S1148 Effect of Cannabis Use on Progression of Non-Alcoholic Fatty Liver Disease in Obese Patients: A Propensity-Matched Retrospective Cohort Study

Abstract

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) describes a condition of pathologic fat accumulation in hepatocytes when a secondary cause cannot be identified (e.g. excessive alcohol use). The spectrum of disease seen in NAFLD includes Non-Alcoholic Fatty Liver (NAFL), and the more pathologic variant, Non-Alcoholic Steatohepatitis (NASH). While NAFL is more common, the hepatocellular injury and inflammation that occurs in NASH contributes significantly to the increased risk of liver failure, cirrhosis, and hepatocellular carcinoma in NAFLD patients. Anti-inflammatory effects of cannabis are well described in experimental literature. Tetrahydrocannabinol (THC) specifically, has been shown to have anti-inflammatory and hepatoprotective activity in myofibroblast and stellate cells. How the hepatoprotective properties of cannabis affect disease manifestation and incidence of NAFLD is the subject of this investigation. The aim of this study is to determine how cannabis use affects the prevalence and progression of NAFLD in obese human subjects. METHODS: We studied the 2016 Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) discharge records, and gathered data on patients who were obese and at least 18 years of age (N = 879952). The main study outcome was prevalence of the four presentations of NAFLD: Steatosis, Steatohepatitis, Cirrhosis and Hepatocellular Carcinoma. We then compared the prevalence of disease stage between cannabis and non-cannabis users. Lastly, we further matched the non-cannabis group with demographic factors and other patient related confounders. All analysis was done using STATA 14 software. RESULTS: A total of 879,952 obese patients were admitted within the study period. Cannabis users 14,236 (1.6%) had less steatohepatitis (0.4% vs 0.7%, P < 0.001) and cirrhosis (1.1% vs 1.5%, P < 0.001) than non-users. After propensity matched analysis, cannabis use remained significantly associated with less steatohepatitis (0.4% vs 0.5%, P = 0.035). Post-match, there was no statistically significant difference in the prevalence of NAFL, cirrhosis and hepatocellular carcinoma. CONCLUSION: Results from this study suggest that cannabis use is associated with reduced prevalence and progression of steatohepatitis in obese patients. These findings could possibly be explained by the anti-inflammatory and hepatoprotective effect of cannabis on hepatocytes through the endocannabinoid system. Additional studies are needed to further explore this relationship.Table 1a.: Descriptive Statistics of Obese Population: Cannabis and Non-Cannabis Users and Propensity Score MatchTable 1b.: Outcome Statistics of Obese Population: Cannabis and Non-Cannabis Users and Propensity Score Match