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尚不清楚。75名吸烟者将被随机分配到三组中的一组(根据限制进食分数进行分层)：42毫克尼古丁替代品、21毫克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周的强化团体咨询。静息代谢率(RMR)、对食物的热反应、戒断等级、三天的饮食记录、尼古丁/可替宁水平和活动度将在戒烟前的隔夜(12小时)热量测量会议以及戒烟后1、4、8和16周的24小时热量测量会议中进行评估。如果42毫克的尼古丁剂量足以维持戒烟前的设定点，那么在戒烟后一周和四周，42毫克组应该比其他组有更高的RMR和更低的卡路里摄入量。到第16周，21毫克组的体重应该超过42毫克组。RMR的下降应该与戒断严重程度的增加密切相关，那些饮食习惯受限的受试者应该表现出卡路里摄入量、体重和RMR下降的最大增幅。这项研究除了对两种理论(调节与效应)进行了有力的检验外，还具有重要的临床意义。这可能有助于识别哪些吸烟者体重增加的风险最大，并提出与戒烟相关的最佳体重增加管理策略。由于对体重增加的恐惧阻止了许多吸烟者尝试戒烟，这一信息可能会提供显著的健康益处。

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.