Yang Keungmo, Lee Jaejun, Han Ji Won, Yang Hyun, Chae Seung Yun, Chung Beom Sun, Ryu Tom
Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
Therap Adv Gastroenterol. 2025 Apr 12;18:17562848251331315. doi: 10.1177/17562848251331315. eCollection 2025.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is an increasingly prevalent liver disorder.
This study investigated the effect of smoking status on various clinical outcomes in MASLD and metabolic dysfunction and alcohol-associated liver disease (MetALD).
This study is a retrospective cohort analysis utilizing data from the UK Biobank (Application ID: 117214). Participants were categorized as current, previous, or never smokers, and outcomes were analyzed using inverse probability of treatment weighting to adjust for confounders.
The primary outcomes were all-cause mortality and liver-related mortality. Secondary outcomes included incidence of liver cirrhosis, hepatic decompensation, cardio-cerebrovascular diseases (CVD), and hepatocellular carcinoma (HCC). Multivariate Cox proportional hazards models were employed to evaluate associations.
Previous and never smokers had significantly lower hazard ratios (HRs) for mortality compared to current smokers in all cohorts (HR: 0.33, 95% confidence interval (CI): 0.31-0.35, < 0.001 for never smokers in No SLD cohort, HR: 0.43, 95% CI: 0.41-0.44, < 0.001 for never smokers in MASLD cohort, and HR: 0.41, 95% CI: 0.38-0.45, < 0.001 for never smokers in MetALD cohort). Previous and never smokers showed significantly lower incidences of liver cirrhosis compared to current smokers across all cohorts, except for MetALD. Previous and never smokers showed lower incidences of CVD compared to current smokers. In the MASLD cohort, never smokers had the lowest incidence of hepatic decompensation and HCC. In the MetALD cohort, no significant differences were observed in the risk of hepatic decompensation and HCC between different smoking statuses.
Smoking is related to worse survival outcomes and higher incidences of liver cirrhosis and CVD in MASLD and MetALD cohorts. Therefore, smoking cessation and prevention are crucial strategies for reducing the burden of liver disease and improving patient prognosis.
代谢功能障碍相关脂肪性肝病（MASLD），以前称为非酒精性脂肪性肝病（NAFLD），是一种日益普遍的肝脏疾病。
本研究调查了吸烟状况对MASLD以及代谢功能障碍和酒精相关肝病（MetALD）各种临床结局的影响。
本研究是一项回顾性队列分析，利用了英国生物银行（申请编号：117214）的数据。参与者被分为当前吸烟者、既往吸烟者或从不吸烟者，并使用治疗权重的逆概率分析结局以调整混杂因素。
主要结局是全因死亡率和肝脏相关死亡率。次要结局包括肝硬化、肝失代偿、心脑血管疾病（CVD）和肝细胞癌（HCC）的发生率。采用多变量Cox比例风险模型评估关联。
在所有队列中，既往吸烟者和从不吸烟者的死亡率风险比（HR）显著低于当前吸烟者（在无脂肪性肝病队列中，从不吸烟者的HR：0.33，95%置信区间（CI）：0.31 - 0.35，P < 0.001；在MASLD队列中，从不吸烟者的HR：0.43，95% CI：0.41 - 0.44，P < 0.001；在MetALD队列中，从不吸烟者的HR：0.41，95% CI：0.38 - 0.45，P < 0.001）。在所有队列中，除MetALD外，既往吸烟者和从不吸烟者的肝硬化发生率显著低于当前吸烟者。既往吸烟者和从不吸烟者的CVD发生率低于当前吸烟者。在MASLD队列中，从不吸烟者的肝失代偿和HCC发生率最低。在MetALD队列中，不同吸烟状况之间的肝失代偿和HCC风险未观察到显著差异。
在MASLD和MetALD队列中，吸烟与较差的生存结局以及更高的肝硬化和CVD发生率相关。因此，戒烟和预防是减轻肝脏疾病负担和改善患者预后的关键策略。
