• Ala'a Alkerwi, Burcu Baydarlioglu, Nicolas Sauvageot, Saverio Stranges, Paul Lemmens, Nitin Shivappa, and James R Hébert.
• Luxembourg Institute of Health (L.I.H.) (formerly CRP-Santé), Epidemiology and Public Health Research Unit (EPHRU), Strassen, Luxembourg. Electronic address: alaa.alkerwi@lih.lu.
• Clin Nutr. 2017 Oct 1; 36 (5): 1275-1282.

Background & AimsRelationships between food consumption/nutrient intake and tobacco smoking have been described in the literature. However, little is known about the association between smoking and overall diet quality. This study examined the associations between eight diet quality indices, namely, the Diet Quality Index-International (DQI-I), Recommendation Compliance Index (RCI), Dietary Approach to Stop Hypertension (DASH) score, Energy Density Score (EDS), Dietary Diversity Score (DDS), Recommended Food Score (RFS), non-Recommended Food Score (non-RFS), and Dietary Inflammatory Index (DII), and smoking status with a focus on smoking intensity.MethodsAnalyses were based on a sample of 1352 participants in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) survey, a nationwide population-based cross-sectional study of adults aged 18-69 years. Nutritional data from food frequency questionnaire (FFQ) were used to compute selected diet quality indices. Participants were classified as never smoker, former smoker (≥12 months cessation period), occasional or light smokers (≤1 cig/d), moderate smokers (≤20 cig/d) and heavy smokers (>20 cig/d). Descriptive and linear regression analyses were performed, after adjustment for several potential covariates.ResultsCompared to the other groups, heavy smokers had significantly higher prevalence of dyslipidemia (83%), obesity (34%), and elevated glycemic biomarkers. About 50% of former smokers had hypertension. Diet quality of heavy smokers was significantly poorer than those who never smoked independent of several socioeconomic, lifestyle, and biologic confounding factors (all p < 0.001). Heavy smokers were less compliant with national or international dietary recommendations, expressed by RCI, DQI-I, and RFS. In addition, they consumed a more pro-inflammatory diet, as expressed by higher DII scores (P < 0.001) and self-reported less dietary diversity in their food choices, as expressed by DDS.ConclusionThis study provides new evidence concerning an inverse relationship between the intensity of tobacco consumption and overall diet quality. The implication is that efforts aimed at tobacco control should target heavy smokers and intervention on smoking cessation should take into account diet quality of smokers and their nutritional habits, to increase effectiveness and relevance of public health messages.Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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