Serum cotinine levels and diabetes mellitus in never smokers

Sex-specific associations of serum cotinine levels with depressive symptoms and sleep disorders in American adults: NHANES 2007-2014

Background

Accumulating evidence have demonstrated that tobacco smoke exposure (TSE) causes damage to human mental issues. However, previous studies almost focus on the individual smoking exposure patterns and some inconsistent results are reported. Serum cotinine is a reliable and quantitative biomarker of TSE. This study aims to explore the association of serum cotinine with depression and sleep disorders and the potential gender differences.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 was used. Weighted multiple logistic regression methods, generalized additive models (GAM), and restricted cubic spline (RCS) models were used for association analyses. Moreover, gender-stratified analyses were conducted.

Results

Of 12,599 individuals included in the final analysis, 1,295 had depression, 3245 had trouble sleeping and 1152 had diagnostic sleep disorders. After adjusting for potential covariates, linear relationship suggested higher serum cotinine levels were positively associated with risk of depression and sleep disorders, including self-reported trouble sleeping and diagnostic sleep disorders in the total sample and female participants, and serum cotinine levels were positively correlated with depression and trouble sleeping in male participants. Additionally, inverted L-shaped associations between serum cotinine and depression and sleep disorders were detected, and at the same cotinine level, females have a higher risk of experiencing depression and sleep disorders.

Conclusions

In this study, higher serum cotinine increased the risk of depression and sleep disorders and there was stronger association in females than males. These findings provided novel evidence about how TSE affected the mental condition of the general US population.

Cardiovascular risk factors in relation to hair polycyclic aromatic hydrocarbons in the NESCAV study

Previous studies have found associations between exposure to polycyclic aromatic hydrocarbons (PAHs) and cardiovascular risk factors. However, the internal dose of PAH exposure was often examined by quantifying monohydroxylated metabolites of PAHs (OH-PAHs) in urine, which can only reflect recent exposure. On the other hand, hair covers wider temporal windows than urine and has been demonstrated to be a suitable matrix for PAH exposure assessment. Using hair analysis, here we investigated the associations between PAH exposure and obesity, diabetes, hypertension, dyslipidemia, and metabolic syndrome (MetS) and its components in a cross-sectional study of adults aged 18-69 years and enrolled in the Nutrition, Environment and Cardiovascular Health (NESCAV) survey conducted in 2007-2009 in Luxembourg. In addition, we also examined hair cotinine and nicotine because they are well-established biomarkers of tobacco smoke exposure. Associations were explored separately for men (n = 265) and women (n = 347) by logistic regression with adjustment for potential confounders. We found positive associations of OH-PAHs with diabetes in both men and women, positive and inverse associations with obesity and positive associations with hypertension/elevated blood pressure and dyslipidemia/elevated triglycerides (TG) in men, and inverse associations with hypertension but positive associations with MetS, elevated waist circumference and reduced high-density lipoprotein cholesterol (HDL-C) in women. These results may suggest that men and women differ in cardiometabolic responses to environmental PAH exposure. As regards hair cotinine and nicotine, they were associated with diabetes/elevated fasting plasma glucose, elevated blood pressure, and dyslipidemia/elevated TG/reduced HDL-C in men and women. Our results suggest that exposure to PAHs and tobacco smoke may be associated with cardiometabolic health risk. Future prospective studies are warranted to corroborate these findings.

Variability in the association of smoking status with the prevalence of diabetes mellitus in the Korean population according to different definitions of smoking status: analysis based on the Korea National Health and Nutrition Examination Survey (2014-2020)

We evaluated the association between smoking and diabetes, as well as the effects of gender differences and hidden smoking among females on this association using nationally representative data. Analyzing data from 44,049 individuals aged 19 and older, we utilized multivariable logistic regression to investigate associations, controlling for sociodemographic factors. Subgroup analysis based on smoking status determined factors associated with diabetes. To better our understanding of the smoking-diabetes relationship, we introduced a new variable, survey-cotinine verified smoking status (SCS). This study provides valuable insight by exploring the correlation between smoking and diabetes using different definitions of smoking status. Both male and female smokers showed correlations with diabetes according to cotinine-verified smoking status (OR: 1.22 and 1.48, respectively). According to smoking amount, cotinine-verified heavy smokers correlated with diabetes in males (OR: 1.37), while light smokers exhibited a negative correlation with diabetes in females for both cotinine-verified smoking status (OR: 0.60) and survey-cotinine verified status (OR: 0.58) Smoking was associated with diabetes in the overall population, with gender differences observed. When evaluating this association, we should consider variables of smoking amount, passive and intermittent smoking, and specifically, account for the influence of hidden smoking among females, particularly when utilizing self-reported questionnaires in Korea.

