Effects of smoking on nutrition status and response to dietary supplements during acute illness

Background: Although smokers have poor health and consequently poor dietary intake compared with nonsmokers, no study has examined the effects of smoking on nutrition status during acute illness. The purpose of this study is to measure the effect of smoking on nutrition status in hospitalized patients. Design: Four hundred and thirty-four patients in a randomized, double-blind, placebo-controlled trial of nutrition supplementation were nutritionally assessed based on anthropometric, hematological, and biochemical data at baseline and 6 weeks later. Nutrition status was compared between current smokers, ex-smokers, and those who never smoked. Mortality was evaluated during the hospital stay and at 6 and 12 months after hospitalization. The association between smoking and nutrition status and mortality was measured after adjustment for poor prognostic indicators. Results: Body weight, body mass index, mid-upper arm circumference, triceps skinfold thickness, serum albumin level, and plasma concentrations of vitamin C, red-cell folate, and vitamin B ₁₂ were all lower in current smokers compared with those who never smoked. Being a current smoker was associated with lower body weight, mid-upper arm circumference, and plasma vitamin C concentration compared with those patients who never smoked. Logistic regression analysis showed that smoking and increasing age were significantly and independently related to 1-year mortality. No significant difference in nutrition status between the supplement and the placebo group was found at the end of 6 weeks. Conclusion: Smoking was independently associated with poor nutrition status in hospitalized patients. This may partly explain the poor clinical outcome associated with smoking.