The prospective relationships between smoking and weight in a young, biracial cohort: the Coronary Artery Risk Development in Young Adults Study.

This study examined the relationship between smoking status and weight change from baseline to Year 7 in a large biracial cohort, the Coronary Artery Risk Development in Young Adults study. Unadjusted for covariates, only male smokers weighed less than nonsmokers, with no effect among women. Adjusted for covariates, male and female smokers weighed less than nonsmokers at baseline, adjusted for age, total energy intake, alcohol intake, and physical fitness. Over the 7-year follow-up, all smoking status groups gained weight, including continuous smokers and initiators. Weight gain was greatest among those who quit smoking. Weight gain attributable to smoking cessation was 4.2 kg for Whites and 6.6 kg for Blacks. Smoking had a small weight-attenuating effect on Blacks. No such effects, however, were observed among Whites. These results suggest, at least in younger smokers, that smoking has minimal impact on body weight.

How much weight gain occurs following smoking cessation? A comparison of weight gain using both continuous and point prevalence abstinence.

Estimates of postcessation weight gain vary widely. This study determined the magnitude of weight gain in a cohort using both point prevalence and continuous abstinence criteria for cessation. Participants were 196 volunteers who participated in a smoking cessation program and who either continuously smoked (n = 118), were continuously abstinent (n = 51), or who were point prevalent abstinent (n = 27) (i.e., quit at the 1-year follow-up visit but not at others). Continuously abstinent participants gained over 13 lbs. (5.90 kg) at 1 year, significantly more than continuously smoking (M = 2.4 lb.) and point prevalent abstinent participants (M = 6.7 lbs., or 3.04 kg). Individual growth curve analysis confirmed that weight gain and the rate of weight gain (pounds per month) were greater among continuously smoking participants and that these effects were independent of gender, baseline weight, smoking and dieting history, age, and education. Results suggest that studies using point prevalence abstinence to estimate postcessation weight gain may be underestimating postcessation weight gain.

Differences in macronutrient selections in users and nonusers of an oral contraceptive.

One of the problems inherent in using women in clinical research is the effect that oral contraceptive (OC) use might have on physical indexes. Although weight gain is frequently reported as a side effect of OC use, there is little empirical evidence that such weight gain actually occurs. The current study investigated differences in energy balance [ie, dietary intake, resting energy expenditure (REE), and physical activity] between groups of users and nonusers of OCs. Each group completed a protocol that covered one menstrual cycle and consisted of daily recording of dietary intake, measurement of REE once during each phase of the menstrual cycle, and reporting of physical activity over the entire cycle. Comparisons indicate that there was a marginal interaction (P = 0.06) of OC use with total energy intake, indicating a different pattern of intake for the two groups. There were qualitative between-group differences such that the OC group consumed a greater percentage of energy as fat (P = 0.02) and a lesser percentage of energy as carbohydrate (P = 0.008). No group differences were found in the percentage of energy consumed as protein, but both groups consumed significantly less protein during menses (P = 0.008). There were no significant differences in REE. Both groups of women reported marginally more activity (P = 0.09) during menses than during the luteal phase.

How interchangeable are different estimators of effect size?

The computation of effect sizes is a key feature of meta-analysis. In treatment outcome meta-analyses, the standardized mean difference statistic on posttest scores (d) is usually the effect size statistic used. However, when primary studies do not report the statistics needed to compute d, many methods for estimating d from other data have been developed. Little is known about the accuracy of these estimates, yet meta-analysts frequently use them on the assumption that they are estimating the same population parameter as d. This study investigates that assumption empirically. On a sample of 140 psychosocial treatment or prevention studies from a variety of areas, the present study shows that these estimates yield results that are often not equivalent to d in either mean or variance. The frequent mixing of d and other estimates of d in past meta-analyses, therefore, may have led to biased effect size estimates and inaccurate significance tests.

Are self-reports of smoking rate biased? Evidence from the Second National Health and Nutrition Examination Survey.

This study determined evidence for digit preference in self-reports of smoking in the Second National Health and Nutrition Examination Survey (NHANES II). Subjects were 4275 adult smokers. Self-reports of smoking showed a marked degree of digit preference, with the vast majority of smokers reporting in multiples of 10 cigarettes per day. When number per day was compared to an objective measure of smoking exposure (carboxyhemoglobin; n = 2070) the distribution was found to be significantly assymetrical. Analysis of the distribution of COHb and various levels of number per day indicates that the differences in distribution are not due to variability in COHb. Heavier smokers, Caucasians, and those with less education were more likely to report a digit preference than lighter smokers. African-Americans, and those with more education. Results suggest that self-reports of number of cigarettes per day may be biased towards round numbers (particularly 20 cigarettes per day). Implications for assessment of smoking behavior are discussed.

Who underreports dietary intake in a dietary recall? Evidence from the Second National Health and Nutrition Examination Survey.

