{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:13:25Z","timestamp":1777497205497,"version":"3.51.4"},"reference-count":16,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,3,13]],"date-time":"2019-03-13T00:00:00Z","timestamp":1552435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Nonalcoholic fatty liver disease (NAFLD) has become the most common liver disease in Western countries. Smoking and diabetes mellitus (DM) have been shown to increase mortality; however, whether NAFLD adds to the detrimental effect of smoking in DM and non\u2010DM patients is unknown. We evaluated the possible interactive effect of NAFLD and smoking on mortality risk in a US population\u2010based sample.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cross\u2010sectional data from 11\u00a0205 participants in the third National Health and Nutrition Examination Survey were analysed. NAFLD was defined as ultrasonographic hepatic steatosis without evidence of other liver diseases. Proportional hazards regression modelling was used to test for the multiplicative interaction of NAFLD and smoking on overall mortality, controlling for DM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>36.5% of the participants had NAFLD of whom 21.1% were current smokers, while among non\u2010NAFLD subjects, 26.2% reported current smoking. Smoking was associated with a hazard ratio (HR) of 2.23 (95% confidence interval (CI): 1.87\u20102.65) among non\u2010NAFLD subjects, and 2.31 (95% CI: 1.33\u20102.92, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) among NAFLD patients. In contrast, the HR for NAFLD was 1.01 (95% CI: 0.78\u20101.31, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.96) among smokers and 0.98 (95% CI: 0.87\u20101.10, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.73) among non\u2010smokers. There was no evidence of interaction between NAFLD and smoking (HR\u00a0=\u00a01.01, 95% CI: 0.74\u20101.38, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.94) in the combined model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found that smoking increased mortality by two\u2010fold among the US population. Although the magnitude of the increase in mortality did not differ from that in non\u2010NAFLD subjects, smoking represents a modifiable determinant of long\u2010term outcomes in NAFLD patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14058","type":"journal-article","created":{"date-parts":[[2019,1,30]],"date-time":"2019-01-30T05:33:33Z","timestamp":1548826413000},"page":"1202-1206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The interaction of nonalcoholic fatty liver disease and smoking on mortality among adults in the United States"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-6343","authenticated-orcid":false,"given":"Karn","family":"Wijarnpreecha","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Bassett Medical Center Cooperstown New York"},{"name":"Division of Gastroenterology and Hepatology Mayo Clinic College of Medicine, Mayo Clinic Jacksonville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Scribani","sequence":"additional","affiliation":[{"name":"Bassett Research Institute, Bassett Medical Center Cooperstown New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1919-6800","authenticated-orcid":false,"given":"Donghee","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. Ray","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2011.03.020"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1966"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001075"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.07.040"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.08.028"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192644"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-3565(05)00743-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S26794"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26156"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.28390"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.12.012"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-5996-6-79"},{"key":"e_1_2_7_14_1","first-page":"106(11)","article-title":"Cigarette smoking and variations in systemic immune and inflammation markers","author":"Shiels MS","year":"2014","journal-title":"J Natl Cancer Inst"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-2281"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/2050312117745223"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195147"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.14058","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14058","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.14058","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.14058","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T14:40:15Z","timestamp":1694270415000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.14058"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,13]]},"references-count":16,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1111\/liv.14058"],"URL":"https:\/\/doi.org\/10.1111\/liv.14058","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,13]]},"assertion":[{"value":"2018-07-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}