Secondhand tobacco exposure is associated with nonalcoholic fatty liver disease in children.
BACKGROUND
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in children in the United States, and prevalence rates are rising. Smoking is associated with NAFLD, but the association of secondhand smoke exposure with NAFLD is unknown.


OBJECTIVE
To investigate the association of secondhand tobacco exposure with NAFLD in children.


METHODS
We surveyed parents/guardians of 304 children aged 3-12 years who had received an abdominal ultrasound at Penn State Hershey Medical Center. The survey addressed demographics, medical history, secondhand tobacco exposure, activity level, screen viewing time and other environmental exposures. A pediatric radiologist and sonographer reviewed the ultrasounds to grade the presence of bight liver compatible with NAFLD. We conducted logistic regression analysis to assess the association of secondhand tobacco exposure and NAFLD.


RESULTS
54% of eligible potential participants responded to the survey. Fatty liver was present in 3% of the children. Increasing child age was associated with increased odds of NAFLD (OR 1.63 95% CI 1.1, 2.4). Reported child obesity was associated with increased odds of NAFLD (OR 44.5 95% CI 5.3, 371.7). The rate of NAFLD was higher in the smoke exposed group (6.7% vs. 1.7%). For every extra pack per day smoked at home, the odds of a child having NAFLD increased 1.8 times (AOR 1.8, 95% CI 1.2, 2.8), and any exposure increased a child's odds of NAFLD four-fold (AOR 4.0, 95% CI 1.02, 15.8).


CONCLUSIONS
We found an association of secondhand smoke exposure and NAFLD in children. This may represent an area for future prevention efforts.
College of Medicine, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA.
Connie
C
Lin
Department of Pediatrics, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA; Department of Pediatrics, Bon Secour St. Mary׳s Hospital, 5801 Bremo Rd, Richmond, VA 23226, USA.
Carl B
CB
Rountree
Department of Pediatrics, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA; Department of Radiology, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA.
Sosamma
S
Methratta
Department of Radiology, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA.
Salvatore
S
LaRusso
Department of Public Health Sciences, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA.
Allen R
AR
Kunselman
Department of Pediatrics, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA; Department of Public Health Sciences, Penn State University Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033-0850, USA. Electronic address: aspanier@hmc.psu.edu.
Adam J
AJ
Spanier
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005234:Fatty Liver / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
D014028:Tobacco Smoke Pollution
Children; Nonalcoholic fatty liver; Secondhand smoke; Steatohepatitis; Ultrasonongraphy