{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:30:01Z","timestamp":1784590201394,"version":"3.55.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82070593"],"award-info":[{"award-number":["82070593"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004731","name":"Natural Science Foundation of Zhejiang Province","doi-asserted-by":"publisher","award":["LD21H030002"],"award-info":[{"award-number":["LD21H030002"]}],"id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Smoking is a cause of nonalcoholic fatty liver disease (NAFLD), but the dose\u2013response relationship between secondhand smoke exposure (SHS) and NAFLD is unclear. This study sought to determine the relationship between SHS and NAFLD risk among adult nonsmokers in the United States.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>Data from 7412 adult nonsmokers aged \u226520 years who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016 were used in this study. SHS was defined as a nonsmoker with a serum cotinine concentration of 0.05\u201310.00 ng\/mL. NAFLD was identified using the U.S. fatty liver index (USFLI), hepatic steatosis index (HSI), and fatty liver index (FLI). Weighted multivariable logistic regression and restricted cubic spline models were applied to evaluate the relationship between SHS and NAFLD risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The participants had a weighted mean age of 49.2 years, and 55.5% were female. SHS was associated with NAFLD (odds ratio [OR] 1.22; 95% confidence interval CI: 1.05 to 1.42), showing a linear dose\u2013response relationship (natural log of cotinine level: OR 1.10, 95% CI: 1.05 to 1.17). Sensitivity analyses using different NAFLD definitions (HSI: OR 1.21, 95% CI: 1.01 to 1.46; FLI: OR 1.26, 95% CI: 1.06 to 1.49), excluding participants taking hepatotoxic drugs, and propensity score-adjusted analysis yielded similar results. The association between SHS and NAFLD was consistent in analyses stratified by age, sex, and race\/ethnicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among this nationally representative sample of U.S. adults, SHS had a linear dose\u2013response relationship with the risk of NAFLD, suggesting that measures to lower SHS might lower NAFLD risk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>This study assessed the association between secondhand smoke exposure and the risk of nonalcoholic fatty liver disease (NAFLD) using data from 7412 adult nonsmokers aged 20 years or older who participated in the United States NHANES between 2007 and 2016. Secondhand smoke exposure was measured using serum cotinine levels. Three different noninvasive indexes were used to measure NAFLD. Secondhand smoke exposure was associated with an increased risk of NAFLD, with a linear dose\u2013response relationship. The results of sensitivity analyses and subgroup analyses were consistent.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntad249","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T07:16:56Z","timestamp":1703143016000},"page":"663-668","source":"Crossref","is-referenced-by-count":11,"title":["Association Between Secondhand Smoke Exposure and Nonalcoholic Fatty Liver Disease in the General U.S. Adult Nonsmoker Population"],"prefix":"10.1093","volume":"26","author":[{"given":"Enqian","family":"Liu","sequence":"first","affiliation":[{"name":"Hepatology Diagnosis and Treatment Center, The First Affiliated Hospital of Wenzhou Medical University and Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases , Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nursing, Xuanwu Hospital, Capital Medical University , Beijing , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongtong","family":"Pan","sequence":"additional","affiliation":[{"name":"Hepatology Diagnosis and Treatment Center, The First Affiliated Hospital of Wenzhou Medical University and Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases , Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4471-3083","authenticated-orcid":false,"given":"Yongping","family":"Chen","sequence":"additional","affiliation":[{"name":"Hepatology Diagnosis and Treatment Center, The First Affiliated Hospital of Wenzhou Medical University and Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases , Zhejiang , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"issue":"1","key":"2024052206025885300_CIT0001","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology."},{"issue":"6","key":"2024052206025885300_CIT0002","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1038\/nrgastro.2013.41","article-title":"Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis","volume":"10","author":"Anstee","year":"2013","journal-title":"Nat Rev Gastroenterol Hepatol."},{"issue":"6","key":"2024052206025885300_CIT0003","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1136\/gutjnl-2017-313884","article-title":"Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases","volume":"66","author":"Adams","year":"2017","journal-title":"Gut."