The association between active cigarette smoking and acute gastrointestinal morbidity in US adults: A NHANES-based cross-sectional analysis

Acute gastroenteritis, characterized by vomiting and/or diarrhea, places a significant burden on healthcare systems and the economy. Although tobacco is recognized as a risk factor for chronic gastrointestinal (GI) diseases, its role in acute GI morbidity has not been widely investigated in population-based studies. To quantify the independent association between smoking status and 30-day prevalence of acute GI illness involving vomiting and/or diarrhea, adjusting for key confounders. We used nationally representative data from the 2005 to 2010 National Health and Nutrition Examination Survey (n = 12,358 adults aged ≥20 years) to classify smoking status as never, former, or current. The outcome was self-reported GI illness involving vomiting and/or diarrhea in the past 30 days. We employed staged multivariable logistic regression, sequentially adjusting for the following factors: demographics, comorbidities and body mass index, diet, and inflammatory and nutritional biomarkers. Current smokers had a significantly higher prevalence of GI illness (11.3%) than never smokers (7.5%) and former smokers (8.2%) (P < .001). In the fully adjusted models, current smoking was associated with a 52% increase in the odds of GI illness (odds ratio: 1.52; 95% confidence interval: 1.29-1.79; P < .001), whereas former smokers had odds that were 19% higher (odds ratio: 1.19; 95% confidence interval: 1.01-1.41; P = .037). Stratified analyses confirmed consistency across demographic and clinical subgroups (all P-interactions > .05). Active cigarette smoking is an independent risk factor for acute GI morbidity. The reduced risk among former smokers suggests that the harm caused by tobacco can be reversed, thus supporting smoking cessation as a preventive strategy. This study broadens our understanding of smoking-related diseases and provides insights into integrated tobacco control interventions.