. The 21 mg group should weigh more than the 42 mg group by week 16. Decline in RMR should be strongly associated with increased withdrawal severity, and those subjects with restrained eating styles should show the greatest increases in caloric intake, weight, and decline in RMR. In addition to providing a powerful test of two theories (regulatory versus effector), this research also has great clinical significance. It may help to identify those smokers at greatest risk for weight gain, and suggest optimal strategies for managing weight gain related to smoking cessation. As fear of weight gain deters many smokers from attempting to quit, this information could provide significant health benefits.