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Smokers have worse diets than non-smokers

Smokers have worse quality diets than former smokers or non-smokers, according to a study published in the open access journal BMC Public Health.

Dr Jacqueline Vernarelli at Fairfield University, Connecticut and Dr R. Ross MacLean at Yale University evaluated data from 5293 US 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.

Dr Vernarelli commented: “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.”

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. The researchers also found that former smokers consumed more calories per gram of food (1.84kcal/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. The authors suggest that this deficiency could potentially put smokers at further risk of cardiovascular disease and cancer, presenting a major public health concern.

The researchers also suggest that a diet low in energy density could help prevent weight gain after quitting smoking. 

Dr Vernarelli explained: “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. 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”

The researchers used data from 5293 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 US. 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. 

The authors caution that the study’s use of self-reported survey data may have introduced information and recall bias. The cross sectional nature of this study does not allow for conclusions about cause and effect between diet quality and smoking.

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Notes to editor:
1.    Research article: 
More to gain: dietary energy density is related to smoking status in US adults
Maclean et al. BMC Public Health 2018
DOI: 10.1186/s12889-018-5248-5
The article is available at the journal website.
Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BMC's open access policy. 

2.    BMC Public Health is an open access, peer-reviewed journal that considers articles on the epidemiology of disease and the understanding of all aspects of public health. The journal has a special focus on the social determinants of health, the environmental, behavioral, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community. 

3.    A pioneer of open access publishing, BMC has an evolving portfolio of high quality peer-reviewed journals including broad interest titles such as BMC Biology and BMC Medicine, specialist journals such as Malaria Journal and Microbiome, and the BMC series. At BMC, research is always in progress. We are committed to continual innovation to better support the needs of our communities, ensuring the integrity of the research we publish, and championing the benefits of open research. BMC is part of Springer Nature, giving us greater opportunities to help authors connect and advance discoveries across the world.