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. 2017 Mar 21;5(1):e000324.
doi: 10.1136/bmjdrc-2016-000324. eCollection 2017.

Association between secondhand smoke and obesity and glucose abnormalities: data from the National Health and Nutrition Examination Survey (NHANES 1999-2010)

Dulcie Kermah  1 , Magda Shaheen  1 , Deyu Pan  1 , Theodore C Friedman  2
Affiliations

Association between secondhand smoke and obesity and glucose abnormalities: data from the National Health and Nutrition Examination Survey (NHANES 1999-2010)

Dulcie Kermah et al. BMJ Open Diabetes Res Care. .

Abstract

Objective: The objective of this study is to investigate the relationship between cotinine level-confirmed secondhand smoke (SHS) exposure and glycemic parameters and obesity.

Research design and methods: We examined a cohort of 6472 adults from the National Health and Nutrition Examination Surveys, 1999-2010. Serum cotinine levels and self-reported data on smoking were used to determine smoking status. The outcome variables were body mass index (BMI) and glycemic status (HbA1c), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and fasting plasma glucose (FPG). Descriptive, bivariate, and multivariate analyses were conducted.

Results: Using cotinine level-confirmed smoking status, 1794 (27.4%) of the sample were current smokers, 1681 (25.0%) were former smokers, 1158 (17.8%) were secondhand smokers, and 1839 (29.8%) were non-smokers. In a generalized linear model after controlling for potential confounding variables, secondhand smokers had higher adjusted levels of HOMA-IR, FPG, and BMI compared with non-smokers (p<0.05). Adjustment for BMI demonstrated that some, but not all, of the detrimental effects of SHS on glycemic parameters are mediated by the increased body weight of secondhand smokers.

Conclusions: We conclude that SHS is associated with obesity and worsening glycemic parameters. More studies are needed to show a causal relationship between SHS and glycemic parameters and to understand the mechanisms involved in the association.

Keywords: Epidemiology; Nicotine; Obesity; Smoking.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Flow chart depicting six successive waves of NHANES cycle (1999–2010). NHANES, National Health and Nutrition Examination Survey.
Figure 2
Figure 2
Adjusted OR and SE for BMI≥30 kg/m2, BMI 25–29.9 kg/m2, HbA1c≥6.5%, HOMA-IR≥2.2, and FPG≥126 mg/dL in CS, FS, and SHS using the survey/cotinine definition compared with the reference group of NS after adjusting for age, sex, races, alcohol, physical activity, education, FPL, year of survey cycle using multiple logistic regression. *p<0.05. BMI, body mass index; CS, current smokers; FPG, fasting plasma glucose; FS, former smokers; HbA1c, hemoglobin A1c; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance; SHS, secondhand smokers.
Figure 3
Figure 3
Adjusted OR and SE for BMI≥30 kg/m2, BMI 25–29.9 kg/m2, HbA1c≥6.5%, HOMA-IR≥2.2, and FPG≥126 mg/dL in those with high cotinine levels (CS) and medium cotinine levels (SHS) compared with the reference group of low cotinine levels (NS) after adjusting for age, sex, races, alcohol, physical activity, education, FPL, year of survey cycle using multiple logistic regression. *p<0.05. BMI, body mass index; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; HOMA-IR, Homeostasis Model Assessment of Insulin Resistance.
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