ArticlesSmoking cessation, lung function, and weight gain: a follow-up study
Introduction
A review of the effect of smoking cessation on outcomes including lung function made no mention of adverse effects of concomitant weight gain,1 although these could be substantial.2 Longitudinal studies that have assessed the relation of change in lung function to smoking cessation and change in body-mass index (BMI) have shown that the beneficial effect of smoking cessation outweighs the adverse effect of weight gain.3, 4, 5 The estimates of the weight gain contribution vary,5 which could in part be due to the different populations studied. Only one study was of a general population,5 another was of steelworkers,3 and the third was a randomised controlled trial of smokers with mild to moderate chronic obstructive pulmonary disease.4 Two studies showed that weight gain had a more deleterious effect on lung function in men than in women,4, 5 and the Lung Health study6 also showed a greater net beneficial effect of smoking cessation in women than in men. The only population study, which used data from the Health and Lifestyle Survey,5 included data for 3391 British men and women aged 18–73 years, who were followed up for 7 years. Although the independent effects of quitting smoking and weight gain were estimated, the total effect of quitting (ie, the effect net of weight gain) was not reported.
The full effect of quitting smoking in the general population is therefore not known, nor is whether the effect is consistent across countries. The European Community Respiratory Health Survey II (ECRHS II)7 was a multicentre follow-up study of participants in ECRHS I, which selected adults aged 20–44 years.8 We analysed change in lung function to estimate the net effect of smoking cessation and independent effects of smoking cessation and weight change, to show whether these differ between men and women, and to study heterogeneity of findings across much of western Europe.
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Participants
Each survey had a self-completed postal questionnaire, stage 1, followed by stage 2, which included an administered questionnaire and measurement of spirometric lung function. Only data for the random sample selected for ECRHS I stage 2, undertaken in 1991–93,8 were included. Participants in ECRHS I stage 2 were eligible for ECRHS II. Most centres that participated in ECRHS I stage 2 took part in ECRHS II.7 Follow-up was from 1998 to 2002. Ethical approval was obtained for each centre from the
Results
A total of 14 632 people in the random sample in the 27 centres were eligible to take part in ECRHS II, of whom 12 417 had lung function measured at ECRHS I (figure 1). Details of response to ECRHS II stage 1 are given elsewhere.13 Of the 12 417, 7738 (62·3%) were traced and responded to the main questionnaire in ECRHS II, and 6654 had valid lung function with at least one valid measurement of FEV1 or FVC. Overall, slightly more eligible men (3484 of 6987, 49·9%) than women (3654 of 7645,
Discussion
Our study has documented the effect of both smoking cessation and weight change on lung function in a general population, and the full (net) effect of smoking cessation in the community. We have found a similar net effect of smoking cessation in men and women, but a greater decline in lung function due to weight gain in men.
There was some differential loss to follow-up, as in the few other longitudinal studies which have reported on such loss.14, 15 This loss is unlikely to greatly bias the
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