| Summary: | Introduction
This study investigated the association between smoking types,
including dual use (usage of both combustible cigarettes and e-cigarettes), and
non-alcoholic fatty liver disease (NAFLD) status in Korean men.
Methods
Data from the 7th and 8th Korea National Health and Nutrition
Examination Survey (KNHANES) 2016–2020 were used. The presence of NAFLD
was defined by the respective cut-off values for the Hepatic Steatosis Index
(HSI), NAFLD Ridge Score (NRS), and Korea National Health and Nutrition
Examination Survey NAFLD score (KNS). Multivariate logistic regression analyses
were used to determine the associations between smoking types and NAFLD as
determined by HSI, NRS, and KNS.
Results
After adjustment for confounders, an independent association was observed
between dual use and NAFLD (HSI: AOR=1.47; 95% CI: 1.08–1.99, p=0.014;
NRS: AOR=2.21; 95% CI: 1.70–2.86, p=0.000; KNS: AOR=1.35; 95% CI: 1.01–
1.81, p=0.045). Cigarette only smokers also had significantly higher odds of
NAFLD compared to never smokers for all of the NAFLD indices (HSI: AOR=1.22;
95% CI: 1.05–1.42, p=0.008; NRS: AOR=2.13; 95% CI: 1.87–2.42, p=0.000; KNS:
AOR=1.33; 95% CI: 1.14–1.55, p=0.000). In subgroup analyses, no significant
interaction effects were found for age, BMI, alcohol consumption, income, physical
activity, and the diagnosis of T2DM. Moreover, cigarette only smokers and dual
users differed significantly in terms of log-transformed urine cotinine and packyears.
The relationship between smoking type and pack-years was attenuated
after stratification by age.
Conclusions
This study shows that the dual use of e-cigarettes and combustible
cigarettes is associated with NAFLD. Age differences may explain why dual users,
with a greater proportion of young people, appear to have fewer pack-years than
cigarette only smokers. Further research should be conducted to investigate the
adverse effects of dual use on hepatic steatosis.
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