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Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 39-42

A comparison between the effect of shisha and cigarette smoking on serum lipid profile of males in Nasiriyah City

Department of Pathological Analysis Techniques, College of Health and Medical Technology, Middle Technical University, Baghdad, Iraq

Date of Web Publication19-Mar-2018

Correspondence Address:
Shatha Hamed Chwyeed
College of Health and Medical Technology, Middle Technical University, Baghdad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/MJBL.MJBL_11_18

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Objective: This study aimed to recognize the harm of shisha smoking compared to cigarettes smoking by measuring serum lipid profile in males in AL-Nasiriya city and association lipid profile change with increase of smoking per day. Materials and Methods: This study was conducted between June to December (2015) in Nasiriya city in Iraq ,all samples were randomly selected. Spectrophotometer was used for biochemical analysis for each group of lipid profile. The subjects were divided into three groups, cigarette smokers (n = 35), shisha smokers (n = 20) and non-smokers groups (n = 20). Age ranged between (30 – 60) years and mean of duration smoking was (13.4±1.3) years. Results: Results showed that the increased levels of total cholesterol (TC), triglyceride (TG), very low density lipoprotein (VLDL) and low density lipoprotein (LDL) were significant in all groups of smokers as compared to non-smokers. Conclusion: The study concludes that the danger of shisha impact on human health may be similar or even worse than cigarette smoking.

Keywords: Cholesterol, cigarette smoking, high-density lipoprotein, low-density lipoprotein, triglyceride

How to cite this article:
Chwyeed SH. A comparison between the effect of shisha and cigarette smoking on serum lipid profile of males in Nasiriyah City. Med J Babylon 2018;15:39-42

How to cite this URL:
Chwyeed SH. A comparison between the effect of shisha and cigarette smoking on serum lipid profile of males in Nasiriyah City. Med J Babylon [serial online] 2018 [cited 2023 May 28];15:39-42. Available from: https://www.medjbabylon.org/text.asp?2018/15/1/39/227809

  Introduction Top

Cigarette smoking is a serious health problem and most important avoidable cause of death in the world. Smoking causes atherosclerosis and deficiency of platelets and predominantly increases risk of cancer causing mutations which may appear until many years after man's first cigarette.

Its estimated that tobacco-related deaths will amount to 6.4 million in 2015, 8.3 million in 2030 and one billion deaths during the 21st century.[1]

Shisha usage has a history which dates back to about 400 years with different names such as hookah, narghile, water-pipe, and argils,[2] it comes in different flavors, such as chocolate, mint, cherry, apple, and coconut which are often linked with social activity where two or more people may share the same pipe. People use Shisha smoke (SH-S) throughout the world, and they are daily used by more than 100 million men and women in Africa, Asia had been smoked for at least 400 years.[3]

Shisha use is widely perceived to be a safer alternative to cigarettes because the smoke is filtered through water but growing evidence which indicates that actively smoking shisha may be as or more harmful than smoking cigarettes.[4],[5]

The danger of smoking promotes free radicals which interact with the biological molecules to cause elevation of oxidative stress through the exchange of lipid peroxidation chain reactions in the membranes thus smoking leads to alteration their metabolites from burning tobacco per day.[6] Free radicals (oxidizing chemicals highly reactive chemicals) which can damage heart muscles, blood vessels and also react with cholesterol leading to the build-up of fatty material on artery walls [7] also tobacco smoke contains dangerous metals including arsenic, cadmium, and lead, several of these metals were carcinogenic.[8],[9]

Lipids are essential for body health which useful in digestion, providing energy storage, acting as functional and structural compounds in biomembranes and forming insulation to allow nerve conduction or to prevent heat loss. Increased number of cigarettes smoked per day lead to cardiovascular disease and increased morbidity and mortality.[10]

The aim of this study was to identify the harmful effects of smoking shisha by measuring lipid levels on healthy smokers and effect of increasing the number of cigarettes per day on lipid levels.

