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ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 4  |  Page : 162-166

Effect of Body Mass Index, Smoking, and Aspirin Administration on Polycythemia Incidences


1 Department of Nutrition, The Medical Technical Institute of Baghdad, The Middle Technical University, Baghdad, Iraq
2 Department of X-ray Techniques, The Medical Technical Institute of Baghdad, The Middle Technical University, Baghdad, Iraq

Date of Web Publication26-Dec-2018

Correspondence Address:
Adnan H Mahmood
Department of Nutrition, The Medical Technical Institute of Baghdad, The Middle Technical University, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_46_18

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   Abstract 


Aims: Polycythemia is an increase in red cell mass as evidenced by increase in hemoglobin (Hb), hematocrit, and number of circulating erythrocytes. The aim of this study was to investigate the effect of some clinical manifestation on the occurrence of polycythemia including overweight, smoking, meat consumption, chronic diseases, previous history, family history, recurrent blood donation, and aspirin administration. Materials and Methods: This study was performed at The Iraqi National Blood Bank in Baghdad. Data including weight, height, and Hb levels were estimated personally from 80 patients attending on three different days at the bank for blood donation. Each of the patients were asked about having clinical manifestation tested in this study. Results: Hb levels were slightly elevated when body mass index values were increased. Approximately 61% of patients having high Hb levels were meat consumers compared to nonmeat consumers who did not have high Hb levels. About 36% of patients who had high Hb levels were smokers compared to 11% who were nonsmokers. A total of 17% of patients having high Hb levels were taking aspirin in comparison to 26% who were not taking this drug. Chronic diseases, family history, previous history, or recurrent donation seem to have unclear effect on Hb levels. Conclusion: Smoker and overweight people seemed to have higher Hb levels, whereas aspirin administration led to decreasing Hb levels. Other manifestation had little or no relationship with Hb levels.

Keywords: Aspirin, hemoglobin, meat consumption, polycythemia, smoking


How to cite this article:
Mahmood AH, Naser MY. Effect of Body Mass Index, Smoking, and Aspirin Administration on Polycythemia Incidences. Int J Nutr Pharmacol Neurol Dis 2018;8:162-6

How to cite this URL:
Mahmood AH, Naser MY. Effect of Body Mass Index, Smoking, and Aspirin Administration on Polycythemia Incidences. Int J Nutr Pharmacol Neurol Dis [serial online] 2018 [cited 2019 Jan 16];8:162-6. Available from: http://www.ijnpnd.com/text.asp?2018/8/4/162/248539




   Introduction Top


As first described in 1892, polycythemia vera is a clonal disorder arising in morphologically normal red cells, white cells, platelets, and their progenitors in the absence of a definable stimulus and to the exclusion of nonclonal hematopoiesis.[1] While uncommon, with an incidence rate of at least 2 per 100,000 of population,[2] a higher incidence has been suggested in individuals of Jewish origin 44–48 and among parent-offspring pairs.[3] Median age at diagnosis of polycythemia is approximately 60 years with a slight (1.2:1) male majority. Approximately 7% of patients are detected below age 40 years, and children are rarely diagnosed with polycythemia.[3] After 10 decades of careful clinical and laboratory investigation, the etiology of polycythemia vera remains unknown, and there is no consensus as to the optimal therapy for the disorder.[4]

There are some factors or parameters affecting the occurrence of polycythemia. A significant proportion of patients with polycythemia are above their ideal body mass index (BMI).[5] Males are markedly predominated of apparent and relative polycythemia studies. Obesity could cause hypoventilation at night and in the recumbent position, which produce arterial hypoxemia. However, hypertension, more common in obese patients, is a relatively common finding in patients with apparent polycythemia.[6],[7],[8] Smokers have higher packed cell volume (PCV) values than nonsmokers. The principal effect of smoking is to reduce the arterial oxygen content by increasing the carbon monoxide content of the blood from the nonsmoker level of less than 2.5% to values up to 10% and occasionally more.[9],[10],[11]

To examine the effect of these factors on the presence of polycythemia in Iraq, this study aimed to define the effect of BMI, smoking, aspirin administration, and other parameters on hemoglobin (Hb) levels.


   Materials and Methods Top


Study design and patients

The study was performed at The Iraqi National Blood Bank in Baghdad in April 2016. Data including age, sex, living place, weight, and height were collected personally from 80 patients attending on three different days at the bank for blood donation. Patients were questioned about different parameters including smoking and having large amounts and/or frequent times of meat. All patients signed a consent form for participating in this study. In addition, chronic diseases and abnormal signs, having history of polycythemia in person and/or in family, and prevolunteering manifestation were also asked. Chronic diseases included hypertension, diabetes, sinusitis, and dyspnea. Patients were also asked about taking aspirin frequently.

