Serum Bilirubin Concentration in a Belgian Population: the Association with Smoking Status and Type of Cigarettes

Background: The endogenous antioxidant serum bilirubin may scavenge free radical species from cigarette smoke. Smokers are expected to have lower serum bilirubin levels than never smokers, but this has never been evaluated in a random population sample of women and men. In addition, in vitro studies indicate that filter cigarette smoke might enhance bilirubin oxidation more than non-filter cigarette smoke.

Methods: In this paper, data were analysed from the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study. We investigated the association of smoking and type of cigarettes with serum bilirubin concentrations in men and women using multiple regression models taking into account differences in baseline and smoking characteristics.

Results: In men, current smokers had lower crude and adjusted serum bilirubin concentrations compared with never smokers (P = 0.0001). For women, the association between smoking and serum bilirubin concentrations adjusted for age was in the same direction as for men, but did not reach statistical significance. Male former smokers had serum bilirubin concentrations in between those of current smokers and never smokers, while female former smokers had even higher (+ 0.50 micromol/l) serum bilirubin concentrations than never smokers. Male subjects smoking filter cigarettes showed a higher serum bilirubin concentration than those smoking cigarettes without a filter (adjusted difference: 0.49 micromol/l; P = 0.03). The duration of smoking was inversely and significantly related to serum bilirubin concentrations (P = 0.0003).

Conclusion: Smoking may lower serum bilirubin concentrations in men, especially in those smoking non-filter cigarettes. The duration of smoking is a more important determinant for serum bilirubin concentrations than the number of cigarettes smoked per day, which may indicate the cumulative negative effects of smoking on the endogenous antioxidant system. Results for females pointed in the same direction, but were less clear, possibly due to low numbers of smoking women, who were largely young and smoked mainly filter cigarettes for a shorter period of time.