Prevalence and Clinical Impact of Smoking and Obesity Among Thalassemia Patients in Egypt: A Single-Center Study

Background Thalassemia is a chronic inherited hemoglobinopathy associated with significant multisystem complications. While transfusion dependency and iron overload are well-recognized determinants of morbidity, the contribution of modifiable lifestyle factors such as obesity and smoking remains incompletely defined. Methods We conducted a cross-sectional study of 108 adults with thalassemia (≥ 18 years) followed at the Oncology Center of Mansoura University. Patients were classified as transfusion-dependent (TDT) or non–transfusion-dependent (NTDT). Clinical, laboratory, and radiologic data were extracted from electronic records. Overweight/obesity was defined as body mass index (BMI) ≥ 25 kg/m², and smoking status was categorized as active, passive, or non-smoker. Statistical analyses were performed using R (v4.4.3) and SPSS (v27). Results The median age was 32 years, with a slight female predominance (52.8%); 81.5% had TDT. Overall, 22.6% were overweight/obese, and 12% were active smokers, while 79.6% had at least one complication. TDT patients exhibited significantly higher rates of cardiac and hepatic complications, splenomegaly, splenectomy, lower hemoglobin levels, and higher red cell distribution width (RDW) than NTDT patients. BMI was modestly higher in NTDT (p = 0.043). In TDT, smoking was associated with hypertension, chronic liver disease, and splenomegaly, with a borderline association with renal insufficiency. Obesity correlated with female sex, valvular heart disease, chronic liver disease, and inflammatory hematologic indices. Conclusion Beyond transfusion-related factors, obesity and smoking appear to contribute to hepatic, cardiovascular, renal, and inflammatory complications in thalassemia. Incorporating lifestyle risk assessment and targeted preventive strategies may improve long-term patient outcomes.