  Materials and Methods Top

The study involved 75 males, their age range being from groups of 30–60 years. The study was divided into three groups: SH-S (20), cigarette smoker (CS) (20), and nonsmokers (NS) (35) groups. A volume of 5 ml of venous blood samples were performed in dry tubes. After centrifugation, the sera were frozen at −8°C until analysis. Total cholesterol (TC), triglycerides (TGs), and high-density lipoprotein (HDL) were measured in all subjects after 12 h fasting. Biochemical parameters including serum for TC, TG, and HDL were determined by enzymatic methods using Randox kit.

All male subjects were selected randomly, evaluated and selected by detailed medical history, physical examination, systemic examination, and routine investigations to rule out any underlying diseases and excluded any diseases which influence the lipid levels. All the statistical analysis was done using Pentium 4 computer through the SPSS program (version-20) statistic software package (IBM Corp, 2011).

  Results Top

[Table 1] shows the biochemical analysis for serum lipid profile TC, TG, HDL, very low-density lipoprotein (VLDL), and low-density lipoprotein (LDL) into three groups: NS, SH-S, and CS.
Table 1: Biochemical analysis for serum lipid profile

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[Table 1] shows highly significant mean differences among three groups (P< 0.00) NS, SH-S, and CS on serum HDL, LDL, TG, TC, and VLDL. In applying the LSD post hoc test, we recorded the CS group compared to the SH-S group and NS.

As shown in [Table 2], this study showed highly significant differences in TC between CS and SH-S impact to NS and nonsignificant difference between SH-S and CS.
Table 2: Multiple comparisons (1: cigarette smoker), (2: shisha smoker), (3: nonsmoker) on serum total cholesterol; least significant difference

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[Table 3] shows nonsignificant difference (P = 0.09) between CS and SH-S groups on serum TG while highly significant between CS, SH-S compared to NS groups (P< 0.00).
Table 3: Multiple comparisons (1: cigarette smoker), (2: shisha smoker), (3: nonsmoker) on serum triglyceride; triglyceride; least significant difference

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No significant difference in VLDL reports between CS and SH-S groups (P = 0.086) on [Table 4] but highly significant in VLDL on CS, SH-S groups compared to NS groups (P< 0.00).
Table 4: Multiple Comparisons (1: cigarette smoker), (2: shisha smoker), (3: nonsmoker) on very low-density lipoprotein

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There was no significant difference in applying the LSD post hoc test in LDL in [Table 5] between CS and SH-S groups and highly significant in CS, SH-S groups compared NS groups (P< 0.00).
Table 5: Multiple comparisons (1: cigarette smoker), (2: shisha smoker), (3: nonsmoker) on serum low-density lipoprotein

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The study [Table 6] confirms that the increasing number of cigarettes smoked per day lead to increase level of serum TC, LDL, HDL, TG, and VLDL.
Table 6: Influence of daily cigarette smoking on lipid profile in healthy male subject

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  Discussion Top

The study showed differences in levels of serum lipid profile between smoking and nonsmoking groups. The current study included 75 smokers who was divided into CS, SH-S, and NS as control groups. The results showed biochemical analysis of serum TC, TG, LDL HDL, and VLDL. We found increased serum levels of TC, TG. LDL, VLDL in smoking group (shisha and cigarette) compared to nonsmoking group. The results suggested that cigarette and SH-S produce the same effect on lipid profile (in spite of SH-S was higher on serum level lipid profile than CS) compared to NS and this is in agree with the study by Al-Fayez and et al.[11] Serum HDL levels were significantly lower in smokers (shisha and cigarette) group as compared to NS groups although the mean levels of TC, TG, VLDL, LDL, and HDL of both groups were within normal limits.

