• Users Online: 581
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 3  |  Page : 267-271

Cigarette smoking and serum level of Vitamin D among older adults


1 Department of Community Health Nursing, College Nursing, University of Babylon, Hilla, Iraq
2 Department of Family and Community Medicine, Hammurabi College of Medicine, University of Babylon, Hilla, Iraq

Date of Submission20-Apr-2020
Date of Acceptance30-May-2020
Date of Web Publication16-Sep-2020

Correspondence Address:
Ismael Hasan Jawad
Department of Community Health Nursing, College of Nursing, University of Babylon, Hilla
Iraq
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_28_20

Get Permissions

  Abstract 


Background: Vitamin D has different biological actions in the body. Vitamin D has pleiotropic effects in multiple organ systems. Vitamin D deficiency has been found to have an inverse relationship with tobacco smoking. Objective: The objective of this study was to identify the prevalence of Vitamin D level and its correlates with tobacco smoking among old adults in Al-Hilla city, Babylon Province. Methods: A cross-sectional study was conducted on a sample of old adults, both males and females, who were selected from dwellers in community of Al-Hilla city, Babylon Province, Iraq, during the period from January to August 2019. A pretested questionnaire was used for data collection adopted from previous standard national surveys and studies, and the questionnaire included information about sociodemographic characteristics and cigarette smoking habit. Results: The study included 300 participants, and most of them had either insufficiency or deficiency of Vitamin D level (84%). Tobacco cigarette smoking elders had a significantly low serum Vitamin D level (both deficiency and insufficiency) as compared to the nonsmoker group (P < 0.05). Conclusion: There was a significant inverse relationship between Vitamin D level and tobacco cigarette smoking.

Keywords: Iraq, old adults, tobacco smoking, Vitamin D levels


How to cite this article:
Jawad IH, Baiee HA. Cigarette smoking and serum level of Vitamin D among older adults. Med J Babylon 2020;17:267-71

How to cite this URL:
Jawad IH, Baiee HA. Cigarette smoking and serum level of Vitamin D among older adults. Med J Babylon [serial online] 2020 [cited 2020 Oct 1];17:267-71. Available from: http://www.medjbabylon.org/text.asp?2020/17/3/267/295134




  Introduction Top


Lifestyles that may influence serum Vitamin D concentrations have not been well examined. Specifically, the association of smoking with serum Vitamin D concentrations was unclear. Most of the recent studies reported lower serum Vitamin D in current smokers than in never smokers.[1],[2],[3],[4],[5] Although the prevalence of smoking has been decreasing in the developed countries in recent years, the less developed countries, including Iraq, are facing an impact from smoking prevalence rise.[6] The absolute number of people aged 65 years and older is expected to double in the next two decades in all world regions.[7] The proportion of U.S. adults who smoke cigarettes declined from 20.9% in 2005 (45.1 million smokers) to 15.5% in 2016 (37.8 million smokers). Sociodemographic disparities in cigarette smoking persist.[8] Vitamin D plays a physiological role and its concentrations is important for the functioning of the metabolic, immune, and respiratory systems of both genders and in all ages.[9],[10] Unhealthy habits may influence serum Vitamin D concentrations which have not been well studied. The association of smoking with serum Vitamin D concentrations was unclear, and many published articles clarified lower serum Vitamin D among tobacco smokers than nonsmokers.[11],[12],[13],[14] Studies in adults have reported that tobacco smoke exposure decreases the serum concentrations of both parathyroid hormone and Vitamin D.[5],[14],[15],[16],[17],[18]

This study was conducted to identify the relationship between cigarette tobacco smoking and serum Vitamin D level among Iraqi elderly people.


  Materials and Methods Top


A descriptive cross-sectional epidemiological study was conducted on old adults of both males and females (65 years and more) who were selected from dwellers in community of Al-Hilla city, Babylon Province, Iraq, during the period from January to August 2019.

The study protocol was revised and approved by the Scientific Committee of the University of Babylon/College of Nursing/Family and Community Health Nursing. The sample size was calculated according to the sample size calculation equation with 95% confidence level; 300 elderly people were participated voluntarily in this study, and all of them agreed to participate after explaining the objective of the study by the researcher (the response rate: 100%).

A pretested questionnaire was used for data collection which was adopted from previous standard national surveys and studies. The questionnaire included information about sociodemographic characteristics and cigarette smoking habit: nonsmokers (those who never smoked cigarette), smokers (those who smoke cigarettes at the time of interview or those who used to smoke within the last 6 months from the time of the study), and ex-smokers (those participants who quitted smoking for at least 6 months and above).[19] The serum level of Vitamin D was measured by chemoimmunoassay method (maglumi instrument).

