Department of General Practice, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Interventional Oncology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Exp Clin Endocrinol Diabetes. 2022 Dec;130(12):793-800. doi: 10.1055/a-1813-7435. Epub 2022 Mar 31.
Cigarette smoke and non-alcoholic fatty liver disease are risk factors for type 2 diabetes mellitus. However, the impact of smoking on diabetes risk among patients with non-alcoholic fatty liver disease remains unclear.
This study included 15,464 Japanese individuals. We defined non-alcoholic fatty liver disease based on abdominal ultrasound findings where excess alcohol intake and other liver diseases were excluded. We used Cox proportional regression analysis to identify risk factors for type 2 diabetes onset.
During 16,446 person-years of follow-up, 223 of 2,714 non-alcoholic fatty liver disease patients developed type 2 diabetes; the cumulative incidence rate of type 2 diabetes was 13.6 per 1,000 person-years. The proportions of never, former, and current smokers (self-report) were 35.3%, 31.1%, and 33.6%, and 88.5%, 5.1%, and 6.4% in men and women, respectively. In a Cox regression model adjusted for sex, age, body mass index, waist circumference, alcohol intake, exercise, and alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, lipid profiles, and blood pressure values, relative to never smokers, current smokers with non-alcoholic fatty liver disease had an increased risk of type 2 diabetes (hazard ratio=2.05; 95% confidence interval: 1.43-2.94). In addition, former smoking affected the risk of type 2 diabetes; however, this effect was not statistically significant.
This longitudinal study showed that current smoking may act as a "second hit" and increase the risk of type 2 diabetes in patients with non-alcoholic fatty liver disease.
香烟烟雾和非酒精性脂肪性肝病是 2 型糖尿病的危险因素。然而，吸烟对非酒精性脂肪性肝病患者糖尿病风险的影响尚不清楚。
本研究纳入了 15464 名日本人。我们根据腹部超声检查结果定义了非酒精性脂肪性肝病，排除了过量饮酒和其他肝脏疾病。我们使用 Cox 比例风险回归分析确定 2 型糖尿病发病的危险因素。
在 16446 人年的随访期间，2714 例非酒精性脂肪性肝病患者中有 223 例发生 2 型糖尿病；2 型糖尿病的累积发病率为每 1000 人年 13.6 例。从不吸烟、曾经吸烟和现在吸烟（自我报告）的比例分别为 35.3%、31.1%和 33.6%，男性和女性分别为 88.5%、5.1%和 6.4%。在调整性别、年龄、体重指数、腰围、饮酒量、运动和丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ-谷氨酰转肽酶、血脂谱和血压值的 Cox 回归模型中，与从不吸烟者相比，患有非酒精性脂肪性肝病的现在吸烟者发生 2 型糖尿病的风险增加（风险比=2.05；95%置信区间：1.43-2.94）。此外，曾经吸烟也会影响 2 型糖尿病的发病风险；然而，这种影响没有统计学意义。
这项纵向研究表明，现在吸烟可能是一种“二次打击”，增加非酒精性脂肪性肝病患者发生 2 型糖尿病的风险。
