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Byline: E. Vidhubala, C. Pisinger, B. Basumallik, D. Prabhakar Background: India is the world's third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) [...]

ims/hypothesis: A genome-wide association study in the Japanese population reported two genome-wide significant loci associated with type 2 diabetes of which the VPS13C/ C2CD4A/ C2CD4B locus was replicated in Europeans. We looked for potential associations between the diabetogenic VPS13C/ C2CD4A/ C2CD4B rs7172432 variant and diabetes-related intermediary traits. Methods: We genotyped the rs7172432 variant in the population-based Inter99 cohort ( n = 6,784) and analysed quantitative diabetes-related traits in 5,722 non-diabetic participants who all were examined by an OGTT. Results: The diabetes-associated A allele was associated with 0.60 cm higher waist circumference ( p = 0.004), 0.037 mmol/l higher fasting plasma glucose ( p = 4 × 10) and 0.11 mmol/l higher plasma glucose at 30 min during an OGTT ( p = 4 × 10). In analyses adjusted for concomitant insulin sensitivity levels the diabetogenic allele was associated with a lower acute glucose-stimulated insulin response (GSIR) as estimated by 30 min serum insulin ( β = −0.039, p = 2 × 10), insulinogenic index ( β = −0.057, p = 1 × 10) and BIGTT-acute insulin release ( β = −0.041, p = 9 × 10). As rs7172432 is situated in a region previously associated with glycaemic traits, we tested linkage disequilibrium (LD) with the reported regional lead single-nucleotide polymorphisms for fasting (rs11071657) and 2 h plasma glucose (rs17271305), and performed conditional analyses of rs7172432. Rs7172432 showed moderate LD with rs11071657 and rs17271305 ( R < 0.34) and we found strong association by almost unchanged effect sizes of rs7172432 with plasma glucose and estimates of GSIR in analyses conditional on rs11071657 and rs17271305. Conclusions/interpretation: The diabetogenic VPS13C/ C2CD4A/ C2CD4B rs7172432 A allele associates with GSIR in non-diabetic individuals from the general population, suggesting an impaired beta cell function as an intermediary diabetes-related trait. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the effect of screening and five years of multi-factorial lifestyle intervention on changes in alcohol intake in a general population. METHODS: The study was a pre-randomized intervention study on lifestyle, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n=6 091) had at baseline a medical health examination and a face-to-face lifestyle counselling. Individuals at high risk of ischemic heart disease were repeatedly offered both individual and group-based counselling. The control group (n=3 324) was followed by questionnaires. Alcohol intake was measured by questionnaires. Changes were analysed by multilevel analyses. RESULTS: Binge drinking decreased both in men and women at three and five-year follow-ups (men: five-year: net-change:-0.13; p=0.03; women: five-year: net-change:-0.08; p=0.04). Furthermore, in women the ratio between wine and total alcohol was increased compared with the control group at five-year follow-up (net-change: 0.04; p<0.01). In men with a high intake of alcohol (>21 drinks per week) the effect on total alcohol intake was maintained at five-year follow-up (net-change: -3.7; p=0.01). No significant effects were found in women on total alcohol intake. CONCLUSION: Multi-factorial lifestyle intervention, including low intensity alcohol intervention, improved long-term alcohol habits in a general population.Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

BACKGROUND: Drop-out rates are high in many lifestyle programmes. To promote adherence, the aim of this study was to identify mediators of participation in a diet and exercise (DE) intervention in a general population. METHODS: Data were baseline data from a randomized non-pharmacological clinical trial in Copenhagen during 1999-2001. The participation rate was 53.3%. Participants at high risk of ischaemic heart disease (IHD) and who were offered participation in a DE counselling group intervention were included (N = 2022). Clinical characteristics, and demographic, psychosocial and lifestyle factors were measured. RESULTS: Mediators of acceptance of participation were awareness of an unhealthy lifestyle or a bad health, low self-rated care of own health, perceived susceptibility of cardiovascular disease (CVD; overall and associated with lifestyle), high degree of motivation towards dietary changes and low self-efficacy about increasing physical activity. Overweight and impaired glucose tolerance (IGT)/screen-detected diabetes predicted acceptance whereas an absolute risk score for IHD was inverse associated with acceptance. Mediators of high adherence were low self-efficacy about changing dietary habits and perceived susceptibility of CVD and furthermore screen-detected diabetes and overweight predicted high adherence. CONCLUSION: Awareness of unhealthy lifestyle, perceived susceptibility of disease and motivation towards lifestyle changes were important mediators of participation. Screen-detected diabetes/IGT predicted participation and adherence whereas overweight individuals were more likely to accept but also to drop out of the course. The use of an absolute risk score in health promotion should be further evaluated. [ABSTRACT FROM AUTHOR]

