Diet and Tobacco Use: Analysis of Data From the Diabetic Control and Complications Trial, a Randomized Study

David K. Cundiff

In This Article

Abstract and Introduction

Context: The Diabetic Control and Complications Trial (DCCT) researchers kept careful records of the food consumption and tobacco using habits of type 1 diabetic subjects. However, they did not report the relationship of tobacco using habits with dietary intake.
Objective: Analyze the relationship between tobacco smoking and intake of macro and micronutrients.
Design: Randomized controlled trial.
Setting: Referral clinics in 27 academic centers.
Patients: Type 1 diabetics.
Intervention: Using the data sets of the DCCT, this study analyzed the strengths of the associations between smoking and macronutrient consumption, hemoglobin A1c (HbA1c), body mass index (BMI), and serum lipid levels at the study baseline, 2 years, and 4 years.
Main Outcome Measures: Statistically significant correlations between smoking and nutrient intake, HbA1c, and serum lipid levels.
Results: Cigarette, cigar, or pipe use at each time interval correlated with significantly increased caloric intake in males but not in females. In both males and females, tobacco users consumed more fat, cholesterol, and alcohol. Female smokers had higher serum low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratios and triglycerides. Serum cholesterols, LDL/HDL ratios, LDL cholesterols, and triglyceride determinations in male tobacco users significantly exceeded those in nonsmoking males. HDL cholesterols were lower in both female and male tobacco users. Nutrient intake of former tobacco users resembled that of nonusers rather than current users.
Conclusions: A significant association exists between smoking and a diet with higher risks of atherosclerosis, cancer, and other degenerative diseases. The strong association of tobacco with heart disease, stroke, vasculopathies, and various malignancies may be in part due to its association with a higher fat diet. The higher fat diet of tobacco users probably accounts in part for their higher risk of developing type 2 diabetes and hyperlipidemia. Tobacco users should be informed about the diet and tobacco use association.

Tobacco smokers have been shown to consume as many or more calories as those who never smoked, yet tobacco smokers have a lower weight.[1,2,3,4,5,6,7] Tobacco has been used to control weight.[1,3,4,7,8,9,10] Exsmokers weight more than age- and sex-matched nonsmokers in some studies,[2,4,11,12,13,14,15] but not others.[7,16,17,18] The relationship between the number of cigarettes smoked per day and body weight is a U-shaped curve, with those using 10-29 cigarettes per day being the lightest group.[4,7,8,11,12,13,16,19]

Explanations for why smokers weigh less than nonsmokers range from increased energy expenditure,[20,21,22,23] increased bowel motility,[24] to nicotine-related appetite suppression. A controlled comparison of energy expenditure with the same subjects during smoking and nonsmoking days showed that tobacco use increases energy use by about 10% and is associated with increased norepinephrine release.[25] A similar study by Collins and colleagues[26] demonstrated a 5.2% to 9.3% increase in energy expenditure, depending on the nicotine content and number of cigarettes smoked. Conversely, Stamford and colleagues[27] studied 13 sedentary women before and during a smoking cessation program. They found no measurable acute effects of smoke inhalation and no chronic net effects of smoking cessation on resting metabolic rate, as determined by oxygen consumption and respiratory exchange ratio.

Zondervan and colleagues[28] found that men who smoked more than 20 cigarettes per day ate almost 60% less fruit than men who never smoked. They also observed a significant but less dramatic reduction of fruit consumption in women smokers compared with nonsmoking women. Using the database of the 1976-1980 Health and Nutrition Examination Survey, Byrd and colleagues[29] found that smokers consumed 16% less fruits and vegetables than nonsmokers. The fruit and vegetable intake of former smokers approached that of nonsmokers.[29] The effect of tobacco use on individual macronutrient and micronutrient intake apart from overall caloric intake is unknown.

The DCCT database provides an opportunity to study the possible relationship of tobacco use, diet, BMI, serum lipids, and HbA1c.


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