The present study sought to identify the presence and degree of apparent underreporting of dietary intake in 11,663 participants in the Second National Health and Nutrition Examination Survey (NHANES II). Self-reported dietary intake was compared with estimated basal metabolic rate. Underreporting was based on cutoff limits that identified plausible levels of energy expenditure for adult individuals. Results indicated that up to 31% of adults in this sample may have underreported dietary intake. Those individuals at greatest risk of underreporting were less well educated and heavier. The Sex x Race interaction indicated that for both ethnic categories, women were more likely to underreport than men, but the difference between men and women was greater among Caucasian participants. It is concluded that such factors as reduced energy needs, deliberate falsification, and measurement error inherent in dietary assessment contribute to apparent underreporting, and this occurs in a large percentage of dietary data.

Physicians' diagnosis of obesity status in NHANES II.

The aim of this work was to assess the accuracy of physicians' subjective assessments of obesity status. The subjects were participants in The Second National Health and Nutrition Examination (NHANES II) Survey. The physicians' subjective judgments of obesity were compared to BMI, an objective measure of actual body mass. Subjects with a body mass index (BMI = weight in kg/(height in cm/100)2) less than or equal to 27.5 were classified as normal weight and those with a BMI greater than or equal to 30.4 were considered to be obese. Physicians were accurate in their diagnosis of the normal weight group with only 4.03% being misdiagnosed as obese. However, 12.6% of the obese group was misdiagnosed as normal weight. The odds of an incorrect normal weight diagnosis increased with age. Similarly, as the fat distribution ratio increased, i.e., a more central pattern, the odds of being actually obese but incorrectly diagnosed as normal weight increased. Men were more likely than women to be incorrectly diagnosed as normal weight. Non-Caucasian normal weight persons appear to have been diagnosed more stringently than Caucasians as they were more likely to be misdiagnosed as obese regardless of their gender. There appear to be several variables affecting the physicians' subjective assessment of obesity status in this data set.

Caffeinated coffee and tea intake and its relationship to cigarette smoking: an analysis of the Second National Health and Nutrition Examination Survey (NHANES II).

Recent studies have shown that smokers' intake of caffeine is higher than nonsmokers. This investigation evaluated the relationships between smoking status and self-reported caffeine intake from both coffee and tea. Subjects were adults who participated in the Second National Health and Nutrition Examination Survey (NHANES II). Results indicated that subjects who ingested caffeine from tea were more likely to be female, less educated, younger, non-Caucasian, and lighter drinkers. In contrast, those who ingested caffeine from coffee were more likely to be older, Caucasian, heavier drinkers, and have higher incomes. Smokers were not more likely to drink caffeinated tea. In contrast, smokers were much more likely to drink caffeinated coffee, and a dose-response relationship between caffeine from coffee and smoking intake was observed. These results clarify the relationship between smoking and caffeine intake. Implications for intervention efforts are discussed.

Infection complicating cholecystectomy.

It is important to attempt clinical selection of patients who will benefit from antibiotic prophylaxis during biliary tract operations. Of equal importance is exclusion of patients in whom the risk of adverse effects outweigh the potential benefits. Using clinical criteria defined by Chetlin and Elliott, we have tested a method of defining these patients in our clinical setting. From the size of the sample in this prospective randomized study we can report trends as follows: 1) The incidence of postoperative infection was two times higher in the high-risk group. 2) The incidence of positive bile culture was greater in the high-risk group. 3) Prophylactic antibiotic treatment decreased the incidence of infection in both groups. 4) Radiographic status of the gallbladder is not correlated with subsequent positive bile cultures or incidence of infection. 5) Common duct exploration is associated with a significant increase in incidence of postoperative wound infection. The conclusions of this study substantiate the efficacy of incorporating clinical criteria to determine patients at high risk of developing wound infections.

Time, dose and volume factors in interstitial Radium implants of carcinoma of the oral tongue.

In a retrospective computer dosimetry analysis of 58 patients with carcinoma of the oral tongue treated with interstitial radium implants alone or in combination with external irradiation, dose and volume appear to be the most important factors in both local control and the incidence of necrosis; in the dose rate range commonly used in clinical interstitial radiotherapy, dose rate has no significant effect. The optimal minimum tumor doses for local control vary with the size of the primary lesion: 6,000 rads for T1 lesions and 6,500 rads for T2 lesions treated with interstitial radium implants alone and 7,500 rads for lesions treated with interstitial radium implants in combination with external irradiation. For lesions treated with implants plus external irradiation, greater local control was achieved when most of the dose was delivered through the interstitial implants. For a given volume, the incidence of necrosis was directly proportional to the degree of overdosage; for a given dose, the incidence of necrosis was directly proportional to the volume receiving the dose.

External and interstitial radiation therapy of carcinoma of the oral tongue. A review of 32 years' experience.

In 204 patients with squamous cell carcinoma of the oral tongue treated with radiation therapy, the most significant prognostic factors appeared to be the presence of neck lymph node metastasis on presentation and the status of the disease three months after treatment. The most common site of failure was the primary lesion, either alone or with neck disease. External irradiation alone was seldom successful. Use of peroral cone irradiation or interstitial implants, either alone or in combination with external irradiation, achieved good local control in early lesions. When the primary tumor was uncontrolled by radiation therapy, salvage with surgery was rare. When failure occurred in the neck alone, radical neck dissection was successful in the majority of cases.