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We hypothesised that HH would be associated with markers of lung inflammation and fibrosis among community-dwelling adults and stronger among<jats:italic>MUC5B<\/jats:italic>(rs35705950) risk allele carriers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In the Multi-Ethnic Study of Atherosclerosis, HH was assessed from cardiac and full-lung computed tomography (CT) scans performed at Exam 1 (2000\u20132002, n=3342) and Exam 5 (2010\u20132012, n=3091), respectively. Percentage of high attenuation areas (HAAs; percentage of voxels with attenuation between \u2212600 and \u2212250\u2005HU) was measured from cardiac and lung scans. Interstitial lung abnormalities (ILAs) were examined from Exam 5 scans (n=2380). Regression models were used to examine the associations of HH with HAAs, ILAs and serum matrix metalloproteinase-7 (MMP-7), and adjusted for age, sex, race\/ethnicity, educational attainment, smoking, height, weight and scanner parameters for HAA analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>HH detected from Exam 5 scans was associated with a mean percentage difference in HAAs of 2.23% (95% CI 0.57\u20133.93%) and an increase of 0.48% (95% CI 0.07\u20130.89%) per year, particularly in<jats:italic>MUC5B<\/jats:italic>risk allele carriers (p-value for interaction=0.02). HH was associated with ILAs among those &lt;80\u2005years of age (OR for ILAs 1.78, 95% CI 1.14\u20132.80) and higher serum MMP-7 level among smokers (p-value for smoking interaction=0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HH was associated with more HAAs over time, particularly among<jats:italic>MUC5B<\/jats:italic>risk allele carriers, and ILAs in younger adults, and may be a risk factor in the early stages of interstitial lung disease.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.03173-2021","type":"journal-article","created":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T12:20:58Z","timestamp":1656678058000},"page":"2103173","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Associations of hiatus hernia with CT-based interstitial lung changes: the MESA Lung Study"],"prefix":"10.1183","volume":"61","author":[{"given":"John S.","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinhye","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaorui","family":"Yin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5135-4309","authenticated-orcid":false,"given":"Grant T.","family":"Hiura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michaela R.","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8456-9437","authenticated-orcid":false,"given":"Eric A.","family":"Hoffman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganesh","family":"Raghu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imre","family":"Noth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ani","family":"Manichaikul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen S.","family":"Rich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin M.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9559-1485","authenticated-orcid":false,"given":"Anna J.","family":"Podolanczuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine Kim","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. 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