Abstract
Background: The evidence suggests a detrimental effect of cigarette smoking on the progression of chronic liver disease. However, the impact of cigarette smoking on mortality among patients with non-alcoholic fatty liver disease (NAFLD) remain unclear.Methods: We used the National Health Examination Survey data collected during 2008–2009 to link the National Death Index to follow-up respondent survival. Diagnosis of NAFLD was based on a lipid accumulation product in participants without significant alcohol use or other liver diseases.Results: During 64,116 person-years of follow-up, 928 of 7,529 participants with NAFLD died, and the cumulative all-cause mortality was 14.5 per 1,000 person-years. In a Cox regression model adjusted for age, body mass index, alcohol intake, exercise, comorbidities, lipid profiles, and handgrip strength, current smoking increased the risk of mortality by 109% (adjusted hazard ratio (aHR): 2.09, 95% confidence interval [CI]: 1.18–3.71) compared with never smoker status in women, but showed only a trend toward harm among men (aHR: 1.41, 95% CI: 0.96–2.08). After controlling for potential confounders, smoking ≥10 pack-years continued to show a significant harmful effect on all-cause mortality among women (aHR: 5.40, 95% CI: 2.19–13.4), but not in men. Among women who drink alcohol ≥10 grams per day, current smoking (aHR: 13.8, 95% CI: 1.66–145) and smoking ≥10 pack-years (aHR: 310, 95% CI: 78–1,296) also significantly increased risk of death.Conclusion: This nationwide population-based study highlight a detrimental effect of cigarette smoking on mortality, with a similar but more definite association in women than in men with NAFLD.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a growing global health problem that affects almost a quarter of the world’s population [1]
Current smokers were more likely to be younger, alcohol drinkers, have higher measurements for glucose, triglycerides, total cholesterol to high-density lipoprotein cholesterol (HDL-C) ratio, and handgrip strength and lower HDL-C, and less likely to have hypertension and history of cerebrovascular disease compared with never smokers (Table 1)
Former smokers were more likely to be older, alcohol drinkers, have hypertension and history of cerebrovascular disease, and have lower measurements for body mass index (BMI), waist circumference (WC), and handgrip strength compared with never smokers
Summary
Non-alcoholic fatty liver disease (NAFLD) is a growing global health problem that affects almost a quarter of the world’s population [1]. A large body of clinical evidence indicates that NAFLD is associated with an increased risk of other extrahepatic manifestations, such as cardiovascular disease and extrahepatic cancers, which are the predominant causes of mortality in patients with NAFLD [3,4,5,6]. Since NAFLD causes a considerable health burden worldwide, it is important to identify modifiable risk factors and develop prevention strategies. There is growing evidence that cigarette smoking has negative association with the prognosis of chronic liver diseases [11,12,13,14,15,16]. The impact of cigarette smoking on mortality among patients with non-alcoholic fatty liver disease (NAFLD) remain unclear
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