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Weight After Smoking Cessation Linked with Increased Risk of Type 2 Diabetes

Sep 29, 2018
 

Recent studies show continued benefit in decreasing all-cause mortality from cardiovascular disease, but changes in weight after smoking cessation can heighten risk.

Smoking cessation has many benefits for patients who stomp the habit, as it reduces the risk of chronic illnesses and extends life expectancy, but an extensive amount of weight gain may occur after cessation. This weight gain is probably due to an increase in appetite, along with a decrease in physical activity. Regardless of this concern, evidence of health consequences from weight gain after smoking cessation is uncertain.

Yang Hu, from the Harvard T.H. Chan School of Public Health, and colleagues assessed in three cohort studies (Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study) involving men and women in the United States who filled out questionnaires regarding their health and lifestyle every two years. They identified patients who had reported smoking cessation and prospectively assessed changes in smoking status compared to body weight. Researchers estimated risks of type 2 diabetes, mortality from cardiovascular disease, and all-cause mortality in those patients who had reported smoking cessation, according to the changes in weight after quitting smoking.

The risk of type 2 diabetes was higher in people who had recently quit smoking (2 to 6 years prior) compared to those who were still smokers (HR 1.22; 95% CI, 1.12-1.32) After 5 to 7 years of smoking cessation, the risk peaked but slowly decreased. The elevated risk of type 2 diabetes was directly associated with weight gain. On the other hand, there was not an increase in mortality, regardless of weight change after cessation. The hazard ratios from heart disease that caused death were 0.69 among those who recently quit smoking and did not gain weight, and long-term quitters had 0.47, 0.25, 0.33 and 0.50 hazard ratios for those who gained 0.1 to 5.0 kg to 5.1 to 10 kg, compared with smokers who never quit.

“Smokers shouldn’t be deterred by potential weight gain after quitting because the short-term and long-term reduction of cardiovascular disease risk is clear,” said Hu, from the  Departments of Nutrition and Epidemiology. “However, quitters may want to consider eating a healthful diet and engaging in physical activities to minimize weight gain to keep their diabetes risk at bay and to maximize the health benefits of quitting.

“In conclusion, our findings suggest that a temporary increase in the risk of type 2 diabetes due to weight gain after smoking cessation did not attenuate the benefits of smoking cessation on reducing total and cardiovascular mortality.”

Practice Pearls:

  • Researchers estimated risks of type 2 diabetes, mortality from cardiovascular disease, and all-cause mortality in those patients who had reported smoking cessation, according to the changes in weight after quitting smoking.
  • The risk of type 2 diabetes was higher in the people who recently quit smoking (2 to 6 years), spiked after 5 to 7 years, then slowly decreased.
  • Patients should eat a healthful diet and exercise often to minimize weight gain to avoid the risk of diabetes type 2 after smoking cessation and maximize the health benefits of quitting.
  • Researchers concluded that a temporary increase in the risk of type 2 diabetes due to weight gain after quitting smoking did not weaken the benefits of smoking cessation on decreasing all-cause mortality from cardiovascular disease.

Reference:

Hu, Y., Zong, G. et al. “Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality.” New England Journal of Medicine, Oxford University Press, www.nejm.org/doi/full/10.1056/NEJMoa1803626.

Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy

 

See more information on the effect of changes in weight after smoking cessation.