Journal of Gastroenterology

, Volume 46, Issue 6, pp 769–778 | Cite as

Impact of cigarette smoking on onset of nonalcoholic fatty liver disease over a 10-year period

  • Ayaka Hamabe
  • Hirofumi UtoEmail author
  • Yasushi Imamura
  • Ken Kusano
  • Seiichi Mawatari
  • Kotaro Kumagai
  • Takeshi Kure
  • Tsutomu Tamai
  • Akihiro Moriuchi
  • Toshio Sakiyama
  • Makoto Oketani
  • Akio Ido
  • Hirohito Tsubouchi
Original Article—Liver, Pancreas, and Biliary Tract



Metabolic syndrome, which includes obesity, hyperglycemia, dyslipidemia, and hypertension, is a major risk factor for the development of nonalcoholic fatty liver disease (NAFLD). Cigarette smoking is a well-known risk factor for metabolic syndrome, but the epidemiological impact of cigarette smoking on development of NAFLD is unclear.


In this retrospective study, 2,029 subjects underwent a complete medical health checkup in 1998 and again in 2008. Those who were positive for hepatitis B surface antigen or hepatitis C virus antibody, or had an alcohol intake of >20 g/day as assessed by questionnaire, were excluded. Fatty liver was diagnosed by abdominal ultrasonography. Independent risk factors associated with the development of NAFLD were determined by multiple logistic regression analysis. Smoking status was expressed using the Brinkman index (BI), which was calculated as the number of cigarettes smoked per day multiplied by the number of years of smoking.


Of 1,560 subjects without NAFLD in 1998, 266 (17.1%) were newly diagnosed with NAFLD in 2008. Multiple logistic analysis identified age [adjusted odds ratio (AOR) 0.95, 95% confidence interval (95% CI) 0.94–0.97], male sex (AOR 1.46, 95% CI 1.01–2.10), body mass index ≥25 (AOR 3.08, 95% CI 2.20–4.32), dyslipidemia (AOR 1.79, 95% CI 1.25–2.58) and cigarette smoking (AOR 1.91, 95% CI 1.34–2.72) as risk factors associated with the development of NAFLD. Smoking status at baseline was also associated with the development of NAFLD (BI 1–399: AOR 1.77, 95% CI 1.02–3.07, BI ≥400: AOR 2.04, 95% CI 1.37–3.03).


Cigarette smoking is an independent risk factor for onset of NAFLD.


NAFLD Risk factor Brinkman index Body mass index Metabolic syndrome 



This work was supported in part by grants from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and the Ministry of Health, Labour and Welfare of Japan.


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Copyright information

© Springer 2011

Authors and Affiliations

  • Ayaka Hamabe
    • 1
  • Hirofumi Uto
    • 1
    Email author
  • Yasushi Imamura
    • 2
  • Ken Kusano
    • 3
  • Seiichi Mawatari
    • 1
  • Kotaro Kumagai
    • 1
  • Takeshi Kure
    • 1
  • Tsutomu Tamai
    • 1
  • Akihiro Moriuchi
    • 1
  • Toshio Sakiyama
    • 1
  • Makoto Oketani
    • 1
  • Akio Ido
    • 1
  • Hirohito Tsubouchi
    • 1
  1. 1.Department of Digestive and Life-Style Related Diseases, Health Research Human and Environmental SciencesKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
  2. 2.Department of Internal MedicineKagoshima Kouseiren HospitalKagoshimaJapan
  3. 3.Kagoshima Kouseiren Medical Health Care CenterKagoshimaJapan

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