Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Am J Gastroenterol. 2019 Mar;114(3):453-463. doi: 10.1038/s41395-018-0283-5.
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.
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.
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).
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.
吸烟在非酒精性脂肪性肝病（NAFLD）发展中的作用仍存在争议。我们评估了根据吸烟状况和尿可替宁水平发生 NAFLD 的风险。
我们对 199468 名基线时无 NAFLD 的韩国成年人进行了队列研究，这些人每年或每两年随访一次，中位随访时间为 4.1 年。使用超声确定脂肪肝的存在。使用非侵入性纤维化标志物 NAFLD 纤维化评分（NFS）评估 NAFLD 严重程度。
在 1070991 人年的随访期间，有 45409 名参与者发生了 NAFLD。自我报告的当前吸烟、吸烟包年数和尿可替宁水平与 NAFLD 风险增加显著相关。对于男性，与 0 包年相比，10-19.9 包年和≥20 包年的多变量调整后的风险比（aHR）（95%置信区间（CI））分别为 1.25（1.21-1.29）和 1.36（1.30-1.42）；对于女性，与 0 包年相比，5-9.9 包年和≥10 包年的 aHR（95%CI）分别为 1.25（1.04-1.50）和 1.46（1.17-1.81）。吸烟包年数也与 NAFLD 伴中或高度纤维化评分的风险增加相关。对于男性，与 0 包年相比，NAFLD 伴中或高度 NFS 的 aHR（95%CI）为 1.29（1.18-1.42）；对于女性，与 0 包年相比，aHR（95%CI）为≥10 包年，为 1.75（1.12-2.73）。
在一项针对年轻和中年男性和女性的大型队列研究中，当前吸烟、吸烟包年数和尿可替宁水平与发生 NAFLD 的风险呈正相关，表明吸烟会导致 NAFLD 的发生。