},{"issue":"12","key":"2024052206025885300_CIT0004","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1001\/jama.2020.2298","article-title":"Nonalcoholic steatohepatitis: a review","volume":"323","author":"Sheka","year":"2020","journal-title":"JAMA."},{"issue":"2","key":"2024052206025885300_CIT0005","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2188\/jea.JE20120067","article-title":"Active smoking, passive smoking, and risk of nonalcoholic fatty liver disease (NAFLD): a population-based study in China","volume":"23","author":"Liu","year":"2013","journal-title":"J Epidemiol."},{"issue":"8","key":"2024052206025885300_CIT0006","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1111\/liv.13701","article-title":"Association between cotinine-verified smoking status and risk of nonalcoholic fatty liver disease","volume":"38","author":"Kim","year":"2018","journal-title":"Liver Int."},{"issue":"3","key":"2024052206025885300_CIT0007","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1038\/s41395-018-0283-5","article-title":"Smoking and the risk of non-alcoholic fatty liver disease: a cohort study","volume":"114","author":"Jung","year":"2019","journal-title":"Am J Gastroenterol."},{"issue":"6","key":"2024052206025885300_CIT0008","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s00535-011-0376-z","article-title":"Impact of cigarette smoking on onset of nonalcoholic fatty liver disease over a 10-year period","volume":"46","author":"Hamabe","year":"2011","journal-title":"J Gastroenterol."},{"issue":"6","key":"2024052206025885300_CIT0009","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/tc.2005.011288","article-title":"Philip morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke","volume":"14","author":"Schick","year":"2005","journal-title":"Tob Control."},{"key":"2024052206025885300_CIT0010","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.envres.2014.04.005","article-title":"Secondhand tobacco exposure is associated with nonalcoholic fatty liver disease in children","volume":"132","author":"Lin","year":"2014","journal-title":"Environ Res."},{"issue":"6","key":"2024052206025885300_CIT0011","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.14309\/ajg.0000000000001141","article-title":"Childhood and adulthood passive smoking and nonalcoholic fatty liver in midlife: a 31-year cohort study","volume":"116","author":"Wu","year":"2021","journal-title":"Am J Gastroenterol."},{"issue":"7","key":"2024052206025885300_CIT0012","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.2105\/AJPH.84.7.1086","article-title":"The validity of self-reported smoking: a review and meta-analysis","volume":"84","author":"Patrick","year":"1994","journal-title":"Am J Public Health."},{"issue":"7","key":"2024052206025885300_CIT0013","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/aje\/kwu182","article-title":"Validation of self-reported smokeless tobacco use by measurement of serum cotinine concentration among US adults","volume":"180","author":"Agaku","year":"2014","journal-title":"Am J Epidemiol."},{"issue":"2","key":"2024052206025885300_CIT0014","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1161\/HYPERTENSIONAHA.112.198218","article-title":"Association of serum cotinine levels and hypertension in never smokers","volume":"61","author":"Alshaarawy","year":"2013","journal-title":"Hypertension"},{"issue":"16","key":"2024052206025885300_CIT0015","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1001\/jama.1996.03530400021033","article-title":"Exposure of the US population to environmental tobacco smoke: the third national health and nutrition examination survey, 1988 to 1991","volume":"275","author":"Pirkle","year":"1996","journal-title":"JAMA."},{"issue":"1","key":"2024052206025885300_CIT0016","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jamainternmed.2020.3975","article-title":"Disparities in secondhand smoke exposure in the united states: National Health and Nutrition Examination Survey 2011-2018","volume":"181","author":"Shastri","year":"2021","journal-title":"JAMA Intern Med"},{"issue":"10","key":"2024052206025885300_CIT0017","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1371\/journal.pmed.0040296","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med."