Nicotine and Toxicant Exposure among U.S. Smokeless Tobacco Users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data.
Nicotine and Toxicant Exposure among U.S. Smokeless Tobacco Users: Results from 1999 to 2012 National Health and Nutrition Examination Survey Data.
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DOI：
10.1158/1055-9965.epi-15-0376
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Blount BC
中科院分区：
文献类型：
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作者：
Rostron BL;Chang CM;van Bemmel DM;Xia Y;Blount BC
有人认为，无烟烟草使用者暴露于尼古丁和一些有毒物质的水平很高，这是通过生物标志物浓度测量的，但具有全国代表性数据的研究有限。我们分析了1999-2012年国家健康与营养和检查调查（NHANES）中23，684名成年参与者的烟草暴露生物标志物。分析的生物标志物为血清可替宁、尿4-（甲基亚硝胺）-1-（3-吡啶基）-1-丁醇（NNAL）、血铅、血镉、血汞、尿砷和尿N-乙酰基-S-（2-氰乙基）-L-半胱氨酸（CYMA）。我们按烟草使用类别（纯无烟烟草使用、纯卷烟吸烟、双卷烟和无烟烟草使用以及非卷烟和无烟烟草使用）计算了每种生物标志物的几何平均浓度，并调整了人口统计学因素的几何平均比率。完全无烟烟草使用者的几何平均浓度较高（178.9 ng/mL，95% CI = 145.5，220.0）和NNAL（583.0 pg/mg肌酐，95% CI = 445.2，763.5），（分别为130.6 ng/mL，95% CI = 122.3、139.6和217.6 pg/mg肌酐，95% CI = 193.0、245.2）。与非吸烟者相比，无烟烟草使用者的血铅浓度也更高（校正的几何均值比= 1.30，95%CI = 1.21，1.38）。没有观察到无烟烟草使用者和非烟草使用者之间镉、汞和CYMA浓度的差异。基于有限的样本量，无烟烟草使用者的NNAL浓度似乎从2007-2008年（几何平均值= 1013.7 pg/mg肌酐，95% CI = 738.9，1390.8）下降至2011-2012年（几何平均值= 325.7 pg/mg肌酐，95% CI = 159.6，664.9）。通过可替宁和NNAL生物标志物浓度测量，无烟烟草使用者暴露于尼古丁和致癌烟草特有亚硝胺的观察水平高于吸烟者。无烟烟草使用者暴露于已知有害成分的高水平是个人和公共健康的一个令人担忧的原因。
It has been suggested that smokeless tobacco users have high levels of exposure to nicotine and some toxic substances as measured by biomarker concentrations, but studies with nationally representative data have been limited. We analyzed biomarkers of tobacco exposure for 23,684 adult participants from the National Health and Nutrition and Examination Survey (NHANES) from 1999-2012. The biomarkers analyzed were serum cotinine, urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), blood lead, blood cadmium, blood mercury, urinary arsenic, and urinary N-acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA). We calculated geometric mean concentrations for each biomarker by tobacco use category (exclusive smokeless tobacco use, exclusive cigarette smoking, dual cigarette and smokeless tobacco use, and non-cigarette and smokeless tobacco use) and geometric mean ratios adjusting for demographic factors. Exclusive smokeless tobacco users had higher geometric mean concentrations of cotinine (178.9 ng/mL, 95% CI = 145.5, 220.0) and NNAL (583.0 pg/mg creatinine, 95% CI = 445.2, 763.5) than exclusive cigarette smokers, (130.6 ng/mL, 95% CI = 122.3, 139.6 and 217.6 pg/mg creatinine, 95% CI = 193.0, 245.2, respectively). Smokeless tobacco users also had higher concentrations of blood lead compared with non-tobacco users (adjusted geometric mean ratio = 1.30, 95% CI = 1.21, 1.38). Differences in concentrations of cadmium, mercury, and CYMA between smokeless tobacco users and non-tobacco users were not observed. Based on limited sample sizes, NNAL concentrations for smokeless tobacco users appear to have declined from 2007-2008 (geometric mean = 1013.7 pg/mg creatinine, 95% CI = 738.9, 1390.8) to 2011-2012 (geometric mean = 325.7 pg/mg creatinine, 95% CI = 159.6, 664.9). Smokeless tobacco users have higher observed levels of exposure to nicotine and carcinogenic tobacco-specific nitrosamines, as measured by cotinine and NNAL biomarker concentrations, than cigarette smokers. High levels of exposure to known harmful constituents for smokeless tobacco users is a cause of concern for individual and public health.