Cigarette Smoking Increased Risk of Overall Mortality in Patients With Non-alcoholic Fatty Liver Disease: A Nationwide Population-Based Cohort Study

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.

Cigarette smoking and liver diseases

“…The impact of smoking on NAFLD natural history has been investigated in prospective population-based studies. Analysis from the USA and Thai National Health Examination Surveys revealed that smoking consistently increases mortality by two-fold among NAFLD subjects (HR: 2.33; 95%CI 1.66-3.27) [116][117][118]. Differences were stronger among heavy smoker women (HR for ≥10 packyears: 5.40; 95%CI 2.19-13.4) [118].…”

“…Analysis from the USA and Thai National Health Examination Surveys revealed that smoking consistently increases mortality by two-fold among NAFLD subjects (HR: 2.33; 95%CI 1.66-3.27) [116][117][118]. Differences were stronger among heavy smoker women (HR for ≥10 packyears: 5.40; 95%CI 2.19-13.4) [118]. Adjusted by gender, the magnitude of the increase in mortality differed from non-NAFLD population if fatty liver was diagnosed with biochemical tests (hepatic steatosis index) but did not differ if diagnosis was based on US [116,117].…”

Treatments for NAFLD: State of Art

“…All patients with NAFLD, regardless of the presence of T2DM, should avoid alcohol consumption (even moderate) and, when possible, the use of hepatotoxic drugs [ 1 , 2 ]. Clinicians should also recommend avoiding cigarette smoking [ 1 , 2 , 15 , 20 ] and fructose-containing beverages and foods [ 1 , 2 , 15 , 21 ].…”

HNRNPA2B1, as a m6A Reader, Promotes Tumorigenesis and Metastasis of Oral Squamous Cell Carcinoma

“…Interestingly, the relationship between HNRNPA2B1 expression and the clinicopathological characteristics was statistically analyzed, and the results showed a direct association between HNRNPA2B1 expression and histological grade and metastasis ( Table 2 ). Here, the definition of smoking is as follows: participants who smoked more than 100 cigarettes were classified as smokers ( 36 ). The definition of drinking is as follows: the participant had drunk alcohol regularly (i.e., drank at least once a week on a regular basis) during the past 12 months, otherwise were considered non-drinkers ( 37 ).…”