},{"key":"2024052206025885300_CIT0018","volume-title":"National report on human exposure to environmental chemicals: CDC","author":"Centers for Disease Control and Prevention","year":"2022"},{"key":"2024052206025885300_CIT0019","author":"National Center for Environmental Health","year":"2018"},{"issue":"48","key":"2024052206025885300_CIT0020","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.15585\/mmwr.mm6748a3","article-title":"Exposure to secondhand smoke among nonsmokers \u2014 united states, 1988\u20132014","volume":"67","author":"Tsai","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"369","key":"2024052206025885300_CIT0021","first-page":"1","article-title":"Secondhand smoke exposure among nonsmoking adults: United States, 2015-2018","author":"Brody","year":"2021","journal-title":"NCHS Data Brief"},{"issue":"7","key":"2024052206025885300_CIT0022","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.dld.2009.08.002","article-title":"Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease","volume":"42","author":"Lee","year":"2010","journal-title":"Dig Liver Dis."},{"issue":"1","key":"2024052206025885300_CIT0023","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1471-230X-6-33","article-title":"The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population","volume":"6","author":"Bedogni","year":"2006","journal-title":"BMC Gastroenterol."},{"issue":"1","key":"2024052206025885300_CIT0024","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/apt.13012","article-title":"Fatty liver indices in the multiethnic united states national health and nutrition examination survey","volume":"41","author":"Ruhl","year":"2015","journal-title":"Aliment Pharmacol Ther."},{"issue":"6","key":"2024052206025885300_CIT0025","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1038\/ajg.2012.128","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American association for the study of liver diseases, American college of gastroenterology, and the american gastroenterological association","volume":"107","author":"Chalasani","year":"2012","journal-title":"Am J Gastroenterol."},{"issue":"19","key":"2024052206025885300_CIT0026","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1001\/jama.2018.14854","article-title":"The physical activity guidelines for Americans","volume":"320","author":"Piercy","year":"2018","journal-title":"JAMA."},{"key":"2024052206025885300_CIT0027","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.2337\/dc18-S002","article-title":"2 classification and diagnosis of diabetes: standards of medical care in diabetes\u20142018","volume":"41","author":"American Diabetes Association","year":"2018","journal-title":"Diabetes Care."},{"issue":"6","key":"2024052206025885300_CIT0028","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1161\/01.HYP.0000107251.49515.c2","article-title":"Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure","volume":"42","author":"Chobanian","year":"2003","journal-title":"Hypertension."},{"key":"2024052206025885300_CIT0029","year":"2013"},{"key":"2024052206025885300_CIT0030","doi-asserted-by":"crossref","first-page":"205031211774522","DOI":"10.1177\/2050312117745223","article-title":"Association between smoking and non-alcoholic fatty liver disease: a systematic review and meta-analysis","volume":"6","author":"Akhavan Rezayat","year":"2018","journal-title":"SAGE Open Med"},{"issue":"3","key":"2024052206025885300_CIT0031","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jhep.2009.03.026","article-title":"Second-hand smoke stimulates lipid accumulation in the liver by modulating AMPK and SREBP-1","volume":"51","author":"Yuan","year":"2009","journal-title":"J Hepatol."},{"issue":"4","key":"2024052206025885300_CIT0032","doi-asserted-by":"crossref","first-page":"E1296","DOI":"10.3390\/ijms21041296","article-title":"Secondhand smoke induces liver steatosis through deregulation of genes involved in hepatic lipid metabolism","volume":"21","author":"Tommasi","year":"2020","journal-title":"Int J Mol Sci."},{"key":"2024052206025885300_CIT0033","doi-asserted-by":"crossref","first-page":"152678","DOI":"10.1016\/j.tox.2021.152678","article-title":"Cigarette smoking exposure breaks the homeostasis of cholesterol and bile acid metabolism and induces gut microbiota dysbiosis in mice with different diets","volume":"450","author":"Yang","year":"2021","journal-title":"Toxicology."},{"issue":"7","key":"2024052206025885300_CIT0034","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1093\/ntr\/ntz132","article-title":"Biochemical verification of tobacco use and abstinence: 2019 update","volume":"22","author":"Benowitz","year":"2020","journal-title":"Nicotine Tob Res."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntad249\/54805360\/ntad249.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/26\/6\/663\/57186323\/ntad249.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/26\/6\/663\/57186323\/ntad249.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T06:05:33Z","timestamp":1716357933000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/26\/6\/663\/7485691"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,20]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,12,20]]},"published-print":{"date-parts":[[2024,5,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntad249","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,6,1]]},"published":{"date-parts":[[2023,12,20]]}}}