Ethical consideration

The study was conducted according to the ethical principles that have their origin in the Declaration of Helsinki. Verbal informed consent was obtained from each participant enrolled in this study. The protocol of the study and the participant information and consent form were reviewed and approved by a local ethics committee.


  Results Top


[Table 1] shows the distribution of elders according to their age. Results found that the mean age of the study groups was 65–69-year group which is the dominant age group. The overall mean age and the standard deviation are 70.96 ± 5.34.
Table 1: Frequency distribution of the mean age of the study group

Click here to view


[Table 2] and [Figure 1] show the frequency distribution of the study participants according to the means of Vitamin D level by gender; the mean of Vitamin D level among females is lower than Vitamin D level among males.
Table 2: Means of Vitamin D level according to gender

Click here to view
Figure 1: Means of Vitamin D level by gender

Click here to view


[Figure 2] explains the distribution of the elders according to the age group, most of the participants in the age group of 65–69 years (66%).
Figure 2: Frequency distribution of the study group by age

Click here to view


[Table 3] and [Table 4] show the frequency distribution of the number of cigarettes smoked per day by the study participants and frequency distribution of the duration of smoking per year, respectively.
Table 3: Frequency distribution of the number of cigarettes smoked per day by the study participants

Click here to view
Table 4: Frequency distribution of the duration of smoking (years)

Click here to view


[Table 5] shows that the majority of smokers (92.3%) have deficiency or insufficiency; this table also explains a positive highly significant association between duration of smoker years and level of Vitamin D among old adults, and there is an inverse relationship between the two variables.
Table 5: Association between smokers in study according to duration of smoking among males and females and level of Vitamin D

Click here to view


[Table 6] shows that 17% of elderly males and females are current smokers.
Table 6: Frequency distribution of smoking status by age among males and females

Click here to view


[Table 7] indicates that 84% of old males and females have low serum Vitamin D level (less than 30 ng/ml), most of them with deficient level; this table also explains a positive highly significant association between low Vitamin D and having high cigarette uses among old adults, and there is an inverse relationship between the two variables (increased cigarette smoking and declined Vitamin D level).
Table 7: Association between Vitamin D level and smoking habit and among both genders

Click here to view


[Table 8] explains a strong association between serum Vitamin D level 12 (18.8) and smoking habits among elderly peoples.
Table 8: Association between Vitamin D level and smoking habit among 64 male and female smokers and ex-smokers

Click here to view



  Discussion Top


The findings of this study depict that the prevalence of low Vitamin D serum level is higher among elderly men compared to women. The proportion of participants with insufficient and deficient Vitamin D in this study is high, and this high prevalence is similar to that reported by other researchers.[13] Our study is in line with several recent studies showing current smoking to be associated with Vitamin D deficiency or lower serum Vitamin D concentrations [20],[21],[22],[23],[24],[25],[26],[27],[28] and provided complementary information on the dose–response pattern. Recently, Soldin et al. found an adverse effect of smoking on the synthesis of steroid hormones, including Vitamin D.[29]

The exact mechanisms by which smoking affects Vitamin D metabolisms are still unclear. One possibility is that current smokers had a lower Vitamin D dietary pattern than never smokers, which may, partly, if at all, explain the negative association of smoking and Vitamin D in our study. The other possible explanation is that chemicals in tobacco smoke may have a direct effect on Vitamin D metabolism and function.[30]

Moreover, there is evidence that smoking may change the expression of some genes that play a role in the metabolic pathway of Vitamin D.[5],[14],[16],[17],[18],[20],[31] These findings in adults were, however, not replicated in a nationwide study of 2515 children and adolescents of 10–18 years old in South Korea which found no relationship between urinary cotinine-verified prevalence of smoking and Vitamin D deficiency.[20],[32]

Studies in adults have reported that tobacco smoke exposure decreases the serum concentrations of both parathyroid hormone and Vitamin D leading to poor absorption of calcium from the gastrointestinal tract and an acceleration of bone loss.[33] Overall low Vitamin D was seen in 79.33% of the population. Low Vitamin D levels were seen in 75.47% of males and 81.39% of females. Smoking is an independent risk factor which has detrimental effect on metabolism of calcium and Vitamin D. The depression Vitamin D PTH axis is seen in chronic smokers which eventually affects the bone metabolism and contributes to the increased risk of osteoporosis and fractures.[20] In this study, the mean Vitamin D level in smokers was 32.2 ng/ml which was lower than nonsmokers (41.8 ng/ml) [Figure 2]. In this study, hypovitaminosis was seen in 86.2% of elderly patients.


