Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 15, Number 3, June 2022, pages 113-119

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

**Table 1.** Epidemiological Characteristics of Respondents
Variable	E-cigarette, n = 7,756 (4.35%)	Traditional smoking, n = 48,625 (27.27%)	Dual smoking, n = 23,444 (13.15%)	No smoking, n = 98,475 (55.23%)	Total, n = 178,300 (100%)	P value
These are column % for comparison of E-cigarette use, traditional smoking, dual smoking and no smoking with sociodemographic variables and comorbidities. IQR: interquartile range; COPD: chronic obstructive pulmonary disease; CHD: coronary heart disease; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transpeptidase; SE: standard error; SD: standard deviation.
Age, median (IQR)	25 (20 - 31)	62 (50 - 71)	41 (30 - 56)	50 (34 - 64)
Gender						< 0.0001
Male	51	62	57	38	47.6
Female	49.3	38	43	62	52.4
Race/ethnicity						< 0.0001
White	27.6	42.2	47	30.5	36
African American	22.6	21.2	21.7	20	21
Hispanic	11.4	11.6	7.1	12.1	11.3
Mexican American	20	13.3	11	16.6	15.1
Asian	12	7	5.5	18	13
Other races	7	4.5	8	3	4.3
Annual household income						< 0.0001
$0 - $25,000	27	32	33	24	27.6
$25,000 - $65,000	32.2	38.6	39.4	34.5	36.2
$65,000 - $99,999	16.8	14	15	17	16
$100,000 and over	24	16	13	24.3	20.4
Comorbidities
Hypertension	67.9	80.2	85	80.3	80.4	< 0.0001
Diabetes mellitus	3.3	22.1	11.4	14	15,4	< 0.0001
Hypercholesterolemia	10.6	46	30	35	36	< 0.0001
COPD	0.25	8.1	10.1	1.1	4.3	< 0.0001
CHD	1.5	8.5	4.2	3.3	4.9	< 0.0001
Received dialysis in past 12 months	0	7.4	5	8.2	7.4	< 0.0001
Anemia	4	4.4	4.1	4.6	4.4	< 0.0001
Cancer	2.3	16.7	8.5	9.5	11.2	< 0.0001
Alcohol abuse	69.5	46.3	66	38.6	47	< 0.0001
Blood chemistry
Serum cotinine (ng/mL), mean ± SE	20.8 ± 0.9	65.2 ± 0.61	177 ± 1.1	6.7 ± 0.2		< 0.0001
ALT (IU/L), mean ± SE	22.8 ± 0.21	23.9 ± 0.07	25.0 ± 0.12	23.3 ± 0.06		< 0.0001
AST (IU/L), mean ± SE	23 ± 0.16	24.6 ± 0.07	24.3 ± 0.15	23.5 ± 0.04		< 0.0001
Alkaline phosphatase, mean ± SE	71.5 ± 0.26	75.6 ± 0.12	75.7 ± 0.26	73.5 ± 0.08		< 0.0001
GGT, mean ± SE	23.8 ± 0.50	34.3 ± 0.25	33.6 ± 0.35	26.4 ± 0.10		< 0.0001
Globulin, mean ± SD	2.97 ± 0.005	2.92 ± 0.002	2.93 ± 0.003	3.0 ± 0.0001		0.569
Albumin, mean ± SD	4.3 ± 0.004	4.2 ± 0.002	4.1 ± 0.003	4.2 ± 0.001		0.967

Table 1. Epidemiological Characteristics of Respondents

Variable

E-cigarette, n = 7,756 (4.35%)

Traditional smoking, n = 48,625 (27.27%)

Dual smoking, n = 23,444 (13.15%)

No smoking, n = 98,475 (55.23%)

Total, n = 178,300 (100%)

P value

These are column % for comparison of E-cigarette use, traditional smoking, dual smoking and no smoking with sociodemographic variables and comorbidities. IQR: interquartile range; COPD: chronic obstructive pulmonary disease; CHD: coronary heart disease; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transpeptidase; SE: standard error; SD: standard deviation.

