Effect of combined tobacco use and type 2 diabetes mellitus on prevalent fibrosis in patients with MASLD

Authors

Oluwafemi Balogun, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Jeffrey Y. Wang, George Washington University School of Medicine, Washington D.C., 2001.
Emad S. Shaikh, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Karine Liu, Harvard Medical School, Boston Massachusetts, USA.
Stefania Stoyanova, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Zoe N. Memel, University of California San Francisco Medical Center, San Francisco, California, USA.
Hayley Schultz, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Lisa Mun, Central Michigan University College of Medicine, Mt Pleasant, Michigan.
Jack Bertman, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Cheryl A. Rogen, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Maryam K. Ibrahim, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Madeline Berschback, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Eugenia Uche-Anya, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Robert Wilechansky, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Tracey G. Simon, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.
Kathleen E. Corey, Department of Medicine, Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA.

Document Type

Journal Article

Publication Date

11-1-2023

Journal

Hepatology communications

Volume

7

Issue

11

DOI

10.1097/HC9.0000000000000300

Abstract

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© 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.

APA Citation

Balogun, Oluwafemi; Wang, Jeffrey Y.; Shaikh, Emad S.; Liu, Karine; Stoyanova, Stefania; Memel, Zoe N.; Schultz, Hayley; Mun, Lisa; Bertman, Jack; Rogen, Cheryl A.; Ibrahim, Maryam K.; Berschback, Madeline; Uche-Anya, Eugenia; Wilechansky, Robert; Simon, Tracey G.; and Corey, Kathleen E., "Effect of combined tobacco use and type 2 diabetes mellitus on prevalent fibrosis in patients with MASLD" (2023). GW Authored Works. Paper 3876.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3876

Department

School of Medicine and Health Sciences Student Works