Serum cotinine as a predictor of lipid-related indices in Turkish immigrants with type 2 diabetes: A clinic-based cross-sectional study

Background

Turkish immigrants form the largest ethnic minority group in the Netherlands and show a higher prevalence of (i) cardiovascular disease (CVD), (ii) cigarette smoking, and (iii) type 2 diabetes (T2D) as compared to the native Dutch. This study examines the association of CVD risk factors: serum cotinine, as an indicator of cigarette smoke, and lipid-related indices among first-generation (foreign-born) Turkish immigrants with T2D living in deprived neighbourhoods in the Netherlands.

Methods

A total of 110 participants, physician-diagnosed with T2D, aged 30 years and older, were recruited by convenience sampling from the Schilderswijk neighbourhood of The Hague in a clinic-based cross-sectional design. Serum cotinine (independent variable) was measured with a solid-phase competitive chemiluminescent immunoassay. Serum lipids/lipoproteins (dependent variables) were determined by enzymatic assays and included: total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG). The Castelli Risk Index-I (CRI-I), and Atherogenic Coefficient (AC) were calculated using standardised formulas and assessed as dependent variables in multiple linear regression (MLR) models. Log-transformation of HDL-c, TG, CRI-I, and AC values were performed to account for the extreme right skewness of the data. Statistical analyses included descriptive characteristics and MLR models were adjusted for all major confounders of cotinine and lipids.

Results

The sample size had a mean age of 52.5 years [standard deviation (SD) = 9.21]. The geometric mean of serum cotinine level was 236.63 ng/mL [confidence interval (CI) = 175.89 ± 318.36]. The MLR models indicated that high serum cotinine levels (≥10 ng/mL) was positively associated with HDL-c (P = 0.04), CRI-I (P = 0.03), and AC (P = 0.03) in the age, gender, WC, diabetes medications, and statins-adjusted models (n = 32).

Conclusion

This study indicated that lipid ratios of HDL-c, CRI-I and AC are dependent determinants of serum cotinine and higher serum cotinine levels (≥10 ng/mL) are associated with worse HDL-c, CRI-I and AC values in participants with T2D. Clinical comprehension of these biochemical indicators (lipids/lipoproteins) and symptomatic results (CVD risk) in individuals with T2D will aid in the intervention (smoking) approach for this vulnerable cohort (Turkish immigrants). Therapy that is targetted to modify this behavioural risk factor may improve cardiovascular health outcomes and prevent comorbidities in Turkish immigrants with T2D living in deprived neighbourhoods in the Netherlands. In the meantime, this report contributes to a growing body of information and provides essential guidance to researchers and clinicians.

Health behaviors and health services accessibility factors associated with diabetes: a propensity score matching analysis

Background: Despite the increasing burden of diabetes in Turkey, there is a lack of information regarding behaviors and accessibility factors associated with diabetes. This study aims to explore diabetes prevalence and to identify the associated health behaviors and accessibility factors. Research design and methods: Data was gathered from TurkStat-Health Survey for the year 2014. 1996 individuals who had reported diabetes were matched to similar non-diabetes participants in terms of socio-demographic characteristics and comorbidities by using 1:1 nearest matching based on estimated propensity scores. Results: The weighted point prevalence of diabetes among adults was 8.98%. Compared with smokers, non-smokers were less likely to develop diabetes (OR:0.96; 95% CI:0.95-0.97). Individuals engaging in regular physical activity were less likely to have experienced diabetes than individuals not engaging in any physical activity (OR:0.51; 95% CI:0.41-0.52). Conclusions: Improving the health behaviors of individuals and promoting a culture of exercise, healthy food consumption and better planning of preventive services are necessary strategies to fight against diabetes in Turkey. Collaboration between health professionals will result in effective clinical decision making and the development of diabetes self-management programs.

Cotinine inhibits TLR4/NF-κB signaling pathway and improves deep vein thrombosis in rats

BACKGROUND

The present study was designed to explore the regulatory mechanisms and influences of cotinine on deep vein thrombosis (DVT) in rats via the toll-like receptor 4/nuclear factor κ binding (TLR-4/NF-κB) pathway.

METHODS

In this experimental study, 30 SD rats were randomly assigned to control group, sham operation group, model group, cotinine (10 μg/kg) group, and model + cotinine (10 μg/kg) group. The thromboxane B2 (TXB2), 6-keto-PGF1α, plasminogen activator inhibitor (PAI), tissue plasminogen activator (t-PA), TLR4, NF-κB, and p65 mRNA and protein expression and tissue changes were analyzed by ELISA, Hematoxylin-Eosin (HE) staining, RT-PCR, and Western blot.

