Cannabis use is associated with reduced prevalence of non-alcoholic fatty liver disease: A cross-sectional study

Abstract

Cannabis use is associated with reduced prevalence of obesity and diabetes mellitus (DM) in humans and mouse disease models. Obesity and DM are a well-established independent risk factor for non-alcoholic fatty liver disease (NAFLD), the most prevalent liver disease globally. The effects of cannabis use on NAFLD prevalence in humans remains ill-defined. Our objective is to determine the relationship between cannabis use and the prevalence of NAFLD in humans. We conducted a population-based case-control study of 5,950,391 patients using the 2014 Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Survey (NIS) discharge records of patients 18 years and older. After identifying patients with NAFLD (1% of all patients), we next identified three exposure groups: non-cannabis users (98.04%), non-dependent cannabis users (1.74%), and dependent cannabis users (0.22%). We adjusted for potential demographics and patient related confounders and used multivariate logistic regression (SAS 9.4) to determine the odds of developing NAFLD with respects to cannabis use. Our findings revealed that cannabis users (dependent and non-dependent) showed significantly lower NAFLD prevalence compared to non-users (AOR: 0.82[0.76-0.88]; p<0.0001). The prevalence of NAFLD was 15% lower in non-dependent users (AOR: 0.85[0.79-0.92]; p<0.0001) and 52% lower in dependent users (AOR: 0.49[0.36-0.65]; p<0.0001). Among cannabis users, dependent patients had 43% significantly lower prevalence of NAFLD compared to non-dependent patients (AOR: 0.57[0.42-0.77]; p<0.0001). Our observations suggest that cannabis use is associated with lower prevalence of NAFLD in patients. These novel findings suggest additional molecular mechanistic studies to explore the potential role of cannabis use in NAFLD development.

Fig 1. Cannabis use is associated with reduced non-alcoholic fatty liver disease.

Dependent and Non-Dependent Cannabis Use (DCU & NDCU) are associated with reduced NAFLD when compared to non-cannabis users (NCU). These observations suggest that dependent cannabis use suppresses or reverses the development and progression of NAFLD to advance liver disease (non-alcoholic steatohepatitis [NASH]). Illustrated schematics made use of some motifolio templates (www.motifolio.com).

Fig 2. Dependent alcohol use abolishes reduced NAFLD prevalence observed in non-dependent cannabis users.

Bar graph described from the leftmost to the rightmost: Taking non-cannabis users/non-alcohol users (NCU+NAU) as the reference group, non-dependent (moderate) cannabis use/non-alcohol use (NDCU+NAU) caused a slight reduction in NAFLD prevalence, though not statistically significant. Non-dependent (moderate) alcohol use among NDCU (NDCU+NDA) resulted in a reduced NAFLD prevalence, though this protection was lost with dependent (abusive) alcohol use (NDCU+DA). However dependent (high volume) cannabis use (DCU) was always associated with a reduction in NAFLD prevalence among all categories of alcohol users: non-alcohol (DCU+NAU), moderate/non-dependent alcohol users (DCU+NDA) and copious/dependent alcohol users (DCU+DA). Illustrated schematics made use of some motifolio templates (www.motifolio.com).