  Conclusion Top


This study explains that tobacco smoke exposure is an independent predictor of Vitamin D deficiency among elderly people in Hilla city.

Limitations

There are several limitations in the current study. First, this was a cross-sectional study. Whether smoking reduces Vitamin D or if there is an association between smoking and Vitamin D levels could not be confirmed due to residual confounding. Given the unquestionable harmful effects of tobacco smoke, no measurements of urinary cotinine levels were done. Unfortunately, however, we were unable to evaluate nutrition as part of this study. Additional studies are required, therefore, to assess the longitudinal duration of exposure smoking and dietary intake for evaluating the cause–effect relationship between tobacco smoke exposure and Vitamin D low level (deficiency and insufficiency) in elders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shinkov A, Borissova AM, Dakovska L, Vlahov J, Kassabova L, Svinarov D. Winter 25-hydroxyvitamin D levels in young urban adults are affected by smoking, body mass index and educational level. Eur J Clin Nutr 2015;69:355-60.  Back to cited text no. 1
    
2.
Kassi EN, Stavropoulos S, Kokkoris P, Galanos A, Moutsatsou P, Dimas C, et al. Smoking is a significant determinant of low serum vitamin D in young and middle-aged healthy males. Hormones (Athens) 2015;14:245-50.  Back to cited text no. 2
    
3.
Colao A, Muscogiuri G, Rubino M, Vuolo L, Pivonello C, Sabatino P, et al. Hypovitaminosis D in adolescents living in the land of sun is correlated with incorrect life style: A survey study in Campania region. Endocrine 2015;49:521-7.  Back to cited text no. 3
    
4.
Lange NE, Sparrow D, Vokonas P, Litonjua AA. Vitamin D deficiency, smoking, and lung function in the Normative Aging Study. Am J Respir Crit Care Med 2012;186:616-21.  Back to cited text no. 4
    
5.
Cutillas-Marco E, Fuertes-Prosper A, Grant WB, Morales-Suárez-Varela M. Vitamin D deficiency in South Europe: Effect of smoking and aging. Photodermatol Photoimmunol Photomed 2012;28:159-61.  Back to cited text no. 5
    
6.
Al-Murshedi RK, Baiee HA. Smoking and its correlates among secondary school students in Al-Hilla City 2018. Med J Babylon 2018;15:326-33.  Back to cited text no. 6
  [Full text]  
7.
United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects; 2015.  Back to cited text no. 7
    
8.
Tiwari P, Sharma N. Role of Vitamin D in various illnesses: A review. J Pharm Care Health Syst 2017;4:3.  Back to cited text no. 8
    
9.
Jamal A, Phillips E, Gentzke AS, Homa DM, Babb SD, King BA, et al. Current cigarette smoking among adults United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:53-9.  Back to cited text no. 9
    
10.
Hollis BW, Wagner CL. Clinical review: The role of the parent compound Vitamin D with respect to metabolism and function: Why clinical dose intervals can affect clinical outcomes. J Clin Endocrinol Metab 2013;98:4619-28.  Back to cited text no. 10
    
11.
Tiwari P, Sharma N. Role of Vitamin D in various illnesses: A review. J Pharm Care Health Syst 2017;4:3.  Back to cited text no. 11
    
12.
Assari S, Smith JL, Zimmerman MA, Bazargan M. Cigarette smoking among economically disadvantaged African-American older adults in South Los angeles: Gender differences. Int J Environ Res Public Health 2019;16:1208.  Back to cited text no. 12
    
13.
Jiang CQ, Chan YH, Xu L, Jin YL, Zhu T, Zhang WS, et al. Smoking and serum Vitamin D in older Chinese people: Cross-sectional analysis based on the Guangzhou Biobank Cohort Study. BMJ Open 2016;6:e010946.  Back to cited text no. 13
    
14.
Banihosseini SZ, Baheiraei A, Shirzad N, Heshmat R, Mohsenifar A. The effect of cigarette smoke exposure on Vitamin D level and biochemical parameters of mothers and neonates. J Diabetes Metab Disord 2013;12:19.  Back to cited text no. 14
    
15.
Sharma N, Sharma B, Singh G, Gupta A, Sharma R, Kapil U. Vitamin D status in cold trans-Himalayan deserts at altitude of 4000 meter and above in India. Indian J Community Health 2018;30:400-42.  Back to cited text no. 15
    
16.
Hermann AP, Brot C, Gram J, Kolthoff N, Mosekilde L. Premenopausal smoking and bone density in 2015 perimenopausal women. J Bone Miner Res 2000;15:780-7.  Back to cited text no. 16
    
