Smoking increases the risk of hepatocellular carcinoma and cardiovascular disease in patients with metabolic-associated fatty liver disease
Open accessAbstract
The association of smoking with hepatocellular carcinoma (HCC) or cardiovascular disease (CVD) has been reported, but the study of its relationship with metabolic-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the effect of smoking on the incidence of HCC or CVD in MAFLD patients. Using the Korean nationwide health screening database, we analyzed subjects between 2001 and 2015. A total of 283,088 subjects including 110,863 MAFLD patients and 172,225 controls were analyzed. Smoking status was divided by non-smoker, ex-smoker, or current smoker. In the follow-up period, a total of 2903 (1.0%) subjects developed HCC, and the MAFLD group (1723, 1.6%) had a significantly higher incidence than the control group (1180, 0.7%). In the MAFLD group, current smokers showed significantly higher risk of HCC compared to non-smokers (adjusted HR 1.24, 95% CI 1.08-1.41), whereas the control group did not (adjusted HR 1.07, 95% CI 0.89-1.30). A total of 18,984 (6.7%) patients developed CVD, and the incidence was significantly higher in the MAFLD group (8688, 7.8%) than in the control group (10,296, 6.0%), similar to HCC. The risk of CVD in current smokers increased by 22% compared to non-smokers in the MAFLD group (adjusted HR 1.22, 95% CI 1.15-1.30) and by 21% (adjusted HR 1.21, 95% CI 1.13-1.29) in the control group. Based on sex stratification, men showed increased incidence of both HCC and CVD by smoking, whereas women had only increased risk of CVD. Smoking significantly increases the incidence of HCC and CVD in MAFLD patients; thus, it is highly recommended to quit smoking completely in the population with MAFLD.
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Smoking is associated with an increased risk of HCC independent of aetiology as well as in MASLD specifically.
“Smoking has been associated with an increased risk of HCC independent of aetiology 72 as well as in MASLD speci fi cally.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [73]
Results §3.3 reports higher HCC risk among current smokers with MAFLD (adjusted HR 1.24, 95% CI 1.08–1.41), supporting the MASLD-specific part of the claim. It does not establish increased risk independent of aetiology: the association was not statistically significant in the control group, and the Discussion (§4) says it is hard to compare the risk in MAFLD with liver disease of other aetiologies. (LLM, conf=0.86)
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- Authors
- Yoo, J.-J., Park, M. Y., Cho, E. J., Yu, S. J., Kim, S. G., Kim, Y. J., Kim, Y. S., & Yoon, J.-H.
- Affiliations
- Soonchunhyang University Hospital Bucheon (KR)
- Korea Institute of Oriental Medicine (KR)
- Seoul National University (KR)
- Corresponding author
- Cho, Eun Ju
- ORCID
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2023-05-08
- Volume
- 12
- Issue
- 9
- Pages
- 3336
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC10179445
- OpenAlex
- W4375865778
- Cited by
- 36
- References
- 49
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 12
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Seoul National University Hospital Research Fund (05-2021-0010, 2023)
- Liver Research Foundation of Korea (05-2021-0010, 2023)
- Soonchunhyang University Research Fund (05-2021-0010, 2023)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- smoking, metabolic-associated fatty liver disease, hepatocellular carcinoma, cardiovascular disease, cancer incidence, sex differences, smoking cessation, Korean population
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