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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 30-34

Levels of some electrolytes and glucose in Saudi water pipe smokers


Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Submission25-Aug-2016
Date of Acceptance26-Sep-2016
Date of Web Publication1-Feb-2017

Correspondence Address:
Sawsan Hassan Mahassni
Department of Biochemistry, Faculty of Science, King Abdulaziz University, Box 42652, Jeddah 21551
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-2010.199330

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  Abstract 

Background: Water pipe smoking (WPS) is associated with many adverse health effects, diseases, and cancers. Few studies exist on the effects of WPS on the human body and, to our Knowledge, this is the first study on levels of glucose and electrolytes in WP smokers. Aim: This study was done to determine the effects of WPS on concentrations of glucose and some electrolytes in WP smokers compared to concentrations in nonsmokers. Materials and Methods: This study was done on 85 randomly chosen healthy controls (21 female and 21 male WP smokers, and 21 female and 22 male nonWP smokers) with an age range of 20–35 years from Jeddah and Al-Muzaylef, Saudi Arabia. Blood samples were collected to determine the plasma concentrations of K+, Na+, P−3, Mg+2, Ca+2, Cl, and glucose. Results: The results show no significant differences for electrolytes and glucose levels in female and male smokers compared to female and male nonsmokers respectively, with the exception of a significantly higher Cl concentration for male smokers. Comparing female and male smokers, Na+, Mg+2, Ca+2, and glucose concentrations were significantly lower for females, whereas the remaining electrolytes were not significantly different. Comparing female and male nonsmokers, K+, Na+, Ca+2, and glucose concentrations were significantly lower, and Cl concentration was significantly higher in females, while the remaining electrolytes were not significantly different. Conclusion: The data suggest that WPS affects Cl- levels in males and affects K+, Mg+2, and Cl- levels when comparing the differences between female and male smokers with nonsmokers.

Keywords: Ca+2, Cl, electrolytes, female, glucose, human, K+, male, Mg+2, Na+, P−3, Saudi, Saudi Arabia, water pipe smoking


How to cite this article:
Mahassni SH, Alajlany KA. Levels of some electrolytes and glucose in Saudi water pipe smokers . J Health Res Rev 2017;4:30-4

How to cite this URL:
Mahassni SH, Alajlany KA. Levels of some electrolytes and glucose in Saudi water pipe smokers . J Health Res Rev [serial online] 2017 [cited 2019 Dec 11];4:30-4. Available from: http://www.jhrr.org/text.asp?2017/4/1/30/199330


  Introduction Top


Smoking kills six million people a year worldwide with most of them from low- and middle-income countries.[1] Tobacco use is a major public health threat worldwide, especially in developing countries where smoking has been increasing. Tobacco may be smoked by different methods, one of which is using a water pipe (WP), otherwise known as shisha, narghile, hookah, hubble-bubble, which has been used for hundreds of years mainly in the Middle East, and some parts of Africa and Asia.[2] WP smoking (WPS) was traditionally mainly practiced by older men in coffee shops, but for the last 20 years or more, increasing numbers of women of all ages, adolescents, and younger men and women have taken up WPS, and many smoke it at home. In the past two decades or so, WPS has been gaining increased popularity in Europe, the USA, and other developed countries, and especially among young, educated men and women.[3],[4],[5] Therefore, WPS poses great health threats presently and in the future with continued use and it is very important to research the effects of WPS on health to better inform the public on the effects of WPS on health.

