“…Second, the inclusion of elderly subjects more than 60 years of age (Al Mutairi et al, 2006; Saffar Soflaei et al, 2018; Shafique et al, 2012) may introduce a bias because the prevalence of altered metabolic data (e.g., MetS) increases with age (Ribeiro, Seixas, Galvez, & Climent, 2018). Third, the lack of information about the different types of the narghile tobacco used (Hallit et al, 2017; Koubaa et al, 2015; Mahassni & Alajlany, 2017; Saffar Soflaei et al, 2018; Shafique et al, 2012), makes any comparison difficult, because in the case of tombak or jurak , in comparison to tabamel , the pattern is different (Ben Saad, 2009). Fourth, different methods of narghile-use quantification (not reported [Hallit et al, 2017; Mahassni & Alajlany, 2017; Saffar Soflaei et al, 2018; Shafique et al, 2012], run/day [Al Mutairi et al, 2006], total duration of smoking [Al Mutairi et al, 2006], narghile/year [NY; Koubaa et al, 2015], and quantity in kg of tobacco smoked/year [Koubaa et al, 2015]) were applied.…”