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. 2018 Apr 17;13(4):e0195147.
doi: 10.1371/journal.pone.0195147. eCollection 2018.

Cigarette smoking is a risk factor for the onset of fatty liver disease in nondrinkers: A longitudinal cohort study

Masashi Okamoto  1 , Teruki Miyake  1 , Kohichiro Kitai  2 , Shinya Furukawa  3   4 , Shin Yamamoto  5 , Hidenori Senba  1 , Sayaka Kanzaki  1 , Akiko Deguchi  1 , Mitsuhito Koizumi  1   2 , Toru Ishihara  1   2 , Hiroaki Miyaoka  6 , Osamu Yoshida  1 , Masashi Hirooka  1 , Teru Kumagi  7 , Masanori Abe  1 , Bunzo Matsuura  5 , Yoichi Hiasa  1
Affiliations

Cigarette smoking is a risk factor for the onset of fatty liver disease in nondrinkers: A longitudinal cohort study

Masashi Okamoto et al. PLoS One. .

Abstract

Background: The effect of cigarette smoking on the onset of nonalcoholic fatty liver disease (NAFLD) is unclear, especially that associated with drinking small amounts of alcohol. We conducted a longitudinal study to investigate the relationship between cigarette smoking and NAFLD onset, which was stratified according to the amount of alcohol consumed.

Methods: We enrolled 7,905 Japanese subjects who had received annual health checkups more than twice between April 2003 and August 2013, 4,045 of whom met at least one of the following exclusion criteria and were excluded: (a) fatty liver at baseline; (b) hepatitis B or hepatitis C; (c) alcohol consumption (men: ≥210 g/wk; women: ≥140 g/wk); (d) change in alcohol drinking status between baseline and the study's endpoint; (e) change in cigarette smoking habits between baseline and the study's endpoint; or (f) current treatment with antidiabetic agents, antihypertensive agents, and/or lipid-lowering agents. The remaining 3,860 subjects (1,512 men, 2,348 women) were divided into two groups based on average alcohol consumption.

Results: After adjusting for the variables associated with metabolic disease, smoking was associated with fatty liver disease onset compared with nonsmokers in nondrinkers (adjusted hazard ratio = 1.988, 95% confidence interval 1.057-3.595; p = 0.034). No association was found between smoking and fatty liver disease onset in the low alcohol consumption group (men: <210 g alcohol/week; women: <140 g alcohol/week). The fatty liver disease incidence increased significantly among the nondrinkers as the number of cigarettes smoked increased (p = 0.001).

Conclusions: Cigarette smoking may be a significant risk factor associated with NAFLD onset in nondrinkers. These results may help clinicians to identify patients who are at a high risk of developing NAFLD and to prevent the progression of NAFLD by promoting earlier interventions that help people discontinue unhealthy lifestyle habits.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of subject selection.
Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus.
Fig 2
Fig 2. Association between the number of cigarettes smoked and the incidence of fatty liver disease in the nondrinker group.
The p values were determined using the Cochran-Armitage test. NAFLD, nonalcoholic fatty liver disease.
See this image and copyright information in PMC

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