Abstract
Water-pipe (WP) smoking has significantly increased in the last decade worldwide. Compelling evidence suggests that the toxicants in WP smoke are similar to that of cigarette smoke. The WP smoking in a single session could have acute harmful health effects even worse than cigarette smoking. However, there is no evidence as such on long term WP smoking and its impact on chronic health conditions particularly cardiovascular and metabolic conditions. Therefore, we conducted this study to investigate the relationship between WP smoking and metabolic syndrome (MetS). This was a cross-sectional study carried out in Punjab province of Pakistan using the baseline data of a population-based study – Urban Rural Chronic Diseases Study (URCDS). Information was collected by trained nurses regarding the socio-demographic profile, lifestyle factors including WP smoking, current and past illnesses. A blood sample was obtained for measurement of complete blood count, lipid profile and fasting glucose level. MetS was ascertained by using the International Diabetic Federation’s criteria. We carried out multiple logistic regressions to investigate the association between WP smoking and MetS. Final sample included 2,032 individuals – of those 325 (16.0%) were current WP smokers. Age adjusted-prevalence of MetS was significantly higher among current WP smokers (33.1%) compared with non-smokers (14.8%). Water-pipe smokers were three times more likely to have MetS (OR 3.21, 95% CI 2.38–4.33) compared with non-smokers after adjustment for age, sex and social class. WP smokers were significantly more likely to have hypertriglyceridemia (OR 1.63, 95% CI 1.25–2.10), hyperglycaemia (OR 1.82, 95% CI 1.37–2.41), Hypertension (OR 1.95, 95% CI 1.51–2.51) and abdominal obesity (OR 1.93, 95% CI 1.52–2.45). However, there were no significant differences in HDL level between WP smokers and non-smokers. This study suggests that WP smoking has a significant positive (harmful) relationship with MetS and its components.
Highlights
Water-pipe (WP; shisha, narghile, hookah and arghile) is a four century old tobacco use device [1,2]
The observed relationship between WP smoking and metabolic syndrome (MetS) was independent of age, sex, social class and area of residence
The components of MetS showed a significant relationship with WP smoking
Summary
Water-pipe (WP; shisha, narghile, hookah and arghile) is a four century old tobacco use device [1,2]. A hose attached to the water bowl is used to draw air through the mouthpiece of the hose which causes the tobacco and charcoal smoke to bubble through the water whereupon they are inhaled by the smoker [1,2]. The highest prevalence of current WP smoking was among school students across countries: the United States, especially among Arab Americans (12%–15%) the Arabic Gulf region (9%–16%), Estonia (21%), and Lebanon (25%) [2,5]. The prevalence of WP smoking was even higher among the university students, 25.5% in Syrian young men [6] and 24.5% in the United States [7]. In Pakistan, approximately half of the University students reported the ever-use of WP and 33% were current WP smokers [8]
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