A team of researchers from Fairfield University and Yale University has evaluated data from 5,293 U.S. adults and found that smokers consumed around 200 more calories a day, despite eating significantly smaller portions of food, than non-smokers or former smokers. The study appears in the journal BMC Public Health.
MacLean et al suggest that smoking status is associated with poor diet quality. Image credit: Quick Fix / CC BY-SA 2.0.
Smoking is the leading cause of preventable mortality and is associated with a variety of chronic illnesses including cardiovascular disease, cancer, and stroke.
Although nearly 7 in 10 adult cigarette smokers want to quit, cessation rates remain alarmingly low. For example, the percentage of smokers reporting a serious quit attempt has significantly increased in recent years from 51.2% in 2011 to 55.0% in 2014; however, successful abstinence has remained unchanged at approximately 20% during the same period.
Therefore, additional efforts are needed to increase the number of people making a serious quit attempt and, by proxy, decrease the impact and incidence of chronic medical conditions associated with smoking. Evaluation of modifiable risk factors that are associated with cigarette smoking can help identify targets that are amendable to intervention.
The objective of the new study was to evaluate the correlation between cigarette use and dietary energy density, a marker for diet quality, in a population of current smokers, former smokers, and never smokers.
Led by Dr. Jacqueline Vernarelli of Fairfield University, the team used data from 5,293 adults who took the National Health and Examination Survey, a program of studies designed to assess the health and nutritional status of adults and children in the United States.
The dietary data used in the study was based on participants recalling what they ate in the past 24 hours.
The mean dietary energy density (kcal/g) was calculated after adjusting for age, sex, race, educational attainment, socioeconomic status, beverage energy density, physical activity and BMI.
“Smokers had diets that were high in energy density, meaning they consumed smaller amounts of food containing a greater number of calories. Non-smokers consumed more food which contained fewer calories,” Dr. Vernarelli said.
The researchers found that people who had never smoked consumed around 1.79 calories per gram of food, daily smokers consumed 2.02 kcal/g and non-daily smokers consumed 1.89 kcal/g.
They also found that former smokers consumed more calories per gram of food (1.84 kcal/g) than those who had never smoked, but the former smokers’ dietary energy density was still significantly lower than that of current smokers.
The finding suggests that any amount of cigarette consumption could be associated with poorer diet quality.
The calorie dense diets consumed by the smokers whose data was used in this study often included less fruit and vegetables, which means their intake of vitamin C was likely to be lower.
“This deficiency could potentially put smokers at further risk of cardiovascular disease and cancer, presenting a major public health concern,” the study authors said.
“A diet low in energy density could help prevent weight gain after quitting smoking.”
“We know from the literature that concerns about weight gain are barriers to quitting smoking, and we know that diets high in energy density are associated with higher body weight,” Dr. Vernarelli said.
“Our results suggest that addressing the energy density in diets of current smokers may be a good target for interventions as part of a larger smoking cessation plan.”
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R. Ross MacLean et al. 2018. More to gain: dietary energy density is related to smoking status in US adults. BMC Public Health 18: 365; doi: 10.1186/s12889-018-5248-5
