Boston Globe Correspondent

November 30, 2009

Smokers know they should quit for their health often balk because they don’t want to gain weight - and a new health problem - once cigarettes’ appetite-suppressing nicotine leaves their bodies. Quitting smoking while starting a weight-control program may seem like a recipe for failure, and guidelines for doctors discourage embarking on both simultaneously. But a new analysis suggests that not only do combined programs work, in the short term they work better than smoking-cessation programs alone.

Bonnie Spring and her colleagues at Northwestern University Feinberg School of Medicine pooled the results of 10 randomized clinical trials in which some 2,233 smokers - all but 154 of them women - were divided into two groups. Some were assigned to programs that combined smoking cessation with weight control and others were enrolled in smoking cessation programs alone. After three months, people in the combined programs were 29 percent more likely to have stopped smoking than people in the smoking-cessation alone group. But after six to 14 months, when the programs had ended, the difference between the groups was no longer statistically significant.

People in the combined program, which emphasized more exercise and eating fewer calories, also gained less weight in the short term. After three months, they gained 2.1 pounds less than people in the smoking-only treatment group. After six months, however, the difference was not statistically significant.

BOTTOM LINE: People who quit smoking while enrolled in a weight control program put on fewer pounds and had more success staying off cigarettes after three months.

CAUTIONS: Because so few men participated in the trials, the results may not apply to them.

WHAT’S NEXT: The researchers want to see if they can replicate the success of the combined programs, which varied from study to study.

WHERE TO FIND IT: Addiction, September

Surgery in older people not linked to cognitive decline

There have long been worries about the effects of anesthesia on older surgery patients’ memory and cognitive abilities. Research dating to the 1950s in patients recovering from heart surgery has pointed to postoperative deterioration in mental skills. A new study calls into question the role of surgery in cognitive decline.

Dr. Michael Avidan of Washington University in St. Louis led a team that looked retrospectively at 575 people who volunteered for studies at the university’s Alzheimer’s Disease Research Center, which meant that after age 50 their cognitive function was tested annually. When Avidan’s study began, 361 people had mild to moderate dementia, and 214 were dementia-free. They were divided into three groups: people who had non-cardiac surgery, major illness, or neither. Heart surgery was excluded because it carries a heightened risk of stroke.

About one-quarter of the participants who did not have dementia at the outset eventually developed symptoms, but this was no more common in people who had had surgery than in the other two groups.

BOTTOM LINE: Surgery in older people was not linked to cognitive decline.

CAUTIONS: People who volunteered to participate in Alzheimer’s research may not reflect the general population.

WHAT’S NEXT: The authors plan a larger study to look at whether specific anesthetics and procedures pose a higher risk of cognitive problems in older people.

WHERE TO FIND IT: Anesthesiology, November