More to Gain: Diet Energy Density is Associated with Smoking Status in US Adults

Cigarette smoking is associated with a host of negative health consequences. A frequent concern among individuals thinking about quitting smoking is weight gain. Although nicotine is a known appetite suppressant, research investigating the diet quality of varying levels of smoking behavior in limited. Energy density (ED) is an established indicator of diet quality as well as an established risk factor for obesity. The objective of the present study was to evaluate the relationship between dietary ED and smoking behaviors in a nationally representative sample of 5,535 adults who participated in the 2013–2014 National Health and Nutrition Examination Surveys (NHANES). During the NHANES, questions related to smoking status, duration, and smoking‐related behaviors as asked. Participants were categorized as non‐smokers (never smokers), former smokers (having smoked >100cig/lifetime but do not currently smoke), and current smokers. Current smokers are further classified as daily smokers and non‐daily smokers (identifies as a smoker, but does not smoke cigarettes every day). Dietary ED was calculated using multiple methods. Adults were categorized into sex‐specific quartiles of energy density. All data were analyzed using appropriate survey weights and procedures in SAS 9.4. Our findings demonstrate that current cigarette smokers have a higher dietary ED than both ex‐smokers and non‐smokers (1.93 vs. 1.84 and 1.81 kcal/g, respectively, p<0.01) after adjusting for age, sex, race, educational attainment, socioeconomic status and BMI. Though ex‐smokers had a higher dietary ED than non‐smokers, this difference was not statistically significant (p=0.67), suggesting that quitting smoking may actually have a positive effect on diet quality. Ex‐smokers who began smoking as adolescents (<18yr) have a higher ED compared to ex‐smokers who began smoking as adults (>18yr), 1.74 kcal/g vs. 1.90 kcal/g p=0.0018. Among current smokers, we also observed a strong linear relationship between smoking pattern and dietary energy density. Compared to non‐smokers, daily smokers and non‐daily smokers have significantly higher dietary energy density (1.81 vs. 2.00 and 1.88, respectively; both p<0.05); demonstrating that any amount of cigarette consumption is associated with poor diet. These results suggest that, contrary to popular belief, those who have successfully quit smoking have comparable diet quality to non‐smokers and better diets than current smokers, including those that only smoke occasionally. Interventions that educate smokers about dietary ED in order to enable them to make educated dietary choices may empower those concerned about weight gain to quit smoking. Additionally, even among those who are no longer smoking, the lasting effect of higher‐ED diets among individuals who started smoking as adolescents underscores the importance of evaluating exposure to cigarettes during important developmental periods.Smoking status categorized as non‐smokers (never smokers), former smokers (having smoked >100cig/lifetime but do not currently smoke), and current smokers. Current smokers are further classified as daily smokers (smokes cigarettes every day) and non‐daily smokers (identifies as a smoker, but does not smoke cigarettes every day). Mean ED is adjusted for age, sex, race, educational attainment, socioeconomic status and BMI.Mean ED is adjusted for age, sex, race, educational attainment, socioeconomic status and BMI. Smokers identified as beginning smoking before or after age 18.