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. 2022 May;29(22):32773-32787.
doi: 10.1007/s11356-021-17905-5. Epub 2022 Jan 12.

The association between tobacco smoke exposure and vitamin D levels among US general population, 2001-2014: temporal variation and inequalities in population susceptibility

Affiliations

The association between tobacco smoke exposure and vitamin D levels among US general population, 2001-2014: temporal variation and inequalities in population susceptibility

Lei Yuan et al. Environ Sci Pollut Res Int. 2022 May.

Abstract

Tobacco smoking is endocrine-disrupting and may interfere with vitamin D endocrine systems (VDES), but supporting evidence is limited and inconsistent. Also, there is a lack of evidence on whether the association between tobacco smoke exposure and VD levels exhibit temporal variation. Data from the National Health and Nutrition Examination Survey was used to evaluate the association between tobacco smoke exposure and VD levels among US general participants from 2001 to 2014. We examined the linear association between serum cotinine and 25(OH)D concentrations, as well as relationship between tobacco smoke exposure categories (active, passive, non-smoking) with VD status (deficiency, inadequacy, sufficiency, intoxication), and assessed whether specific gender, age (3-11, 12-19, 20-59, ≥ 60 years), ethnicity/race, or body mass index (BMI) groups were disproportionately impacted. During 2001-2004, a decrease in both serum cotinine and passive smoking prevalence was observed, with a stabilized active smoking rate. The estimates for the association between tobacco smoke exposure and suboptimal VD levels increased over the study period. Overall results indicated that serum cotinine was negatively associated with 25(OH)D in all participants. Tobacco smoke exposure, including both active and passive smoking exposure, was associated with increased risk of VD deficiency. Moreover, active smoking was additionally related to enhanced risk of VD inadequacy. These associations showed some age and gender differences, with consistent and stronger associations observed in female adults. In contrast, effects of tobacco smoke exposure on VD levels were mostly negative or non-significant among children and adolescents aged 3-19 years. The percentage of US general population with active smoking exposure stabilized over the 14-year period and was still high. Tobacco smoke exposure may disrupt vitamin D levels with an increasing temporal trend in the risk. Our results also provided initial evidence of smoking exposure on VD intoxication, which needs to be further verified. Convincing studies have linked tobacco use exposure, to dysfunctional VDES accompanied with declined serum levels of VD metabolites. However, evidence on the association between tobacco smoke exposure and VD status was rather limited and inconsistent, and there were no researches to date that estimated the temporal variation of the association as well as the effects of smoke exposure on VD intoxication. This study analyzed national survey data, to evaluate the temporal trends in effects of tobacco smoke exposure on VD levels over a decade, and to comprehensively assess the impacts of tobacco smoke exposure on VD levels across specific subgroups. The evidence suggests that the prevalence of active smoking exposure stabilized over the 14-year period and was still high. Moreover, tobacco smoke exposure may disrupt vitamin D levels among general population, with an increasing temporal trend and age-, gender-differences in risk.

Keywords: Cotinine; NHANES; Tobacco smoke; Vitamin D; Vitamin D deficiency.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Estimated prevalence (%) of active smoking (brown bars) and passive smoking (gray bars) exposure among US population aged ≥ 3 years. Notes: Geometric mean serum cotinine levels (ng/mL) plotted on the ln scale for children aged 3–11 years (orange circles, solid line) and adolescents aged 12–19 years (green triangles, dashed line), adults aged 20–59 years (blue squares, dashed line), and aged ≥ 60 years (purple crosses, dashed line) in the NHANES 2001–2014 by survey cycles; data shown in Supplementary Table 1
Fig. 2
Fig. 2
Association between continuous serum cotinine and vitamin D by age-gender groups in NHANES 2001–2014. Notes: Both cotinine and vitamin D were ln-transformed. Estimates were presented as coefficients and 95% confidence intervals (CIs) and were adjusted for age (continuous), BMI (categorical), ethnicity/race (categorical), PIR (continuous), and NHANES cycle (categorical). Gender was also adjusted in the total population, oral contraceptive use was adjusted for females aged ≥ 12 years, and kidney health (categorical) was adjusted for participants aged ≥ 20 years
Fig. 3
Fig. 3
Association between tobacco smoke exposure and VD status by age-gender groups in NHANES 2001–2014. Notes: Estimates were presented as odd ratios (ORs) and 95% confidence intervals (CIs) and were adjusted for age (continuous), ethnicity/race (categorical), PIR (continuous), BMI (categorical), alcohol use (dichotomous; ≥ 12 years), vigorous activity (dichotomous; ≥ 12 years), moderate activity (dichotomous; ≥ 12 years), kidney health condition (dichotomous; ≥ 20 years), and NHANES cycle (categorical). Gender was also adjusted for total population, and oral use of contraceptives (dichotomous) was additionally adjusted for females aged ≥ 12 years; the estimates could not be derived for active smoking exposure among children aged 3–11 years and passive smoking in adults aged ≥ 60 years due to limited case sizes

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