The results were in line with the work Kronenberger et al.[12] The result demonstrates that smokers are predisposed to developing coronary heart disease earlier than their nonsmoking.[13] This is due to the stimulation of the adrenal-sympathetic system by nicotine level which releases catecholamine which induces lipolysis in adipose tissue, thus increasing levels of serum free fatty acid, promoting cholesterol synthesis, and secretion in the liver.[14] This mechanism may be due to impairment of lipoprotein metabolism reduces the ability of blood vessel walls.[15]

Other contributing factor on normal lipid profile values in this study is the mean duration of smoking among the subjects. Majority of these smokers were heavy smokers (>20 cigarettes/day) shown by dyslipidemia condition in smoking group, which induces atherosclerosis.[16] Cigarette smoking generates substantial quantities of oxidative stress, explained by that smoke inhaled by the smoking modes (shisha and cigarette) leads to increasing effects of nicotine and similar risks of alteration and inflammation by these two types of smoking methods. Smoking significantly increases biomarkers of oxidative damage to proteins, DNA, and lipids.[17]

  Conclusions Top

The harmful effect of SH-S on healthy lifestyle may be similar or even worse than cigarette smoking. It is recommended that men who have a habit of shisha smoking as an alternative to cigarette smoking tobacco should be informed about the potential adverse effects of their habit on cardiorespiratory health.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Report on the Global Tobacco Epidemic. World Health Organization; 2009. p. 136.  Back to cited text no. 1
Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: Direct comparison of toxicant exposure. Am J Prev Med 2009;37:518-23.  Back to cited text no. 2
Wolfram RM, Chehne F, Oguogho A, Sinzinger H. Narghile (water pipe) smoking influences platelet function and (iso-) eicosanoids. Life Sci 2003;74:47-53.  Back to cited text no. 3
Chaouachi K. Hookah (Shisha, Narghile) smoking and environmental tobacco smoke (ETS). A critical review of the relevant literature and the public health consequences. Int J Environ Res Public Health 2009;6:798-843.  Back to cited text no. 4
Fiala SC, Morris DS, Pawlak RL. Measuring indoor air quality of hookah lounges. Am J Public Health 2012;102:2043-5.  Back to cited text no. 5
Chaouachi K, Sajid KM. A critique of recent hypotheses on oral (and lung) cancer induced by water pipe (Hookah, Shisha, Narghile) tobacco smoking. Med Hypotheses 2010;74:843-6.  Back to cited text no. 6
Fortmann AL, Romero RA, Sklar M, Pham V, Zakarian J, Quintana PJ, et al. Residual tobacco smoke in used cars: Futile efforts and persistent pollutants. Nicotine Tob Res 2010;12:1029-36.  Back to cited text no. 7
Salameh P, Bacha ZA, Waked M. Saliva cotinine and exhaled carbon monoxide in real life waterpipe smokers: A Post hoc analysis. Tobacco Use Insights 2009;2:1-10.  Back to cited text no. 8
Barnett TE, Curbow BA, Soule EK Jr., Tomar SL, Thombs DL. Carbon monoxide levels among patrons of hookah cafes. Am J Prev Med 2011;40:324-8.  Back to cited text no. 9
Adedeji OA, Etukudo MH. Lipid profile of cigarette smokers in Calabar municipality Pakistan. Pak J Nutrition 2006;5:237-8.  Back to cited text no. 10
Al-Fayez SF, Salleh M, Ardawi M. Zahran FM. Effects of sheesha and cigarette smoking on pulmonary functions of Saudi males and females. Trop Geogr Med 1988;40:115-123.  Back to cited text no. 11
Kronenberger H, Seiffert UB, Grob W. Effects of cigarette smoking on plasma lipids, apolipoproteins and lipoprotein (a) in healthy subjects. Clin Chem 1994;40:1350.  Back to cited text no. 12
Bazzano LJ, Muntner S. Relationship between Cigarette smoking and novel risk factors for cardiovascular disease in the United States. Annl Int Med 2003;138:891-7.  Back to cited text no. 13
Hadidi KA, Mohammed FI. Nicotine content in tobacco used in hubble-bubble smoking. Saudi Med J 2004;25:912-7.  Back to cited text no. 14
Meenakshisundaram R, Rejendiran C, Thirumalaikolundusubramanian P. Lipid and lipoprotein profiles among middle aged male smokers: Study from Southern India. Tob Induc Dis 2010;8:1-5.  Back to cited text no. 15
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33:1635-701.  Back to cited text no. 16
Bonnie RJ, Stratton K, Kwan LY, editors. Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products. US: National Academies Press; 2015.  Back to cited text no. 17


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

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