The Association Between Self-Reported Cigarette Smoking and Spinal Pain is Not Explained by Serum Cotinine Levels.

PURPOSE: The aim of this study was to check if self-reported smoking is still associated with back pain above and beyond its association with cotinine, to test the hypothesis that the association of self-reported cigarette smoking with back pain is due to residual confounding. METHODS: Secondary analyses of population-based cross-sectional data pertaining to 4470 adults were conducted. In multivariate analyses examining the associations of self-reported smoking with several spinal pain outcomes (neck pain, low back pain, low back pain with pain below knee, self-reported diagnosis of arthritis/rheumatism, and related limitations), further adjustment for serum cotinine concentrations was made. RESULTS: Self-reported cigarette smoking was associated with neck pain (adjusted Odds Ratio (aOR) Regular smokers vs. Non-smokers: 1.44; 95% Confidence Interval (CI): 1.14-1.82), low back pain (aOR: 1.48; 95% CI: 1.24-1.78), low back pain with pain below knee (aOR: 1.98; 95% CI: 1.42-2.76), as well as arthritis/rheumatism (aOR: 1.33; 95% CI: 1.03-1.71), and related functional limitations (P < .05). Further adjustment for serum cotinine concentrations brought about little change in the ORs or beta coefficients. CONCLUSIONS: These results do not support the hypothesis that serum cotinine concentrations explain the well-known relationship between cigarette smoking and spinal pain.

Vitamin C is not the Missing Link Between Cigarette Smoking and Spinal Pain.

STUDY DESIGN: A nationwide cross-sectional study. OBJECTIVES: To measure the associations between cigarette smoking (defined as serum cotinine concentration >15 ng/mL) and the 3-month prevalence of spinal pain (neck pain, low back pain, low back pain with pain below knee, and self-reported diagnosis of arthritis/rheumatism) and related limitations, and to verify whether these associations are mediated by serum concentrations of vitamin C. SUMMARY OF BACKGROUND DATA: Cigarette smoking has been consistently associated with back pain, but this association has never been explained. Because vitamin C has recently been reported to be associated with spinal pain and related functional limitations, and the metabolism of vitamin C differs between smokers and nonsmokers, we hypothesized that the prevalence of spinal pain and related limitations might be greater among smokers because they are more susceptible to be in a state of hypovitaminosis C. METHODS: We conducted secondary analyses of National Health and Nutrition Examination Survey (NHANES) 2003 to 2004 data on 4438 individuals aged ≥20 years. RESULTS: Serum concentrations of vitamin C and cotinine were strongly and inversely correlated (r = -0.35, P < 0.0001). Smoking was statistically associated with the prevalence of neck pain [adjusted odds ratio: aOR: 1.25; 95% confidence interval (95% CI): 1.06-1.47], low back pain (aOR: 1.20; 95% CI: 1.04-1.39), and low back pain with pain below knee (aOR: 1.58; 95% CI: 1.13-2.22) and related limitations, with a dose-response relationship (P < 0.05). However, the associations between smoking and spinal pain were not mediated by concentrations of vitamin C. CONCLUSION: These results confirm the relationship between smoking and spinal pain, but they do not support a mediating effect of vitamin C on this relationship. LEVEL OF EVIDENCE: 2.

Nutrition intervention and adequate hygiene practices to improve iron status of vulnerable preschool Burkinabe children.

OBJECTIVE: To determine the impact of an intervention that combined an increase in dietary and bioavailable iron intakes and an improvement in hygiene behaviors on the iron status of preschool children from Burkina Faso. METHODS: Thirty-three orphans and vulnerable children from 11 families who were 1-6 y old, were non-anemic, or had mild to moderate anemia were enrolled in an 18-wk trial. Using the probability approach for planning diets in an assisted-living facility, bioavailable iron intake was increased from 0.4 to 0.9 mg/d by increasing the amounts of meat and citrus fruits and by adding iron-rich condiments to the diet, for an estimated cost of U.S. $0.59/mo. Hygiene behaviors were modified by implementing hand-washing before meals and by the use of individual plates for meals. Iron status indicators were measured twice and means at enrollment and after intervention were compared. RESULTS: After intervention, hemoglobin concentration increased from 98.7 to 103.8 g/L (P=0.006). There was a decrease in total iron binding capacity (107 to 91 micromol/L, P=0.05) and a marginal increase in transferrin saturation (13% to 17%, P=0.06). Significant improvement was not observed for serum ferritin concentration or prevalence of depleted iron stores, likely due to the confounding effect of infection. Anemia and iron-deficiency anemia were decreased from 64% to 30% and from 61% to 30%, respectively. CONCLUSION: Dietary modification associated with adequate hygiene behaviors could be a relevant strategy to control iron deficiency and anemia in areas where infection is a major health problem.

Estimated absorbable iron intakes in quebec adults.

In the last 30 years, the prevalence of low dietary iron intake has increased, partly because North Americans have been encouraged to choose lower fat foods, including leaner meats. As a result, there has been a decrease in red meat consumption. The objective of this study was to estimate absorbable iron intakes of a representative sample of the Quebec adult population and to compare these results with the new North American recommendations for iron. Dietary intakes were obtained by 24-hour recall and absorbable iron intakes were estimated using Monsen & coworker's model. While 18.9 % and 2.5% of women and men respectively had an iron intake below the estimated average requirement (EAR), 66.2 % and 25.6% had an estimated available iron intake below the recommended level for absorbed iron. Beef consumption had the strongest association with estimated absorbable iron, followed by vegetables. Subjects with a high education level consumed significantly less meat, beef and heme iron than subjects whose education level was low or moderate. These results indicate that there is a need for improving iron intake in the Quebec adult population.