Physicians' Academy for Cardiovascular Education

CV benefits of smoking cessation not attenuated by resultant weight gain

Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality

Literature - Hu Y, Zong G, Liu G et al. - N Engl J Med 2018; 379:623-632

Introduction and methods

Although smoking cessation decreases the risk of major chronic diseases and extends life expectancy [1], it may cause weight gain in quitters [2]. Weight gain may discourage quitting attempts and attenuate health benefits of smoking cessation through increasing the risk of cardiometabolic disease and premature death [3]. However, evidence regarding health consequences of weight gain after smoking cessation is contradictory [4-8], possibly due to unmeasured smoking behavior during follow-up [9]. Moreover, a relapse within the next decade has been shown in >30% of quitters who were abstinent for one year [10].

This longitudinal study evaluated risk trajectories of disease and death in people who quitted smoking by measuring body-weight changes after smoking cessation. Secondary analyses studied the role of physical activity and diet in weight gain.

The study enrolled participants from three cohorts - the Nurses’ Health Study (NHS), the Nurses’ Health Study II (NHS II), and the Health Professionals Follow-up Study (HPFS) - without prevalent diabetes, cardiovascular disease (CVD), or cancer at baseline. A study sample of 162,807 participants could be analyzed for diabetes analyses and 170,723 participants for mortality analyses. Medical and lifestyle information was obtained by questionnaires every two years (one cycle) during follow-up. The role of physical activity and diet in weight gain were measured by using the metabolic equivalent tasks (METs) and Alternative Healthy Eating Index (AHEI), respectively.

Participants were classified according to smoking status and weight gain, discriminating between current smokers (smoking in previous and next cycles), recent quitters (2-6 consecutive years without smoking), and long-term quitters (>6 consecutive years without smoking), and weight gain of 0.1-5.0 kg, 5.1-10.0 kg, or >10 kg. The outcome was type 2 diabetes (T2DM), deaths from CVD, and all-cause mortality during a mean follow-up of 19.6 years.

Main results


Benefits of smoking cessation on all-cause and CV mortality were not attenuated by substantial weight gain, even though this is associated with a temporarily increased risk of T2DM after quitting. Weight gain after smoking cessation can be reduced by physical activity and a healthy diet.


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