Tobacco use is a major preventable cause of death globally. It causes many diseases, such as chronic obstructive pulmonary disease; heart disease; cardiovascular disease and stroke; diabetes; many types of cancers, such as lung, mouth, and bladder; and respiratory system diseases, such as bronchitis and asthma.[6] Smoking is considered the greatest risk factor for many of these diseases. Tobacco contains thousands of toxic and carcinogenic substances that are responsible for the diseases caused by smoking.[7] Tobacco's components are readily absorbed by mucosal tissues in the mouth and the lungs, and they quickly reach the blood circulation. The blood carries the toxic and carcinogenic substances to all organs and tissues of the body including the brain.[8] Thus, tobacco, most commonly in the form of cigarettes, may negatively influence all tissues, organs, and systems of the body. Contrary to popular belief, and as substantiated by research, WPS is more harmful to health than cigarette smoking. WPS sessions last for a much longer time than cigarette smoking, thus exposing the smoker and anyone around her/him to greater volumes of smoke and, therefore, a much larger concentration of toxic and harmful substances.[9]

Cigarette smoking and its effects on humans have been thoroughly studied, but the same cannot be said of WPS. A few studies have studied the effects of WPS on levels of specific components in the human body. An extensive search of the available research studies on the internet did not turn out any studies, in humans or animals, on the effects of WPS on levels of electrolytes and glucose in the circulation. On the other hand, researchers have found that cigarette smoking alters membrane permeability of tissues and organs resulting in altered electrolyte levels.[10],[11]

Electrolytes are essential to maintaining the balance of body fluids across membranes and for cells to be able to transport electric signals and molecules across their membranes. They are important to cellular functions, proper pH of body fluids, metabolic reactions, muscle fiber contraction, blood coagulation, activity of some enzymes and they are components of some proteins, enzymes, and vitamins. An imbalance in electrolytes, due to higher or lower levels of an electrolyte, may lead to deleterious effects on health. These effects include fatigue, muscle weakness, higher risk for cardiovascular diseases, high blood pressure, kidney failure, osteoporosis, and breathing problems.[12] Glucose, a monosaccharide, is the parent compound of the monosaccharides family. It is a nonelectrolyte, and it is soluble in body fluids. High blood levels of glucose are linked to heart attack, stroke, and diabetes.

Studies on blood levels of electrolytes in cigarette smokers compared to nonsmokers showed contradictory results. Some studies did not find significant differences between levels of K +, Na +, P −3, Mg +2, and Cl [10],[13],[14],[15] in cigarette smokers compared to nonsmokers. On the other hand, other studies found increased levels of K +, Na +, P −3, and Ca +2,[10],[11] and decreased levels of K +, and Ca +2[13],[16] in cigarette smokers compared to nonsmokers. No studies on glucose levels in WP smokers were found. A study on glucose levels in cigarette smokers [14] found no significant difference between levels in smokers and nonsmokers.

Therefore, this research study was done to determine the effects of WPS on plasma levels of some electrolytes and glucose in healthy female and male WP smokers living in Saudi Arabia. This study may very well be the first study to determine these levels in WP smokers. This would help in determining the effects of WPS on the health of the local population, to help raise awareness in the community of the dangers of smoking WPs and the need to reduce this unhealthy habit.


  Materials and Methods Top


This is a case–control observational study approved by the Research Ethics Committee of the King Abdulaziz Hospital, Jeddah, Saudi Arabia. The recruitment of subjects and blood samples collection lasted from the beginning of the month of June up to the month of December 2015. Each subject signed a consent form (approved by the Research Ethics Committee) and filled a questionnaire to assess her/his health state and any lifestyle factors that may influence the parameters. The subjects were randomly chosen from people accompanying patients attending or working at the King Abdulaziz Hospital, Jeddah, Saudi Arabia and Al-Muzaylef General Hospital, Al-Muzaylef, Saudi Arabia. In addition, some were recruited through personal connections of the second author.

The 85 subjects used in this study, with an age range of 20–35 years, were 21 adult female WP smokers, 21 adult female nonWP smokers (control), 21 adult male WP smokers, 22 adult male nonWP smokers (control). Any subject that was within the age range specified and willing to participate in the study was included. In addition, the subjects included in the study must not have been taking any medications on a regular basis, nor suffering from any chronic diseases (such as diabetes, immune diseases, blood pressure, hereditary diseases, anemia, or heart disease) or allergic diseases. Only female subjects that were neither pregnant nor menstruating at the time of blood collection were utilized. All WP smokers must have been smoking the WP for 5 years or more and not smoking any other forms of tobacco. As for nonsmokers, to be included in this study they must not be smokers of any form of tobacco.

