{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:56:52Z","timestamp":1790780212237,"version":"4.1.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Electronic cigarettes (e-cigarettes) have rapidly emerged as a popular alternative to conventional tobacco smoking, contributing to a substantial rise in their global use over the past decade. Although marketed as a safer, combustion-free method of nicotine delivery, increasing evidence suggests that e-cigarette exposure may adversely affect metabolic health. This literature review evaluates current evidence regarding the impact of e-cigarette use on the metabolic system. Relevant studies published until 2026 were identified through searches of databases including PubMed, Embase, CINAHL, and reports from the World Health Organization. This narrative review incorporates findings from both human and animal studies examining the metabolic consequences of e-cigarette exposure. Current evidence suggests that nicotine and other aerosol constituents may contribute to metabolic dysregulation through oxidative stress, inflammation, mitochondrial dysfunction, and altered cellular signaling pathways. Several studies have demonstrated associations between e-cigarette use and obesity-related outcomes, including increased body mass index and adipose tissue dysfunction. Evidence has also linked e-cigarette exposure to insulin resistance, impaired glucose metabolism, elevated HbA1c levels, reduced antioxidant activity, and increased expression of glycogen synthase kinase-3 beta (GSK3\u03b2), a pathway implicated in the development of prediabetes. Additionally, broader components of metabolic syndrome, including hypertension, dyslipidemia, endothelial dysfunction, and cardiovascular risk factors, have been explored in the literature. While the findings collectively suggest a potential relationship between e-cigarette use and adverse metabolic outcomes, the current body of evidence remains limited by the predominance of cross-sectional and short-term studies. Further longitudinal, clinical, and mechanistic research is necessary to better establish causality and clarify the long-term metabolic effects of e-cigarette use.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1930924","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:12:16Z","timestamp":1790777536000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of e-cigarette exposure on metabolic function: a narrative review"],"prefix":"10.3389","volume":"14","author":[{"given":"Insiya Sajjad Hussain","family":"Saifudeen","sequence":"first","affiliation":[{"name":"School of Medicine, Royal College of Surgeons in Ireland","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sama","family":"Thiab","sequence":"additional","affiliation":[{"name":"School of Medicine, Royal College of Surgeons in Ireland","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abrar","family":"Alhermi","sequence":"additional","affiliation":[{"name":"School of Medicine, Royal College of Surgeons in Ireland","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L.","family":"Atkin","sequence":"additional","affiliation":[{"name":"Research Department, Royal College of Surgeons in Ireland","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra E.","family":"Butler","sequence":"additional","affiliation":[{"name":"Research Department, Royal College of Surgeons in Ireland","place":["Busaiteen, Bahrain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1161\/CIRCULATIONAHA.114.007667","article-title":"E-cigarettes: a scientific review","volume":"129","author":"Grana","year":"2014","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1136\/tobaccocontrol-2013-051122","article-title":"Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review","volume":"23","author":"Pepper","year":"2014","journal-title":"Tob Control."},{"key":"B3","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12954-021-00556-7","article-title":"Estimation of the global number of e-cigarette users in 2020","volume":"18","author":"Jerzy\u0144ski","year":"2021","journal-title":"Harm Reduct J."},{"key":"B4","volume-title":"Technical Note on the Call to Action on Electronic Cigarettes","year":"2023"},{"key":"B5","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1056\/NEJMc1413069","article-title":"Hidden formaldehyde in e-cigarette aerosols","volume":"372","author":"Jensen","year":"2015","journal-title":"N Engl J Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.envpol.2014.12.033","article-title":"Environmental health hazards of e-cigarettes and their components: oxidants and copper in e-cigarette aerosols","volume":"198","author":"Lerner","year":"2015","journal-title":"Environ Pollut."},{"key":"B7","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s43994-024-00123-3","article-title":"Nicotine in electronic cigarettes","volume":"10","author":"Althakfi","year":"2024","journal-title":"J Umm Al-Qura Univ Appl Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/ajcn\/87.4.801","article-title":"Consequences of smoking for body weight, body fat distribution, and insulin resistance","volume":"87","author":"Chiolero","year":"2008","journal-title":"Am J Clin Nutr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0116732","DOI":"10.1371\/journal.pone.0116732","article-title":"Vapors produced by electronic cigarettes and e-juices with flavorings induce toxicity, oxidative stress, and inflammatory response in lung epithelial cells and in mouse lung","volume":"10","author":"Lerner","year":"2015","journal-title":"PLoS ONE."},{"key":"B10","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1038\/414799a","article-title":"Insulin signalling and the regulation of glucose and lipid metabolism","volume":"414","author":"Saltiel","year":"2001","journal-title":"Nature."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1080\/17425247.2019.1665647","article-title":"What is the nicotine delivery profile of electronic cigarettes?","volume":"16","author":"Voos","year":"2019","journal-title":"Expert Opin Drug Deliv."},{"key":"B12","doi-asserted-by":"publisher","first-page":"807","DOI":"10.2337\/db11-1079","article-title":"Morentin PB, Whittle AJ, Fern\u00f8 J, Nogueiras R, Di\u00e9guez C, Vidal-Puig A, et al. 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