Dietary Adequacy among Tobacco User Households in Bangladesh

Background: Smokers have less adequate diet as compared to non-smokers. The indirect effects of tobacco on diet may have profound implications for health and disease outcomes. Less is known about the influence of tobacco on dietary intakes in low-income countries where malnutrition is a major public health challenge. Additionally, the effect of smokeless tobacco on dietary intake are unknown. The purpose of this study was to evaluate influence of tobacco use on dietary intakes in a developing country. Methods: We used the nationally representative Household Income Expenditure Survey (HIES-2010) from Bangladesh. Detailed dietary data including both ethnic and regional specific foods were collected for 14 days and comprised of 7 visits with two days recalls. Overall, 71% of the households reported positive expenditure on tobacco (smoking and/or smokeless), and were considered tobacco users. Results: Out of 12240 households, 2061 used smoking tobacco only (16.8%), 3284 used smokeless tobacco only (26.8%), and 3348 were dual-users (27.4%). Our results indicate that after controlling for household expenditure, household size, place of residence, and education, tobacco users consumed significantly lower daily mean per capita of vegetables (β = −18.35 g/day; P < 0.0001), milk and dairy (β = −12.83 g/day; P < 0.0001), fish (β = −11.19 g/day; P < 0.0001), meat (β = −7.60 g/day; P < 0.0001), legumes (β = −3.31g/day; P < 0.0001), eggs (β = −1.60 g/day; P < 0.0001) as compared to non-users. However, mean per capita daily intakes of cereal products (β = 24.744 g/day; P < 0.0001) was significantly higher among tobacco users as compared to non-users. We observed similar significant associations for smokeless tobacco users as compared to non-users. Conclusion: The project provides evidence to support policy recommendations for addressing poor dietary intakes and malnutrition burden among tobacco user households in a developing country like Bangladesh. Addressing tobacco use in relation to malnutrition would make tobacco control a higher priority for effective tobacco related chronic disease prevention, as well as achieving the Millennium Development Goal 1, and post-2015 development agenda of eradicating extreme poverty and hunger.