OBJECTIVE.: Central obesity is an independent risk factor of mortality. Change in waist circumference after smoking cessation has not been previously reported in a population-based prospective study of both sexes. METHODS.: Population-based study, Inter99, 1999-2001 in Copenhagen, Denmark. 2408 daily smokers completed questionnaires and had their waist circumference and weight measured. Of these, 221 biochemically verified non-smokers and 1122 continuous smokers attended 1-year follow-up and had their waist circumference and weight measured. RESULTS.: The mean increase in waist circumference was 3.88 cm (+/-5.4 cm) and 42% of the quitters had increased their waist circumference by >/=5 cm. Quitters with high baseline tobacco consumption (OR 1.05, 95% CI=1.0-1.1) and quitters with self-reported reduced physical activity (OR 3.4, 95% CI=1.5-7.7) were more likely to have substantially increased waist circumference. The mean weight gain in quitters was 4.22 kg (+/-4.3 kg) and 41% had gained at least 5 kg. Female quitters gained more weight and had a higher increase in waist circumference than men. Abstinence from smoking was the most important predictor of substantial weight gain and substantial increase in waist circumference. CONCLUSIONS.: Smoking cessation resulted in substantial increase in weight and central fat, which might attenuate some of the beneficial effects of smoking cessation. Quitters who reduced their physical activity and persons with high baseline tobacco consumption were more likely to have had a substantial increase in abdominal fat. Abstinence from smoking was the most important predictor of short-term weight gain and increase in waist circumference. It is a challenge for future smoking cessation interventions to achieve a combination of high quit rates and weight-control. Copyright © 2007 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

OBJECTIVE.: No previous studies have explored weight concerns in relation to smoking habits, or investigated how weight concerns affect smoking cessation in a general population. METHOD.: Inter99 is a population-based lifestyle interventional study, conducted in 1999-2001 in Copenhagen, Denmark, comprising 30-60 year old men and women. All daily smokers (N=2408) were offered help to quit. The baseline investigation (N=6784) was used for analysing associations of smoking status with weight concerns (cross-sectional design). To analyse how weight concerns affected smoking cessation we included the 1387 daily smokers attending 1-year follow-up; 221 of these were verified quitters (longitudinal design). RESULTS.: Daily smoking men and women had a significantly lower body mass index than never smokers (men: 3%, women 5%) but reported to be significantly less concerned of their weight (men: OR=0.64, 95%CI=0.4-0.9), women: 0.78(0.6-1.0)). Ex-smoking normal weight women were significantly more likely to be frequently concerned of their weight than never smoking normal weight women (OR=2.06, 95CI%=1.6-2.7). Fifty-two percent of the women and 32% of the men with a previous quit attempt reported that weight gain was a reason for relapse. Neither weight concerns nor eating patterns were predictive of point abstinence at 1-year follow-up. CONCLUSION.: Smokers are believed to be very concerned of their weight but in this population-based study, daily smokers more frequently ate what they wanted, had a lower BMI and were significantly less concerned of their weight than never smokers. Weight concerns and eating patterns did not predict abstinence at 1-year follow-up. It seems that weight gain and weight concerns are independent factors. Copyright © 2007 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Aims: Potential exists for improving the impact of quit-smoking programmes, by recruiting smokers in early motivational stages, by using active recruitment strategies, and by offering professional assistance to quit. Methods: This was a randomized population-based intervention study, in Copenhagen, Denmark. A total of 2,408 daily smokers in all motivational stages were included. All participants completed a questionnaire, and underwent a health examination and a lifestyle consultation. Smokers in the high-intensity intervention were offered assistance to quit smoking in smoking cessation groups. Results: Before the lifestyle consultation only 11% of the smokers stated that they planned to quit within one month. After the lifestyle consultation 27% accepted smoking cessation in groups and an additional 12% planned to quit without assistance. Of the smokers who accepted smoking cessation groups 23% had not been planning to quit before the lifestyle consultation. Being a woman, having high tobacco consumption, having a long smoking history, having tried to quit within the previous year, and having a higher motivation to quit predicted participation in smoking cessation groups. Conclusions: It was possible to recruit a large number of smokers in early motivational stages by using active recruitment strategies and by offering assistance to quit. Lifestyle consultations markedly increased the number of smokers willing to try to quit. Smokers preferred assistance to quit in a smoking cessation group to quitting on their own; therefore, it is important to improve recruitment strategies for smoking cessation programmes. [ABSTRACT FROM AUTHOR]

Cigarette smoking is a very important causative factor in cardiovascular disease (CVD). Smoking increases the risk of acute myocardial infarction, unstable angina and sudden death, and it is a risk factor for recurrent episodes of these diseases. It is well documented that patients with CVD who stop smoking, decrease their risk of future events markedly. Smoking cessation is obviously very important in this category of patients, and it has been demonstrated in several trials that the use of nicotine replacement therapy (NRT) markedly improves the long term smoking cessation rates in healthy individuals, with further improvement in the rate if additional supportive adjunctive behavioural therapy is offered. The use of NRT products for CVD patients has been, however, sparsely investigated: only 2 randomised placebo-controlled trials of NRT in these patients have been published. This fact, and the fact that nicotine has sympathomimetic effects, which lead to increased heart rate, increased blood pressure and coronary vasoconstriction, probably causes doctors to hesitate before using NRT products in this setting. In this paper we review relevant literature on this subject and explore the efficacy and tolerability of NRT in CVD patients, which in this context is limited to patients with ischaemic heart diseases and arrhythmias. Patients with hypertension, stroke or peripheral vascular diseases are not discussed, due to lack of investigations in these fields. We present recommendations for doses and duration of NRT in patients with CVD that, due to the few studies in this field, are mainly based on parallels from findings in healthy individuals. The conclusion of the 2 existing randomised placebo-controlled studies was that nicotine patches are well tolerated by patients with stable angina, and that the use of nicotine patches increases short term smoking cessation rates. [ABSTRACT FROM AUTHOR]