RESULTS

There was no significant difference between the control and sham operation groups (P>0.05). The model and cotinine groups showed significantly higher mRNA and protein levels of TXB2, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), PAI, TLR-4, and NF-κB, and significantly lower levels of 6-keto-PGF1α and t-PA than the control and sham operation groups (P<0.05), and the model + cotinine group showed significantly higher mRNA and protein levels of TXB2, IL-6 and TNF-α, PAI, TLR-4, and NF-κB and significantly lower levels of 6-keto-PGF1α and t-PA than the model group (P<0.05).

CONCLUSION

Cotinine can aggravate thrombus and inflammation in rats with DVT, and the mechanism may be associated with the activation of the TLR-4/NF-κB inflammatory signaling pathway.

Association between Cigarette Smoking and New-Onset Diabetes Mellitus in 78,212 Koreans Using Self-Reported Questionnaire and Urine Cotinine

BACKGROUND

No study has assessed association between cigarette smoking and new-onset diabetes mellitus (NODM) incidence using two different smoking classification systems: self-reported questionnaire and urine cotinine. The objective of this longitudinal study was to evaluate NODM risk using the above two systems in Korean adults.

METHODS

Among individuals enrolled in Kangbuk Samsung Health Study and Cohort Study who visited between 2011 and 2012 at baseline and 2014 at follow-up, 78,212 participants without baseline diabetes mellitus were followed up for a median of 27 months. Assessment of NODM incidence was made at the end of follow-up period. Cotinine-verified current smoking was having urinary cotinine ≥50 ng/mL.

RESULTS

Percentages of self-reported and cotinine-verified current smokers were 25.9% and 23.5%, respectively. Overall incidence of NODM was 1.5%. According to multivariate regression analyses, baseline self-reported current smoking (relative risk [RR], 1.33; 95% confidence interval [CI], 1.07 to 1.65) and cotinine-verified current smoking (RR, 1.27; 95% CI, 1.08 to 1.49) increased NODM risk compared to baseline self-reported never smoking and cotinine-verified current non-smoking. Higher daily amount and longer duration of smoking were also associated with increased NODM risk (P for trends <0.05). In particular, self-reported current smokers who smoked ≥20 cigarettes/day (RR, 1.62; 95% CI, 1.25 to 2.15) and ≥10 years (RR, 1.34; 95% CI, 1.08 to 1.67) had the highest RRs for NODM. These results remained significant in males, although there was no gender interaction.

CONCLUSION

This longitudinal study showed that baseline self-reported and cotinine-verified current smoking were associated with increased risks of NODM, especially in males.

Peripheral blood lymphocyte subsets of newly diagnosed DLBCL patients and their dynamic changes with rituximab based immunochemotherapy

The purpose of this study was to explore lymphocyte subsets of newly diagnosed DLBCL patients, and dynamics along with treatment of R-CHOP. A total of 40 DLBCL patients were enrolled. ALC of grade III-IV DLBCL patients was significantly lower than that of health controls (1.33*10E9/L vs 1.89*10E9/L, p = 0.003), mostly attributing to decreased CD4+ cells (p = 0.012). And serum LDH level of patients was negatively correlated with ALC (p = 0.033). ALC progressively decreased along with treatment, so as to CD3+, CD4+ and CD19+ cells, while proportion of CD4+ and CD8+ cells increased significantly after two cycles' treatment (p < 0.05). CR of ALC low (<1.18*10E9/L) group was lower than that of ALC high group (37.5% vs 73.3%), though not statistically significant (p = 0.179).

Association between cigarette smoking and diabetes mellitus using two different smoking stratifications in 145 040 Korean individuals: Self-reported questionnaire and urine cotinine concentrations

BACKGROUND

Although previous studies have assessed the relationship between smoking and diabetes using self-reported questionnaires, interpretations may be limited by an underestimation of the actual smoking population. This study evaluated the relationship between smoking and diabetes using both self-reported questionnaires and urine cotinine concentrations.

METHODS

The present cross-sectional study enrolled 145 040 Koreans in Kangbuk Samsung Health and Cohort Studies between 2011 and 2013. Urinary cotinine was measured after a 10-hour smoking-free period. Cotinine-verified current smoking was defined as a urinary cotinine concentrations ≥50 ng/mL.

RESULTS

Overall diabetes prevalence in self-reported (4.5% vs 1.6%) and cotinine-verified (4.4% vs 2.1%) current smokers was higher than in self-reported and cotinine-verified never smokers. Multivariate regression analysis showed that cotinine-verified current smoking (odds ratio [OR] 1.25; 95% confidence interval [CI] 1.13-1.38), self-reported former smoking (OR 1.16; 95% CI 1.01-1.33) and current smoking (OR 1.33; 95% CI 1.17-1.50) were associated with increased diabetes compared with cotinine-verified and self-reported never smoking. Unobserved smoking (OR 1.79; 95% CI 1.20, 2.66) also increased the odds for diabetes. There were no significant sex interactions in the analyses.