Age, median (IQR)

25 (20 - 31)

62 (50 - 71)

41 (30 - 56)

50 (34 - 64)

Gender

< 0.0001

Male

47.6

Female

49.3

52.4

Race/ethnicity

< 0.0001

White

27.6

42.2

30.5

African American

22.6

21.2

21.7

Hispanic

11.4

11.6

7.1

12.1

11.3

Mexican American

13.3

16.6

15.1

Asian

5.5

Other races

4.5

4.3

Annual household income

< 0.0001

$0 - $25,000

27.6

$25,000 - $65,000

32.2

38.6

39.4

34.5

36.2

$65,000 - $99,999

16.8

$100,000 and over

24.3

20.4

Comorbidities

Hypertension

67.9

80.2

80.3

80.4

< 0.0001

Diabetes mellitus

3.3

22.1

11.4

15,4

< 0.0001

Hypercholesterolemia

10.6

< 0.0001

COPD

0.25

8.1

10.1

1.1

4.3

< 0.0001

CHD

1.5

8.5

4.2

3.3

4.9

< 0.0001

Received dialysis in past 12 months

7.4

8.2

7.4

< 0.0001

Anemia

4.4

4.1

4.6

4.4

< 0.0001

Cancer

2.3

16.7

8.5

9.5

11.2

< 0.0001

Alcohol abuse

69.5

46.3

38.6

< 0.0001

Blood chemistry

Serum cotinine (ng/mL), mean ± SE

20.8 ± 0.9

65.2 ± 0.61

177 ± 1.1

6.7 ± 0.2

< 0.0001

ALT (IU/L), mean ± SE

22.8 ± 0.21

23.9 ± 0.07

25.0 ± 0.12

23.3 ± 0.06

< 0.0001

AST (IU/L), mean ± SE

23 ± 0.16

24.6 ± 0.07

24.3 ± 0.15

23.5 ± 0.04

< 0.0001

Alkaline phosphatase, mean ± SE

71.5 ± 0.26

75.6 ± 0.12

75.7 ± 0.26

73.5 ± 0.08

< 0.0001

GGT, mean ± SE

23.8 ± 0.50

34.3 ± 0.25

33.6 ± 0.35

26.4 ± 0.10

< 0.0001

Globulin, mean ± SD

2.97 ± 0.005

2.92 ± 0.002

2.93 ± 0.003

3.0 ± 0.0001

0.569

Albumin, mean ± SD

4.3 ± 0.004

4.2 ± 0.002

4.1 ± 0.003

4.2 ± 0.001

0.967

**Table 2.** Prevalence of Smoking and Liver Disease in US Population From 2015 to 2018
Variable	E-cigarette, n = 7,756 (4.35%)	Traditional smoking, n = 48,625 (27.27%)	Dual smoking, n = 23,444 (13.15%)	No smoking, n = 98,475 (55.23%)	Total, n = 178,300 (100%)	P value
*These are column % for comparison of E-cigarette use, traditional smoking, dual smoking and no smoking with liver disease. ^#Concurrent prevalence percentage of liver disease in different types of smoking patterns. Hence, no P value is calculated.
History of any liver disease*	149 (2.4)	5,949 (7.2)	1,470 (6.4)	3,892 (4.1)	9,029 (5.25)	< 0.0001
Active liver disease*	70 (47)	1,837 (52.2)	866 (59)	2,032 (52.2)	4,805 (53.2)	< 0.0001
Hepatitis B*	0	824 (1.7)	368 (1.6)	1,143 (1.2)	2,335 (1.3)	< 0.0001
Hepatitis C*	48 (0.62)	1,413 (2.9)	764 (3.3)	508 (0.52)	2,733 (1.53)	< 0.0001
Prevalence percentage of various liver conditions^#
Fatty liver	85 (3.8)	572 (26)	243 (11)	1,014 (46)	1,914 (86.6)	0.0002
Liver cirrhosis	15 (4)	167 (45)	20 (5.4)	169 (45.5)	371 (100)	NA
Liver fibrosis	0	57 (61)	0	37 (39.4)	94 (100)	NA
Autoimmune hepatitis	0	112 (62.2)	26 (14.4)	42 (23.3)	180 (100)	NA
Other liver diseases	29 (2.3)	574 (45.1)	185 (14.5)	484 (38)	1,272 (100)	NA

Table 2. Prevalence of Smoking and Liver Disease in US Population From 2015 to 2018

Variable

E-cigarette, n = 7,756 (4.35%)

Traditional smoking, n = 48,625 (27.27%)

Dual smoking, n = 23,444 (13.15%)

No smoking, n = 98,475 (55.23%)

Total, n = 178,300 (100%)

P value

*These are column % for comparison of E-cigarette use, traditional smoking, dual smoking and no smoking with liver disease. ^#Concurrent prevalence percentage of liver disease in different types of smoking patterns. Hence, no P value is calculated.