Tested parameters

Hb values for each patient were estimated immediately after collecting at the bank by technicians using HemoCue Hb 301 Analyzer System (HemoCue AB, Kuvettgatan 1, Sweden). Patients who had Hb value of 17 g/dL and more were categorized as polycythemic patients.

BMI was calculated using the following equation:



where power = (height)2

Normal distribution of the sample was tested. All data were measured and statistically analyzed to be presented using the Microsoft Excel.


   Results Top


Thirty out of 80 patients had Hb levels more than 17 g/dL and considered to be polycythemic. According to Hb values, patients were found to be normally distributed with dominancy of high values [Figure 1]. Hb levels were slightly raised when BMI values increased, this indicates a positive relationship between Hb levels and BMI values [Figure 2].
Figure 1: The graph shows the distribution of patients tested according to hemoglobin levels

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Figure 2: The graph shows the relationship between hemoglobin levels and BMI values of tested patients

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[Table 1] shows numbers and percentages of high to nonhigh Hb levels for each parameter of manifestation (existence of remarked parameter), and high to nonhigh Hb levels of parameters with no manifestation. [Table 2] presented percentages of high Hb levels compared to low and normal Hb levels with or without existence of the same manifestation. About 61% of patients with high Hb levels were meat consumers compared to nonmeat consumers who had no high Hb levels. Approximately 36% of patients who had high Hb levels were smokers compared to 11% who were nonsmokers. In contrast, 17% of patients who were taking aspirin had high Hb levels in comparison to 28% who were not taking this drug.
Table 1: Numbers and percentages of high Hb level patients compared to those who had low and normal Hb with or without incidence of the same separate manifestation

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Table 2: The percentages of high Hb levels compared to low and normal Hb levels with or without occurrence of the same separate manifestation

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All other parameters such as chronic diseases, family history, previous history, or recurrent donation seem to have little or unclear effect on Hb levels (see [Table 2]).


   Discussion Top


The study included 80 blood donors to examine the effect of some parameters including BMI, smoking, meat consumption, chronic diseases, family history and previous individual history, recurrent blood donation, and administration of aspirin. The sample size seems to be realistic to the population after been tested in [Figure 1].

The increase in BMI led to increase in Hb levels [Figure 2]; this might be consistent with the previous findings that the proportion of patients with polycythemia was significantly above their superlative BMI.[5],[12],[13] Obese or overweight people may have hypoxia more than others who have normal BMI.[14],[15] Tissue hypoxia is suggested as a cause of erythrocytosis.[1],[15]

The results indicated that smoking leads to increase of Hb levels as well as the findings of previous reports that stated smoking is considered a reason of reversible primary or secondary polycythemia.[9],[16] Secondary erythrocytosis was also manifested in a young male due to abuse of hookah (narghile) smoking.[17] However, laboratory results showed that Hb was 22.7 g/dL and haematocrit was 69.1%, whereas WBC differential count, and platelets count were within the normal limits.[17]

Consumption of meat might have significant effect on Hb levels (see [Figure 3] and [Figure 4] and [Table 1] and [Table 2]). In our study, it is difficult to confirm that eating of meat has an effect on Hb levels as only one person was nonmeat eater among tested patients. However, previous reports stated that red meat enhance heme-iron absorption leading to elevation of Hb and PCV levels,[18] whereas another study reported that meat consumption has no effect on Hb levels.[19]
Figure 3: Manifestations’ frequencies of tested parameters with different hemoglobin levels. Manifestation means existence of parameter; no manifestation means no existence of parameter

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Figure 4: Percentages of each parameter with different hemoglobin levels. Manifestation means existence of parameter; no manifestation means no existence of parameter

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Diseases and family history might have little or no effect on Hb levels; due to few manifestations of these parameters, further comprehensive studies will be needed to determine the impact if existed.Previous history and recurrent donation seem to have little or no effect on Hb levels (see [Figure 3] and [Figure 4] and [Table 2]). Prior studies found that repeated blood donations (more than three times a year) might reduce iron level, which consequently leads to boost blood genesis.[20]

Aspirin in this study seems to have an impact on decreasing Hb levels as seen in the results. Interestingly, no data are provided to approve or describe this finding. Previous studies have only reported that aspirin as an antithrombotic agent decreased the risk of thrombosis in polycythemic patients[21],[22],[23],[24],[25] with no indication whether it is affecting Hb levels or not. Therefore, further studies will be needed to confirm its effect on Hb levels.

The interaction effects among different manifestation were not examined in this study; additional studies will be required to investigate these interferences.


   Conclusion Top


This study was performed to exhibit the effect of some clinical manifestations on the occurrence of polycythemia. Overweight and smoking may lead to elevating Hb levels, whereas aspirin administration led to reducing its levels. Previous history and recurrent donation seemed to have little effect. Meat consumption, chronic diseases, and family history had unclear effect on Hb levels; therefore, further studies will be needed to determine this effect.