CONCLUSIONS

This study shows that self-reported former and current smoking, cotinine-verified current smoking, and unobserved smoking (i.e. self-reported never smoking with urine cotinine >50 ng/mL) are all associated with increased diabetes prevalence. These findings suggest that cotinine could provide additional information when assessing cardiometabolic risks, such as diabetes.

Relation between secondhand smoke exposure and cardiovascular risk factors in never smokers

Supplemental Digital Content is available in the text

Objective:

Secondhand smoke exposure (SHSE) in nonsmokers has been associated with premature cardiovascular mortality and ischemic heart disease. We conducted a cross-sectional, population-based study evaluating the relationship between SHSE, measured by subjective and objective methods, and conventional cardiovascular risks such as blood pressure, lipid profiles, and fasting glucose.

Methods:

We extracted information on 7376 healthy adults who had never smoked, for whom there were available urine cotinine levels, from the Korea National Health and Nutrition Examination Survey 2008–2011. SHSE was defined using self-report questionnaires and urine cotinine levels. The main outcomes included SBP and DBP, serum lipid profiles, and fasting glucose.

Results:

The mean age of the study population was 45.4 ± 0.4 years and 75.2% were women. Self-reported SHSE had no significant association with study outcomes except for DBP, which had marginally positive relationships (P = 0.060). Unadjusted analysis showed higher cotinine levels were associated with lower SBP, total cholesterol, LDL cholesterol, and triglyceride. All associations lost statistical significance after multivariable adjustment. Fasting glucose had a positive relationship with urine cotinine in quartiles but not with logarithm-transformed cotinine.

Conclusion:

Although SHSE is associated with increased risk of cardiovascular mortality and morbidity, we did not find any consistent relationship among SHSE and blood pressure, lipid, or fasting glucose levels in this cross-sectional study. Using objective measurements of urine cotinine did not alter this relationship. Further long-term prospective studies are needed to evaluate the effect of SHSE as a cardiovascular risk factor.

Serum Cotinine and Hemoglobin A1c Among a National Sample of Adolescents Without Known Diabetes

Introduction

National data suggest tobacco smoke is positively associated with higher glycated hemoglobin (HbA1c) among adults. Our objective was to examine the association between serum cotinine and HbA1c among adolescents without known diabetes.

Methods

We assessed adolescents 12-19 years old (N = 11550) who participated in the 1999-2012 National Health and Nutrition Examination Survey. We applied sampling weights while performing multiple linear regression analyses.

Results

The prevalence of serum cotinine indicative of no tobacco smoke exposure (TSE, <0.05 ng/mL) was 43.2%, passive TSE (0.05-2.99 ng/mL) was 38.9%, and active TSE (>3 ng/mL) was 17.9% in our sample. Mean (± standard error) HbA1c in participants with no TSE was 5.16% (±0.01), passive TSE was 5.16% (±0.01), and active TSE was 5.14% (±0.01). No differences in HbA1c were found between TSE groups including sex, age, race/ethnicity, education, income, and physical activity or the fully adjusted model with waist circumference. We found cotinine × sex (p = .01) and cotinine × age (p = .02) interactions. There was an association between cotinine and HbA1c for males but not females. Within males, participants with cotinine ≥3 ng/mL (5.26 ± 0.02) had higher mean HbA1c than those with cotinine 0.05-2.99 ng/mL and <0.05 ng/mL (both 5.20 ± 0.01, p ≤ .02). The negative association between age and HbA1c was stronger for participants with cotinine ≥3 ng/mL than participants with cotinine <0.05 ng/mL.

Conclusion

No linear association was found between HbA1c and serum cotinine in adolescents overall after adjusting for potential confounders. Differences between TSE groups were found in males. Future research in adolescents should examine chronic TSE over time to examine the potential for development of type 2 diabetes.

Implications

TSE has been associated with increased risk for the development of type 2 diabetes among adults. It is unclear if this relationship holds in adolescents. We examined the association between serum cotinine and HbA1c in adolescents without known diabetes who completed the 1999-2012 National Health and Nutrition Examination Survey. Although no association was found between serum cotinine and HbA1c overall while controlling for potential confounding factors, we observed interaction effects that are indicative of TSE influencing HbA1c differentially by sex and age. Reducing TSE in adolescents should be a priority for future tobacco control efforts.