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Recommendations Summary

EE: Smoking and Nicotine in Healthy and Non-Critically Ill 2014

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    EE: Smoking and Nicotine in Healthy Adults

    If a healthy adult uses nicotine products, the registered dietitian nutritionist (RDN) should ask the individual to abstain from such products for longer than 140 minutes prior to a resting metabolic rate (RMR) measurement. Limited research in healthy adult cigarette smokers indicates that there is a significant acute increase in RMR for at least 140 minutes after smoking. No studies evaluated the use of other nicotine-containing products.

    Rating: Weak

    • Risks/Harms of Implementing This Recommendation

      Abstaining from nicotine products for more than 140 minutes may be difficult for some individuals.

    • Conditions of Application

      • The recommendation applies to adults who smoke or use other nicotine products
      • Clinical judgment should be used in applying this recommendation to healthy children and non-critically ill children and adults because there is no evidence in these populations.

    • Potential Costs Associated with Application

      If an individual uses nicotine products within 140 minutes prior to the RMR measurement, additional costs may be incurred because the measurement will need to be rescheduled.


    • Recommendation Narrative

      EE: Smoking and Nicotine in Healthy Adults

      • Limited evidence in healthy adults indicates that there is a significant acute increase in resting metabolic rate (RMR) after smoking cigarettes. While evidence suggests that RMR is elevated for at least 140 minutes after smoking, the length of time required for RMR to return to baseline is unknown.
      • Additional research is needed regarding nicotine-containing products
      • Evidence is based on one neutral-quality non-randomized crossover trial (Collins et al, 1996).


    • Recommendation Strength Rationale

      Conclusion statement supporting this recommendation is Grade III.

    • Minority Opinions