Volunteers who undertake (repeated) blood donation should receive special nutritional care, especially in terms of iron and energy supplements. Additional studies are needed to investigate cross-effect interactions of clinical manifestations above on Hb levels.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Spivak JL. Polycythemia vera: Myths, mechanisms, and management. Blood 2002;100:4272-90.  Back to cited text no. 1
    
2.
Berglund S, Zettervall O. Incidence of polycythemia vera in a defined population. Eur J Haematol 1992;48:20-6.  Back to cited text no. 2
    
3.
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4.
Streiff MB, Smith B, Spivak JL. The diagnosis and management of polycythemia vera in the era since the Polycythemia Vera Study Group: A survey of American Society of Hematology members’ practice patterns. Blood 2002;99:1144-9.  Back to cited text no. 4
    
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Messinezy M, Pearson TC. A retrospective study of apparent and relative polycythaemia: Associated factors and early outcome. Clin Lab Haematol 1990;12:121-9.  Back to cited text no. 5
    
6.
Ward HP, Bigelow DB, Petty TL. Postural hypoxemia and erythrocytosis. Am J Med 1968;45:880-8.  Back to cited text no. 6
    
7.
Zwillich CW, Sutton FD, Pierson DJ, Creagh EM, Weil JV. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med 1975;59:343-8.  Back to cited text no. 7
    
8.
Pearson TC. Apparent polycythaemia. Blood Rev 1991;5:205-13.  Back to cited text no. 8
    
9.
Smith JR, Landaw SA. Smokers’ polycythemia. N Engl J Med 1978;298:6-10.  Back to cited text no. 9
    
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Strieder DJ, Murphy R, Kazemi H. Mechanism of postural hypoxemia in asymptomatic smokers. Am Rev Res Dis 1969;99:760-6.  Back to cited text no. 10
    
11.
Doll DC, Greenberg BR. Cerebral thrombosis in smokers’ polycythemia. Ann Intern Med 1985;102:786-7.  Back to cited text no. 11
    
12.
Mujica-Coopman MF, Brito A, López de Romaña D, Pizarro F, Olivares M. Body mass index, iron absorption and iron status in childbearing age women. J Trace Elem Med Biol 2015;30:215-9.  Back to cited text no. 12
    
13.
Weil MH. Polycythemia associated with obesity. J Am Med Assoc 1955;159:1592-5.  Back to cited text no. 13
    
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Jubber AS. Respiratory complications of obesity. Int J Clin Pract 2004;58:573-80.  Back to cited text no. 14
    
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Simmons D. Increased red cell count in diabetes and pre-diabetes. Diabetes Res Clin Pract 2010;90:e50–3.  Back to cited text no. 15
    
16.
Sagone AL Jr, Balcerzak SP. Smoking as a cause of erythrocytosis. Ann Intern Med 1975;82:512-5.  Back to cited text no. 16
    
17.
Tadmor T, Mishchenko E, Polliack A, Attias D. Hookah (narghile) smoking: A new emerging cause of secondary polycythemia. Am J Hematol 2011;86:719-20.  Back to cited text no. 17
    
18.
Fleming DJ, Tucker KL, Jacques PF, Dallal GE, Wilson PWF, Wood RJ. Dietary factors associated with the risk of high iron stores in the elderly Framingham Heart Study cohort. Am J Clin Nutr 2002;76:1375-84.  Back to cited text no. 18
    
19.
Nicklas TA, Farris RP, Myers L, Berenson GS. Impact of meat consumption on nutritional quality and cardiovascular risk factors in young adults. J Acad Nutr Diet 1995;95:887-92.  Back to cited text no. 19
    
20.
Djalali M, Tirang R, Neyestani JB, Fereydoun S. The effect of repeated blood donations on the iron status of Iranian blood donors attending the Iranian Blood Transfusion Organization. Int J Vitam Nutr Res 2006;76:132-7.  Back to cited text no. 20
    
21.
Gruppo Italiano Studio Policitemia. Low-dose aspirin in polycythaemia vera: A pilot study. Br J Haematol 1997;97:453-6.  Back to cited text no. 21
    
22.
Passamonti F. How I treat polycythemia vera. Blood 2012;120:275–84.  Back to cited text no. 22
    
23.
Vannucchi AM. How I treat polycythemia vera. Blood 2014;124:3212–20.  Back to cited text no. 23
    
24.
Grinfeld J, Godfrey AL. After 10 years of JAK2V617F: Disease biology and current management strategies in polycythaemia vera. Blood Rev 2017;31:101–18.  Back to cited text no. 24
    
25.
Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono T et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med 2004;350:114-24.  Back to cited text no. 25
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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