Impact of smoking hookah and cigarettes on hematological and biochemical profiles in the Iranian population

Despite widespread tobacco use, current evidence about how different smoking methods affect hematological and biochemical parameters remains limited and inconsistent. We aimed to explore the specific impacts of hookah smoking, cigarette smoking, and dual tobacco use on key hematological and biochemical markers to address these knowledge gaps and guide targeted clinical interventions.

The present analysis was conducted among participants in Bandar-Kong Non-Communicable Diseases (BKNCD) Cohort Study, as a part of Prospective Epidemiological Research Studies in IrAN (PERSIAN). The analytical sample consists of 4000 adults who self-reported as non-smokers, current (past 30 days) hookah-only users, cigarette-only users, and dual users. Hematological and biochemical parameters were measured using fasting blood sampling. Multiple linear regression models were used to assess the association between smoking status and each parameter, adjusting for age, gender, BMI, occupation, and hypertension.

This cross-sectional study of 4,000 adults-non-smokers (n = 2,890), hookah-only users (n = 530), cigarette-only users (n = 405), and dual users (n = 175)-examined differences in hematological and biochemical profiles. Hookah smokers showed higher red blood cell indices (RBC: β = 0.16, Hb: β = 0.33, HCT: β = 1.16; all p < 0.001) and monocytes (β = 0.26, p = 0.005), but lower cholesterol, HDL-C, and LDL levels (p < 0.05). Cigarette smokers had elevated WBC (β = 0.73, p < 0.001), RDWCV (β = 0.36, p < 0.001), and triglycerides (β = 14.41, p = 0.002), with reduced HDL-C (β=-1.91, p = 0.002). Dual users exhibited increased WBC, RBC, and granulocytes but decreased lymphocytes and serum lipids (p < 0.05). Overall, distinct and statistically significant blood and metabolic alterations were observed across tobacco use patterns, reflecting differential biological effects of hookah, cigarette, and dual smoking.

Our findings revealed distinct hematological and biochemical profiles across smoking groups after demographic adjustment. Elevated WBC in cigarette smokers suggests systemic inflammation, while increased RBC in hookah users may indicate hypoxic effects from prolonged carbon monoxide exposure. Future randomized controlled trials should explore the differential effects of smoking with and without nicotine on hematological and biochemical parameters, particularly including emerging tobacco products like e-cigarettes to inform targeted cessation strategies.