Association of Smoking and E-Cigarette in Chronic Liver Disease: An NHANES Study

Raja Chandra Chakinala, Sameer Dawoodi, Stephanie P. Fabara, Muhammad Asad, Azadeh Khayyat, Sangeetha Chandramohan, Aysha Aslam, Nkechi Unachukwu, Bibimariyam Nasyrlaeva, Richa Jaiswal, Sriram B. Chowdary, Preeti Malik, Rizwan Rabbani



Background: There is an increased trend of e-cigarette but the toxic effects of e-cigarette metabolites are not widely studied especially in liver disease. Hence, we aimed to evaluate the prevalence and patterns of recent e-cigarette use in a nationally representative sample of US adults and adolescents and its association amongst respondents with liver disease.

Methods: We conducted a retrospective cross-sectional study using National Health and Nutrition Examination Survey (NHANES) database from 2015 to 2018. The self-reported NHANES questionnaire was used to assess liver disease (MCQ160L, MCQ170L and MCQ 510 (a-e)), e-cigarette use (SMQ900) and traditional smoking status (SMQ020 or SMQ040). We conducted univariate analysis and multivariable logistic regression models to predict the association of e-cigarette use, traditional smoking and dual smoking amongst the population with liver disease.

Results: Out of total 178,300 respondents, 7,756 (4.35%) were e-cigarette users, 48,625 (27.27%) traditional smoking, 23,444 (13.15%) dual smoking and 98,475 (55.23%) non-smokers. Females had a higher frequency of e-cigarette use (49.3%) compared to dual (43%) and traditional smoking (40.8%) (P < 0.0001). Respondents with a past history of any liver disease have lower frequency of e-cigarette use compared to dual and traditional smoking, respectively (2.4% vs. 6.4% vs. 7.2%; P < 0.0001). In multivariate logistic regression models, we found that e-cigarette users (odds ratio (OR): 1.06; 95% confidence interval (CI): 1.05 - 1.06; P < 0.0001) and dual smoking (OR: 1.50; 95% CI: 1.50 - 1.51; P < 0.0001) were associated with higher odds of having history of liver disease compared to non-smokers.

Conclusion: Our study found that despite the low frequency of e-cigarette use in respondents with liver disease, there was higher odds of e-cigarette use amongst patients with liver disease. This warrants the need for more future prospective studies to evaluate the long-term effects and precise mechanisms of e-cigarette toxicants on the liver.

Gastroenterol Res. 2022;15(3):113-119


E-cigarette; Smoking; Dual smoking; Liver disease; Liver toxicity; Hepatitis B; Hepatitis C

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