17.
Díaz-Gómez NM, Mendoza C, González-González NL, Barroso F, Jiménez-Sosa A, Domenech E, et al. Maternal smoking and the Vitamin D-parathyroid hormone system during the perinatal period. J Pediatr 2007;151:618-23.  Back to cited text no. 17
    
18.
Manavi KR, Alston-Mills BP, Thompson MP, Allen JC. Effect of serum cotinine on vitamin D serum concentrations among american females with different ethnic backgrounds. Anticancer Res 2015;35:1211-8.  Back to cited text no. 18
    
19.
Yaseen SM, Ahmed SK. prospective study of upper gastro intestinal tract endoscopy findings and its relation to smoking in Baquba Teaching Hospital. Diyala J Med 2015;8:46-54.  Back to cited text no. 19
    
20.
Moon JH, Kong MH, Kim HJ. Effect of Secondhand Smoking, Determined by Urinary Cotinine Level on Bone Health. Int J Prev Med 2018;9:14.  Back to cited text no. 20
[PUBMED]  [Full text]  
21.
Methodology. The European School Survey Project on Alcohol and Other Drugs; 2015. Available from: http://espad.org/sites/espad.org/files/TD0116477ENN_002.pdf. [Last accessed on 2018 Jul 11].  Back to cited text no. 21
    
22.
Engine S, Rivera-collazo I, Piedras R, Rico P, States U. Youth Smoking Survey 2010/2011; 2010. Available from: https://uwaterloo.ca/canadian-student-tobacco-alcohol-drugs-survey/201011-yss-mod. [Last accessed on 2018 Jul 12].  Back to cited text no. 22
    
23.
GSHS. Global School-Based Student Health Survey (GSHS) Purpose and Methodology: 2013 Core Questionnaire Modules. World Health Organization Chronicle Diseases Health Promot; 2013.  Back to cited text no. 23
    
24.
Florida Department of Children and Families. 2016 Florida Youth Substance Abuse Survey; 2016. p. 154.  Back to cited text no. 24
    
25.
Anjum MS, Srikanth M, Reddy PP, Monica M, Rao KY, Sheetal A. Reasons for smoking among the teenagers of age 1417 years in Vikarabad town: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:80.  Back to cited text no. 25
  [Full text]  
26.
Brot C, Jorgensen NR, Sorensen OH. The influence of smoking on Vitamin D status and calcium metabolism. Eur J Clin Nutr 1999;53:920-6.  Back to cited text no. 26
    
27.
Supervía A, Nogués X, Enjuanes A, Vila J, Mellibovsky L, Serrano S, et al. Effect of smoking and smoking cessation on bone mass, bone remodeling, Vitamin D, PTH and sex hormones. J Musculoskelet Neuronal Interact 2006;6:234-41.  Back to cited text no. 27
    
28.
Shi L, Nechuta S, Gao YT, Zheng Y, Dorjgochoo T, Wu J, et al. Correlates of 25-hydroxyvitamin D among Chinese breast cancer patients. PLoS One 2014;9:e86467.  Back to cited text no. 28
    
29.
Kühn T, Kaaks R, Teucher B, Hirche F, Dierkes J, Weikert C, et al. Dietary, lifestyle, and genetic determinants of Vitamin D status: A cross-sectional analysis from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study. Eur J Nutr 2014;53:731-41.  Back to cited text no. 29
    
30.
Soldin OP, Makambi KH, Soldin SJ, O'Mara DM. Steroid hormone levels associated with passive and active smoking. Steroids 2011;76:653-9.  Back to cited text no. 30
    
31.
O'Shaughnessy PJ, Monteiro A, Bhattacharya S, Fowler PA. Maternal smoking and fetal sex significantly affect metabolic enzyme expression in the human fetal liver. J Clin Endocrinol Metab 2011;96:2851-60.  Back to cited text no. 31
    
32.
Byun EJ, Heo J, Cho SH, Lee JD, Kim HS. Suboptimal Vitamin D status in Korean adolescents: A nationwide study on its prevalence, risk factors including cotinine-verified smoking status and association with atopic dermatitis and asthma. BMJ Open 2017;7:e016409.  Back to cited text no. 32
    
33.
Pathak SK, Maheshwari P, Ughareja P, Shah S, Prashanth Raj M Gour SK. Is Vitamin D deficiency a modern epidemic in tropical countries? Int J Orthop Sci 2017;3:568-71.  Back to cited text no. 33
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed74    
    Printed2    
    Emailed0    
    PDF Downloaded14    
    Comments [Add]    

Recommend this journal