PMID- 37889558 OWN - NLM STAT- MEDLINE DCOM- 20231030 LR - 20240212 IS - 2471-254X (Electronic) IS - 2471-254X (Linking) VI - 7 IP - 11 DP - 2023 Nov 1 TI - Effect of combined tobacco use and type 2 diabetes mellitus on prevalent fibrosis in patients with MASLD. LID - 10.1097/HC9.0000000000000300 [doi] LID - e0300 AB - BACKGROUND: Several studies have investigated the independent effect of cigarette smoking or type 2 diabetes mellitus (T2DM) on MASLD. However, the interaction effect between tobacco consumption and T2DM on MASLD severity remains underexplored. In this study, we assessed the combined effect of tobacco use and T2DM on hepatic fibrosis in MASLD. METHODS: We conducted a single-center retrospective cross-sectional analysis of eligible participants from the Mass General Brigham Fibroscan(c) database. The participants were divided into 3 groups: those with T2DM and a history of tobacco use (primary exposure group), those with T2DM but no history of tobacco use (secondary exposure group), and those without T2DM and no history of tobacco use (reference group). An additional model was developed, which included a fourth group, participants with a history of tobacco use but no T2DM. The likelihood of fibrosis was determined using a defined fibrosis-4 index cutoff value of 1.3. In addition, we computed the estimated marginal means for liver stiffness measurement and compared the values among the exposure groups. Bivariable and multivariable logistic regression models were used to explore the associations between the exposure groups and the risk for hepatic fibrosis. RESULTS: Overall, 598 individuals were enrolled in the study. The bivariable logistic regression model revealed a significant independent association between T2DM, combined smoking and T2DM, and the outcome of interest, fibrosis. Age, sex, metabolic syndrome, aspirin use, statin use, hemoglobin A1C (A1C), and total bilirubin level were also significantly associated with fibrosis. In the adjusted fibrosis-4 multivariable model (comparing exposure groups to controls), cigarette smoking and T2DM interaction had higher odds of prevalent fibrosis (aOR, 3.04; 95% CI, 1.62-5.76), compared to those with T2DM alone (aOR 2.28; 95% CI, 1.37-3.85). The continuous liver stiffness measurement comparison across the exposure group showed an estimated marginal means of 6.26 (95% CL: 5.58-6.94), 7.54 (95% CL: 6.78-8.30), and 7.88 (6.78-8.99) for the reference group, T2DM only group, and tobacco-T2DM group, respectively. The diabetes-only group and the combined tobacco-T2DM group had statistically significant associations with liver stiffness measurement (p values: 0.013 and 0.014, respectively). CONCLUSION: Although diabetes is independently associated with hepatic fibrosis in patients with MASLD, the combination of tobacco consumption and diabetes is associated with a higher prevalence of fibrosis. Therefore, lifestyle change through tobacco use cessation in patients with diabetes could be beneficial in reducing the incidence of liver fibrosis among individuals with MASLD. CI - Copyright (c) 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases. FAU - Balogun, Oluwafemi AU - Balogun O AUID- ORCID: 0000-0002-6578-1851 AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Wang, Jeffrey Y AU - Wang JY AD - George Washington University School of Medicine, Washington D.C., 2001. FAU - Shaikh, Emad S AU - Shaikh ES AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Liu, Karine AU - Liu K AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Stoyanova, Stefania AU - Stoyanova S AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Memel, Zoe N AU - Memel ZN AD - University of California San Francisco Medical Center, San Francisco, California, USA. FAU - Schultz, Hayley AU - Schultz H AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Mun, Lisa AU - Mun L AD - Central Michigan University College of Medicine, Mt Pleasant, Michigan. FAU - Bertman, Jack AU - Bertman J AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Rogen, Cheryl A AU - Rogen CA AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Ibrahim, Maryam K AU - Ibrahim MK AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Berschback, Madeline AU - Berschback M AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Uche-Anya, Eugenia AU - Uche-Anya E AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Wilechansky, Robert AU - Wilechansky R AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Simon, Tracey G AU - Simon TG AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Department of Medicine, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston Massachusetts, USA. FAU - Corey, Kathleen E AU - Corey KE AUID- ORCID: 0000-0003-2882-7264 AD - Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA. AD - Harvard Medical School, Boston Massachusetts, USA. AD - Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston Massachusetts, USA. LA - eng PT - Journal Article DEP - 20231027 PL - United States TA - Hepatol Commun JT - Hepatology communications JID - 101695860 RN - 0 (Glycated Hemoglobin) SB - IM MH - Humans MH - *Diabetes Mellitus, Type 2/epidemiology/complications MH - Glycated Hemoglobin MH - Cross-Sectional Studies MH - Retrospective Studies MH - *Non-alcoholic Fatty Liver Disease/complications MH - Liver Cirrhosis/diagnostic imaging/epidemiology/etiology MH - Tobacco Use PMC - PMC10615418 COIS- The authors have no conflicts to report. EDAT- 2023/10/27 12:43 MHDA- 2023/10/30 06:47 PMCR- 2023/10/27 CRDT- 2023/10/27 11:55 PHST- 2023/04/06 00:00 [received] PHST- 2023/09/07 00:00 [accepted] PHST- 2023/10/30 06:47 [medline] PHST- 2023/10/27 12:43 [pubmed] PHST- 2023/10/27 11:55 [entrez] PHST- 2023/10/27 00:00 [pmc-release] AID - 02009842-202311010-00014 [pii] AID - HEP4-23-0295 [pii] AID - 10.1097/HC9.0000000000000300 [doi] PST - epublish SO - Hepatol Commun. 2023 Oct 27;7(11):e0300. doi: 10.1097/HC9.0000000000000300. eCollection 2023 Nov 1.