Blood samples were collected, in lithium heparin vacutainer tubes, from all subjects. On collection, these samples were stored in a cooler for about 3–4 h and then they were centrifuged at 3500 rpm for 5 min to separate the plasma.

The determinations of the electrolytes (Na +, K +, Ca +2, Cl , Mg +2, and P −3) and glucose levels for the samples were done on a Beckman DxC 600 instrument (Beckman Coulter, Brea, California, USA) using the recommended chemicals from the same company, at King Abdulaziz Hospital, Jeddah, Saudi Arabia and Al-Muzaylef General Hospital, Al-Muzaylef, Saudi Arabia.

Statistical analysis

All the reported data were recorded and graphically represented on a worksheet using the MegaStat statistical program (version 9.4, Orris, JB, Butler University, Indianapolis, IN, USA), which was also used for all statistical analyses. The mean (x–), standard deviation (±SD), and standard error of the mean were calculated for all parameters using the MegaStat statistical program.

After testing for the normal distribution and the homogeneity of the populations, it was found that all the data follow the normal distribution. Therefore, the t-test was used to test for the significance in the differences between the WP smokers and nonsmokers (control) groups. The resulting P values demonstrate significance or lack thereof as follows: P > 0.05 is a nonsignificant difference, 0.01 ≤ P ≤ 0.05 is a significant (S) difference, and P < 0.01 is a highly significant (HS) difference.


  Results Top


The mean plasma concentrations of K +, Na +, P −3, Mg +2, Ca +2, Cl and glucose, for female smokers and nonsmokers,

using the t-test, showed no significant differences between the two groups [Table 1].
Table 1: Descriptive statistics and test of significance for the differences between female smokers and nonsmokers for plasma electrolytes and glucose concentrations

Click here to view


Using the t-test, the mean plasma concentrations for K +, Na +, P −3, Mg +2, Ca +2 and glucose for male smokers and nonsmokers

were not significantly different [Table 2]. On the other hand, the mean Cl concentration for male smokers was significantly higher than the mean concentration for nonsmokers.
Table 2: Descriptive statistics and test of significance for the differences between male smokers and nonsmokers for plasma electrolytes and glucose concentrations

Click here to view


Using the t-test [Table 3], the mean plasma electrolytes and glucose concentrations for female and male smokers were compared. The mean Na +, Mg +2 and glucose concentrations for female smokers were HS lower than the respective means for male smokers. The mean Ca +2 concentration for female smokers was significantly lower than the mean Ca +2 concentration for male smokers. The mean K +, P −3 and Cl concentrations for female and male smokers showed no significant differences.
Table 3: Descriptive statistics and test of significance for the differences between female and male smokers for plasma electrolytes and glucose concentrations

Click here to view


The mean plasma electrolytes and glucose concentrations for female and male nonsmokers were compared using the t-test [Table 4]. The mean K +, Na + and glucose concentrations for female nonsmokers were HS lower than the respective means for male nonsmokers. In addition, for female nonsmokers, the mean Ca +2 concentration was significantly lower, while the mean Cl concentration was significantly higher comparing each to the respective mean concentration for male nonsmokers. The meanP −3 and Mg +2 concentrations for female and male nonsmokers showed no significant differences.
Table 4: Descriptive statistics and test of significance for the differences between female and male nonsmokers for plasma electrolytes and glucose concentrations

Click here to view



  Discussion Top


This study was undertaken to investigate the effects of WPS on the plasma levels of some electrolytes and glucose in healthy female and male WP smokers compared to levels in nonsmoking females and males living in Jeddah and Al-Muzaylef, Saudi Arabia. The results for the parameters were analyzed separately for female and male smokers and nonsmokers to compare the findings in smokers and nonsmokers in each gender. In addition, the differences between female and male smokers, and female and male nonsmokers were compared to determine the differences between genders. Our findings for the separate comparisons for female and male smokers and nonsmokers were compared to other studies on cigarette smokers since no studies on WP smokers that measured the same parameters were found. In addition, no research studies on cigarette or WP smokers compared the same parameters in female and male smokers and in female and male nonsmokers. Therefore, these results were not compared to any other studies.

