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Association of environmental tobacco smoke exposure with chronic constipation: a nationwide survey (NHANES 2005–2010)

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Abstract

Environmental tobacco smoke (ETS) exposure has been proven to induce digestive diseases such as hepatic steatosis, cirrhosis, and gastrointestinal cancer, yet little is known about the link between ETS exposure and constipation. This study aimed to investigate the impact of ETS exposure on the risk of chronic constipation in adults aged 20 years or older. This is a cross-sectional study based on population. A total number of 7705 participants from the National Health and Nutrition Examination Survey (NHANES) 2005–2010 were included. Cotinine, an alkaloid found in tobacco, serves as a reliable and precise biomarker for measuring exposure to ETS. Hence, the categorization of exposure to ETS was conducted based on serum cotinine levels, resulting in four distinct categories. The association between ETS exposure and the risk of constipation was assessed using multivariable restricted cubic spline and logistic regression with odds ratio (OR) and 95% confidence interval (CI). The weighted prevalence of constipation in this study was estimated to be 7.51% based on stool consistency, or 3.11% based on stool frequency. The fully adjusted models indicated a positive correlation between exposure to ETS and constipation as measured by stool frequency, among adults with poor dietary quality (OR (95% CI): moderate exposure: 2.49 (1.05, 5.94); high exposure: 2.36(1.13, 4.95), P for trend = 0.03), while no significant difference was observed in the subgroup with a higher healthy eating index. Furthermore, the log10-transformed serum cotinine level exhibited a non-linear inverted U-shaped association with constipation in individuals with poor dietary quality (P overall = 0.0207, P non-linear = 0.0427). Conversely, a J-shaped non-linear relationship was observed in the subgroup with a higher healthy eating index (P overall = 0.0028, P non-linear = 0.0036). Our results show that ETS exposure appears to be positively associated with stool frequency-related chronic constipation in adults with poor dietary quality.

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Abbreviations

BMI:

Body mass index

BSFS:

Bristol Stool Form Scale

CI:

Confidence interval

ETS:

Environmental tobacco smoke

HEI-2015:

Healthy Eating Index-2015

IBD:

Inflammatory bowel disease

ID HPLC-APCI MS/MS:

Isotope dilution high-performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometry

IQR:

Interquartile range

LOD:

Limit of detection

MEC:

Mobile Examination Center

NET:

Neutrophil extracellular trap

NHANES:

National Health and Nutrition Examination Survey

OR:

Odds ratio

PIR:

Ratio of family income to poverty

RCS:

Restricted cubic spline

S. E:

Standard error

SHS:

Secondhand smoke

THS:

Thirdhand smoke

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Acknowledgements

We would like to express our heartfelt thanks to all the participants in this study.

Funding

This work is supported by the National Natural Science Foundation of China (the funder: Yongning Zhou, No. 71964021) and the Foundation of The First Hospital of Lanzhou University, China (the funder: Ya Zheng, No. ldyyyn2021-59).

Author information

Author notes

  1. Ruixiao Duan, Ya Zheng, and Wanru Kong contributed equally to this work.

Authors and Affiliations

  1. The First Clinical Medical College, Lanzhou University, Lanzhou, China

    Ruixiao Duan

  2. Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China

    Ruixiao Duan, Ya Zheng, Yuping Wang & Yongning Zhou

  3. Gansu Province Clinical Research Center for Digestive Diseases, The First Hospital of Lanzhou University, Lanzhou, China

    Ruixiao Duan, Ya Zheng, Yuping Wang & Yongning Zhou

  4. Department of Infection Management, Gansu Provincial Hospital, Lanzhou, 730000, China

    Wanru Kong

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  1. Ruixiao Duan
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  4. Yuping Wang
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Contributions

Project design and conception: R. D., Y. Z., and W. K.; administrative support and supervision: Y. W. and Y. Z.; data download and processing: R. D. and Y. Z.; data analysis and interpretation: R. D. and W. K.; manuscript writing and retouching: R. D.; final approval of manuscript: all authors.

Corresponding author

Correspondence to Yongning Zhou.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate.

The NHANES study protocol was reviewed and approved by the National Center for Health Statistics ethics review board (approved by Protocol #2005–06) (https://www.cdc.gov/nchs/nhanes/irba98.htm), and informed consent was obtained from all participants at recruitment.

Consent to participate

This is not applicable.

Consent for publication

This is not applicable.

Data availability

The datasets generated and/or analyzed during the current study are available in the NHANES database, https://wwwn.cdc.gov/nchs/nhanes/.

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Responsible Editor: Lotfi Aleya

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Highlights

• NHANES data were used to investigate the association between environmental tobacco smoke (ETS) exposure and chronic constipation.

• Serum cotinine levels were used to more objectively assess the extent of ETS exposure.

• ETS exposure is positively associated with a higher risk of chronic constipation in US adults with poor dietary quality.

• The log10-transformed serum cotinine level exhibited a non-linear inverted U-shaped association with constipation in individuals with poor dietary quality. Conversely, a J-shaped non-linear relationship was observed in the subgroup with a higher healthy eating index.

Recommendations.

• Environmental tobacco smoke (ETS) exposure and dietary modification should be considered in medical interventions to prevent chronic constipation.

• Larger sample size studies are needed to verify the association between ETS exposure and the risk of chronic constipation.

• Further prospective studies are needed to determine the causal relationship between serum cotinine levels and chronic constipation.

Supplementary Information

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Duan, R., Zheng, Y., Kong, W. et al. Association of environmental tobacco smoke exposure with chronic constipation: a nationwide survey (NHANES 2005–2010). Environ Sci Pollut Res 30, 115776–115787 (2023). https://doi.org/10.1007/s11356-023-30542-4

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