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戒烟、体重变化、2型糖尿病和死亡率
Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality


Yang Hu ... 糖尿病 • 2018.08.16
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• 戒烟后体重增加产生的影响 • 控制危险因素可降低2型糖尿病的危险 • 肥胖悖论或许可用瘦体重解释 • 电子香烟、奖励和药物戒烟的实用性试验 • 男性和女性饮食和生活方式的改变与长期体重增加的关系

戒烟后糖尿病风险暂时升高,但总死亡率下降

 

徐福洁

浙江大学附属第一医院

 

戒烟能够降低慢性病的发病率,延年益寿,但戒烟后可能带来明显的体重增加,这种体重增加有可能打击戒烟的积极性,并可能增加心血管疾病、代谢性疾病和死亡的风险,削弱戒烟对于健康的益处。戒烟之后的体重增加是否会减弱戒烟对健康的好处,目前还不是很清楚。

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摘要


背景

目前尚不清楚戒烟后体重增加是否会减弱戒烟对健康的益处。

 

方法

在美国三项包括男性和女性的队列研究中,我们确定了报告戒烟的人,并且前瞻性地评估了吸烟状况和体重的变化。在报告戒烟的参与者中,我们根据戒烟后的体重变化分类,估计了2型糖尿病、心血管疾病所致死亡以及任何原因所致死亡的风险。

 

结果

近期戒烟者(戒烟后2~6年)的2型糖尿病风险高于当前吸烟者(风险比,1.22;95%置信区间[CI],1.12~1.32)。该风险在戒烟后5~7年达到峰值,然后逐渐下降。2型糖尿病风险的短期增加与体重增加成正比,并且体重未增加的戒烟者的风险没有增加(交互作用P<0.001)。相比之下,不论戒烟后体重变化如何,戒烟者的死亡率都没有短期增高。与当前吸烟者相比,在体重未增加的近期戒烟者、体重增加0.1~5.0 kg的近期戒烟者、体重增加5.1~10.0 kg的近期戒烟者、体重增加>10.0 kg的近期戒烟者和长期戒烟者(戒烟>6年)中,心血管疾病死亡的风险比分别为0.69(95% CI,0.54~0.88)、0.47(95% CI,0.35~0.63)、0.25(95% CI,0.15~0.42)、0.33(95% CI,0.18~0.60)和0.50(95% CI,0.46~0.55)。对于任何原因所致死亡,我们观察到了类似的相关性。

 

结论

伴随着体重显著增加的戒烟与2型糖尿病的短期风险增加相关,但并未减弱戒烟在降低心血管死亡率和全因死亡率方面的益处(由美国国立卫生研究院资助)。





作者信息

Yang Hu, S.M., Geng Zong, Ph.D., Gang Liu, Ph.D., Molin Wang, Ph.D., Bernard Rosner, Ph.D., An Pan, Ph.D., Walter C. Willett, M.D., Dr.P.H., JoAnn E. Manson, M.D., Dr.P.H., Frank B. Hu, M.D., Ph.D., and Qi Sun, M.D., Sc.D.
From the Departments of Nutrition (Y.H., G.Z., G.L., W.C.W., F.B.H., Q.S.), Epidemiology (Y.H., M.W., W.C.W., J.E.M., F.B.H.), and Biostatistics (M.W., B.R.), Harvard T.H. Chan School of Public Health, and the Channing Division of Network Medicine (M.W., W.C.W., J.E.M., F.B.H., Q.S.) and the Division of Preventive Medicine (J.E.M.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School — all in Boston; and the Key Laboratory of Nutrition, Metabolism, and Food Safety, Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai (G.Z.), and the Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (A.P.) — both in China. Address reprint requests to Dr. Sun at the Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at qisun@hsph.harvard.edu.

 

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