Cigarette smoking is associated with a variety of disorders through affecting various processes, factors, and mechanisms. Electrolyte variations are only one of the many changes occurring in response to smoking.[13] Chronic cigarette smoking might induce alterations in membrane permeability properties of tissues and organs, which might result in changes in signal transduction and electrolyte imbalance.[10]

The results show that there were no significant differences between female smokers and nonsmokers, and male smokers and nonsmokers for the mean concentrations of K + (P = 0.229, and P = 0.268, respectively), Na + (P = 0.799, and P = 0.671, respectively), P −3 (P = 0.090, and P = 0.776, respectively), Mg + 2 (P = 0.729, and P = 0.210, respectively), Ca +2 (P = 0.664, and P = 0.880, respectively), and glucose (P = 0.773, and P = 0.551, respectively). As for the mean Cl levels, smoking led to a significant increase (P = 0.022) in the mean Cl level (mean ± SD: 105 ± 2) for male smokers compared with nonsmokers (103 ± 2), but there was no significant difference (P = 0.628) for the mean Cl levels between female smokers and nonsmokers.

Comparing female and male smokers, there were no significant differences between the mean K +, P −3, Cl concentrations (P = 0.365, P = 0.482, and P = 0.644, respectively) for the two groups. Mean Na +, Mg +2 and glucose concentrations were HS lower (P = 0.000, P = 0.000, and P = 0.004, respectively) for the female smokers group (139 ± 2, 0.75 ± 0.07, and 4.57 ± 1.09, respectively) compared with the male smokers group (143 ± 3, 0.83 ± 0.06, and 5.68 ± 1.18, respectively). As for the mean Ca +2 levels, they decreased significantly (P = 0.011) for the female smokers group (2.31 ± 0.10) compared with the male smokers group (2.39 ± 0.09).

Comparing female and male nonsmokers, there were no significant differences between the two groups for the meanP −3 and Mg +2 concentrations (P = 0.188, and P = 0.066, respectively). Mean K +, Na + and glucose concentrations showed HS decreases (P = 0.004, P = 0.000, and P = 0.001, respectively), and Ca +2 showed a significant decrease (P = 0.019) for the female smokers group (3.7 ± 0.3, 138 ± 2, 4.49 ± 0.49, and 2.30 ± 0.09, respectively) compared with the male smokers group (4.0 ± 0.4, 143 ± 3, 5.46 ± 1.10, and 2.40 ± 0.15, respectively). Finally, the mean Cl levels were significantly higher (P = 0.022) for female nonsmokers (105 ± 2) compared to male nonsmokers (103 ± 2).

Therefore, to summarize the results, comparing female smokers and nonsmokers there were no significant differences between the measured electrolytes and glucose for the two groups. As for the comparison between male smokers and nonsmokers, only the mean Cl concentration showed a significant difference where it was significantly higher for smokers compared to nonsmokers. Comparing female and male smokers, mean Na +, Mg +2 and glucose concentrations were HS lower and mean Ca +2 concentration was significantly lower for female smokers compared with the respective mean concentrations for male smokers, while the remaining electrolytes were not different. Comparing female and male nonsmokers, mean K +, Na + and glucose concentrations were HS lower and mean Ca +2 concentration was significantly lower for females, while the mean Cl concentration for female nonsmokers was significantly higher.