History of any liver disease*

149 (2.4)

5,949 (7.2)

1,470 (6.4)

3,892 (4.1)

9,029 (5.25)

< 0.0001

Active liver disease*

70 (47)

1,837 (52.2)

866 (59)

2,032 (52.2)

4,805 (53.2)

< 0.0001

Hepatitis B*

824 (1.7)

368 (1.6)

1,143 (1.2)

2,335 (1.3)

< 0.0001

Hepatitis C*

48 (0.62)

1,413 (2.9)

764 (3.3)

508 (0.52)

2,733 (1.53)

< 0.0001

Prevalence percentage of various liver conditions^#

Fatty liver

85 (3.8)

572 (26)

243 (11)

1,014 (46)

1,914 (86.6)

0.0002

Liver cirrhosis

15 (4)

167 (45)

20 (5.4)

169 (45.5)

371 (100)

Liver fibrosis

57 (61)

37 (39.4)

94 (100)

Autoimmune hepatitis

112 (62.2)

26 (14.4)

42 (23.3)

180 (100)

Other liver diseases

29 (2.3)

574 (45.1)

185 (14.5)

484 (38)

1,272 (100)

**Table 3.** Multivariate Logistic Regression Models of Association Between Smoking and Liver Diseases
Outcomes*	E-cigarette, OR (95% CI); P value	Traditional smoking, OR (95% CI); P value	Dual smoking, OR (95% CI); P value	No smoking	c value
*Models were adjusted for age, gender, race, annual household income, hypertension, diabetes, hypercholesterolemia, body mass index, drug abuse, and alcohol abuse. OR: odds ratio; 95% CI: 95% confidence interval.
History of liver disease	1.06 (1.05 - 1.06); P < 0.0001	1.47 (1.46 - 1.47); P < 0.0001	1.50 (1.50 - 1.50); P < 0.0001	Reference	0.67
Active liver disease	0.27 (0.27 - 0.28); P < 0.0001	1.44 (1.43 - 1.44); P < 0.0001	1.43 (1.43 - 1.44); P < 0.0001	Reference	0.71
Hepatitis B	0.78 (0.78 - 0.79); P < 0.0001	2.56 (2.57 - 2.58); P < 0.0001	2.70 (2.70 - 2.71); P < 0.0001	Reference	0.71
Hepatitis C	0.28 (0.28 - 0.56); P < 0.0001	2.05 (2.05 - 2.05); P < 0.0001	1.90 (1.90 - 1.91); P < 0.0001	Reference	0.85

Table 3. Multivariate Logistic Regression Models of Association Between Smoking and Liver Diseases

Outcomes*

E-cigarette, OR (95% CI); P value

Traditional smoking, OR (95% CI); P value

Dual smoking, OR (95% CI); P value

No smoking

c value

*Models were adjusted for age, gender, race, annual household income, hypertension, diabetes, hypercholesterolemia, body mass index, drug abuse, and alcohol abuse. OR: odds ratio; 95% CI: 95% confidence interval.

History of liver disease

1.06 (1.05 - 1.06); P < 0.0001

1.47 (1.46 - 1.47); P < 0.0001

1.50 (1.50 - 1.50); P < 0.0001

Reference

0.67

Active liver disease

0.27 (0.27 - 0.28); P < 0.0001

1.44 (1.43 - 1.44); P < 0.0001

1.43 (1.43 - 1.44); P < 0.0001

Reference

0.71

Hepatitis B

0.78 (0.78 - 0.79); P < 0.0001

2.56 (2.57 - 2.58); P < 0.0001

2.70 (2.70 - 2.71); P < 0.0001

Reference

0.71

Hepatitis C

0.28 (0.28 - 0.56); P < 0.0001

2.05 (2.05 - 2.05); P < 0.0001

1.90 (1.90 - 1.91); P < 0.0001

Reference

0.85