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Smoking and the Risk of Non-Alcoholic Fatty Liver Disease

A Cohort Study

Jung, Hyun-Suk, MD1; Chang, Yoosoo, MD, PhD1,2,3; Kwon, Min-Jung, MD, PhD2,4; Sung, Eunju, MD, PhD1,4; Yun, Kyung Eun, MD, PhD1; Cho, Yong Kyun, MD, PhD5; Shin, Hocheol, MD, PhD1,6; Ryu, Seungho, MD, PhD1,2,3

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 453–463
doi: 10.1038/s41395-018-0283-5
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OBJECTIVES: The role of smoking in the development of non-alcoholic fatty liver disease (NAFLD) remains controversial. We assessed the risk of incident NAFLD according to smoking status and urinary cotinine levels.

METHODS: We performed a cohort study of 199,468 Korean adults without NAFLD at baseline who were followed annually or biennially for a median of 4.1 years. The presence of fatty liver was determined using ultrasound. NAFLD severity was assessed using NAFLD fibrosis score (NFS), a non-invasive fibrosis marker.

RESULTS: During 1,070,991 person-years of follow-up, 45,409 participants developed NAFLD. Self-reported current smoking, pack-years, and urinary cotinine level were significantly associated with increased risk for NAFLD. For men, the multivariable-adjusted hazard ratios (aHR) (95% confidence intervals (CI)) for incident NAFLD comparing 10–19.9, and ≥20 pack-years to 0 pack-years were 1.25 (1.21– 1.29), and 1.36 (1.30–1.42), respectively; for women, aHR (95% CI) for NAFLD comparing 5–9.9, and ≥10 pack-years to 0 pack-years were 1.25 (1.04–1.50), and 1.46 (1.17–1.81), respectively. Smoking pack-years were also associated with increased risk for NAFLD plus intermediate or high fibrosis score. For men, the aHR (95% CI) for NAFLD plus intermediate or high NFS comparing ≥20 pack-years to 0 pack-years was 1.29 (1.18–1.42); for women, the aHR (95% CI) comparing ≥10 pack-years to 0 pack-years was 1.75 (1.12–2.73).

CONCLUSIONS: In a large cohort of young and middle-aged men and women, current smoking, pack-years, and urinary cotinine levels were positively associated with the risk of incident NAFLD, suggesting that smoking contributes to the development of NAFLD.

1Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;

2Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;

3Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea;

4Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;

5Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;

6Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Correspondence: Yoosoo Chang, MD, PhD. E-mail: yoosoo.chang@gmail.com or Seungho Ryu, MD, PhD. E-mail: sh703.yoo@gmail.com.

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A44

Received April 13, 2018

revised August 22, 2018

Accepted August 23, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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