The results obtained in this study for levels of electrolytes in female and male smokers compared to nonsmokers are in agreement with studies on female and male cigarette smokers that showed no significant differences between smokers and nonsmokers for serum levels of K +,[13],[14] Na +,[10],[13],[14]P −3,[15] Mg +2,[15] and Cl .[10],[14] On the other hand, our results disagree with studies on female and male cigarette smokers compared with nonsmokers that found that smokers had increased levels of Na +,[11] K +, P −3, and Ca +2,[10],[11] and lower serum Ca +2[13] and K + levels.[16] The result of no significant differences in glucose levels between male and female smokers agrees with the study on cigarette smokers by Biltos.[14]


  Conclusion Top


Female smokers showed no significant differences from female nonsmokers for levels of electrolytes and glucose. Male smokers had a significantly higher Cl level compared to male nonsmokers, whereas levels of all other electrolytes and glucose remained unchanged. Comparing the differences between female and male smokers with the differences between female and male nonsmokers, only K +, Mg +2, and Cl levels showed significant differences between the comparisons. Thus, some electrolytes were influenced by WPS while glucose was not. These changes in electrolytes may cause unfavorable changes in the body that may lead to diseases. Therefore, this is one more reason to refrain from WPS. It is recommended that more studies be carried out on WP smokers of different ages and other parameters.

Financial support and sponsorship

This research was partially funded by a grant provided by King Abdulaziz City of Science and Technology.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Tobacco Fact Sheet, USA; 2016. Link: http://www.who.int/mediacentre/factsheets/fs339/en/. [Last accessed on 2016 Oct].  Back to cited text no. 1
    
2.
Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: A re-emerging strain in a global epidemic. Tob Control 2004;13:327-33.  Back to cited text no. 2
    
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Maziak W. The global epidemic of waterpipe smoking. Addict Behav 2011;36:1-5.  Back to cited text no. 3
    
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Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: An emerging health risk behavior. Pediatrics 2005;116:e113-9.  Back to cited text no. 4
    
5.
Primack BA, Sidani J, Agarwal AA, Shadel WG, Donny EC, Eissenberg TE. Prevalence of and associations with waterpipe tobacco smoking among U.S. university students. Ann Behav Med 2008;36:81-6.  Back to cited text no. 5
    
6.
US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004. p. 62.  Back to cited text no. 6
    
7.
US Department of Health and Human Services. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What it Means to You. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.  Back to cited text no. 7
    
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American Cancer Society. Questions about Smoking, Tobacco and Health. USA: American Cancer Society; 2014.  Back to cited text no. 8
    
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Hadidi KA, Mohammed FI. Nicotine content in tobacco used in hubble-bubble smoking. Saudi Med J 2004;25:912-7.  Back to cited text no. 9
    
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Padmavathi P, Reddy VD, Varadacharyulu N. Influence of chronic cigarette smoking on serum biochemical profile in male human volunteers. J Health Sci 2009;55:265-70.  Back to cited text no. 10
    
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Elshikh YM. Effect of Smoking on Level of Electrolytes in Sudanese Male Smokers. Dissertation. Sudan: Sudan University of Science and Technology; 2015.  Back to cited text no. 11
    
12.
Scanlon VC, Sanders T. Essentials of Anatomy and Physiology. 5th ed. U.S.A: F.A. Davis Company; 2007.  Back to cited text no. 12
    
13.
Alharbi WD. Electrolyte change in cigarette smoking male students. Pak J Pharmacol 2012;29:33-8.  Back to cited text no. 13
    
14.
Bilto YY. Effects of cigarette smoking on blood rheology and biochemistry. Int J Sci Res 2013;4:108-12.  Back to cited text no. 14
    
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Supervía A, Nogués X, Enjuanes A, Vila J, Mellibovsky L, Serrano S, et al. Effect of smoking and smoking cessation on bone mass, bone remodeling, Vitamin D, PTH and sex hormones. J Musculoskelet Neuronal Interact 2006;6:234-41.  Back to cited text no. 15
    
16.
Osman EI, Dafallah AA, Omer WH, Elimiri GM. Effect of cigarette smoking on blood sodium and potassium levels in Sudanese subjects. Int J Pharma Bio Sci 2011;2:B75-9.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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