Association Between Smoking Hookahs (Shishas) and Higher Risk of Obesity: A Systematic Review of Population-Based Studies.

Reem Baalbaki,Nermine Abbas,Lara El Kebbi,Razan Farsakouri,Hana Tannir,Rawan Dehni,Marwan El Ghoch,Dana Awad,Dana El Masri,Leila Itani,Dima Kreidieh

doi:10.3390/jcdd6020023

Reem Baalbaki, Nermine Abbas + Show 9 more

Open Access

https://doi.org/10.3390/jcdd6020023

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Abstract

The American Heart Association has published a scientific statement on the effect of hookah smoking on health outcomes; nevertheless, hookah smoking continues to be popular worldwide, especially among the young. Recent reports mention a potential link between hookah smoking and obesity; however, uncertainties still surround this issue. The aim of the current study was to conduct a systematic review to clarify whether hookah smoking is associated with a higher risk of obesity among the general population. This study was conducted in compliance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and data were collated by means of a meta-analysis and a narrative synthesis. Of the 818 articles retrieved, five large-population and low-bias studies comprising a total of 16,779 participants met the inclusion criteria and were reviewed. All included studies reported that, regardless of gender, hookah smoking increases the risk of obesity among all ages and observed an association between the two after a correction for several confounders or reported a higher prevalence of obesity among hookah smokers. This was confirmed by the meta-analysis. Therefore, hookah smoking seems to be associated with a higher risk of obesity. Public health policymakers should be aware of this for the better management of obesity and weight-related comorbidities.

Highlights

The hookah, known as a water pipe, narghile, arghile, or shisha, was invented in the 16th century as an attempt to purify smoke through water [1]
This caused the American Heart Association to issue a scientific statement on hookah smoking and the increased risk of cardiovascular disease [15]
Of the remaining 84 articles dealing with smoking and health status, a further 79 papers were excluded on the following grounds: They were on smoking but not on hookahs, they considered health outcomes other than obesity and related comorbidities, or other factors

Summary

Introduction

The hookah, known as a water pipe, narghile, arghile, or shisha, was invented in the 16th century as an attempt to purify smoke through water [1]. Strong evidence supports the association between hookah smoking and several chronic diseases as well as a high risk of cancer [6,7,8,9,10,11,12,13,14] to the extent where it is considered a serious public health problem. To the best of our knowledge, no systematic review considering this issue as a primary outcome has yet been conducted in order to provide a valid interpretation of the evidence published to date based on a systematic review and a meta-analysis In light of these considerations, we hypothesised an association between hookah smoking and a higher risk of obesity and aimed to systematically review the published literature on this topic in accordance with the PICO process [23], as detailed below: P—Population: adolescents and adults of both genders [24]; I—Intervention: active hookah smoking; C—Comparison: hookah-smoking group vs nonsmoking group (when available) or hookah-smoking group vs cigarette-smoking group (when available); and O—Outcome: obesity, defined, based on international guidelines, (e.g., BMI, BMI percentiles, waist circumference, body fat percentage, etc.)

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