摘要：Objectives. We studied the association of adolescent smoking with overweight and abdominal obesity in adulthood. Methods. We used the FinnTwin16, a prospective, population-based questionnaire study of 5 consecutive and complete birth cohorts of Finnish twins born between 1975 and 1979 (N = 4296) and studied at four points between the ages of 16 and 27 years to analyze the effect of adolescent smoking on abdominal obesity and overweight in early adulthood. Results. Smoking at least 10 cigarettes daily when aged 16 to 18 years increased the risk of adult abdominal obesity (odds ratio [OR]=1.77; 95% confidence interval [CI] = 1.39, 2.26). After we adjusted for confounders, the OR was 1.44 (95% CI = 1.11, 1.88), and after further adjustment for current body mass index (BMI), the OR was 1.34 (95% CI = 0.95, 1.88). Adolescent smoking significantly increased the risk of becoming overweight among women even after adjustment for possible confounders, including baseline BMI (OR = 1.74; 95% CI = 1.06, 2.88). Conclusions. Smoking is a risk factor for abdominal obesity among both genders and for overweight in women. The prevention of smoking during adolescence may play an important role in promoting healthy weight and in decreasing the morbidity related to abdominal obesity. Smoking and obesity are major causes of preventable death in developed countries. 1 The life expectancy of obese smokers is reduced by as much as 13 years. 2 Obesity-related excess mortality may mainly be caused by abdominal obesity. 3 The association between smoking and obesity is complex: smoking has been associated with both low and high body mass index (BMI; weight in kilograms divided by height in meters squared) and also with adverse fat distribution. In most cross-sectional studies, adult smokers were leaner than were nonsmokers but had a larger waist circumference or smaller waist-to-hip ratio. 4 – 8 Also, among smokers, a greater number of cigarettes smoked per day was related to waist circumference and BMI. 5 In one large Australian study of women, smokers were found to be more likely to gain weight during the follow-up than were women who had never smoked. 9 Age, duration of smoking, and socioeconomic status have been shown to modify the effect of smoking on body weight. 4 , 8 , 10 , 11 Among adolescents, the results of studies of the association between smoking and BMI have been inconsistent. In some studies, the relation between smoking and lower body weight often observed in adults was found to be reduced or absent among youth. 12 , 13 Adolescence is a critical age for the development of obesity 14 and the establishment of health habits such as smoking, eating behaviors, and physical activity. Only a few studies dealing with the association between smoking and later abdominal obesity have spanned the age period from adolescence to adulthood. Those studies were all beset with methodologic problems, however, and no associations were found. 15 – 17 On the basis of previous studies of adults, it seems reasonable to assume that tobacco smoking is associated with changes in body weight and shape even though the possible biological mechanisms remain unclear. Because the time span from adolescence to adulthood is an important period in stabilizing health habits and in the development of obesity, we examined the effect of smoking during late adolescence on overweight and abdominal obesity in early adulthood. To examine the independent effects of smoking on subsequent measures of obesity, we controlled our analyses for several potential confounders.
