Urinary tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cognitive functioning in older adults: The National Health and Nutrition Examination Survey 2013-2014

Song Ge; Weixia Ma; Zhe Qu; Xingmei Zhu; Zijing Chen; Xuechun Lin; Zhenmei Fu

doi:10.18332/tid/162368

Urinary tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and cognitive functioning in older adults: The National Health and Nutrition Examination Survey 2013-2014

Tob Induc Dis. 2023 May 25:21:68. doi: 10.18332/tid/162368. eCollection 2023.

Authors

Song Ge¹, Weixia Ma², Zhe Qu³, Xingmei Zhu⁴, Zijing Chen⁵, Xuechun Lin⁶, Zhenmei Fu⁷

Affiliations

¹ Department of Natural Sciences, College of Sciences and Technology, University of Houston-Downtown, Houston, United States.
² Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
³ School of Nursing, Xuzhou Medical University, Xuzhou, China.
⁴ Yaxin School of Nursing, Wuhan Institute of Design and Science, Wuhan, China.
⁵ Chinese Nursing Association, Beijing, China.
⁶ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁷ Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

Abstract

Introduction: Tobacco contains carcinogens called tobacco-specific nitrosamines. Among the tobacco-specific nitrosamines, is nicotine-derived nitrosamine ketone (NNK) which produces the metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). We aimed to examine the association between urinary tobacco-specific NNAL and cognitive functioning among older adults.

Methods: A total of 1673 older adults aged ≥60 years from the National Health and Nutrition Examination Survey 2013-2014 were included. Urinary tobacco-specific NNAL was analyzed in the laboratory. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning subtest (CERAD-WL) immediate and delayed memory tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated based on means and standard deviations of the cognitive test scores. Multivariable linear regression models were constructed to examine the independent association between quartiles of urinary tobacco-specific NNAL and cognitive test-specific and global cognition z-scores controlling for age, sex, race/ethnicity, education level, depressive symptoms, body mass index, systolic blood pressure, urinary creatinine, hypertension, diabetes, alcohol use, and smoking status.

Results: About half of the participants (mean age 69.8 years) were female (52.1%), non-Hispanic White (48.3%), and completed some college and above (49.7%). Multivariable linear regression results showed that participants in the 4th quartile (highest quartile) of urinary NNAL, compared with those in the 1st quartile (lowest quartile), had lower DSST z-scores (β= -0.19; 95% CI: -0.34 - -0.04).

Conclusions: Tobacco-specific NNAL was negatively associated with processing speed, sustained attention, and working memory in older adults.

Keywords: NHANES; cognitive function; older adults; smoking; tobacco-specific nitrosamines.