Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study

Abstract

Objective To determine the relation between body mass index (BMI) and liver cirrhosis and the contribution that BMI and alcohol consumption make to the incidence of liver cirrhosis in middle aged women in the UK. Design Prospective cohort study (Million Women Study). Setting Women recruited from 1996 to 2001 in NHS breast screening centres and followed by record linkage to routinely collected information on hospital admissions and deaths. Participants 1 230 662 women (mean age 56 years at recruitment) followed for an average of 6.2 years. Main outcome measures Relative risk and absolute risk of first hospital admission with or death from liver cirrhosis adjusted for age, recruitment region, alcohol consumption, smoking, socioeconomic status, and physical activity. Results 1811 women had a first hospital admission with or died from liver cirrhosis during follow-up. Among women with a BMI of 22.5 or above, increasing BMI was associated with an increased incidence of liver cirrhosis: the adjusted relative risk of cirrhosis increased by 28% (relative risk 1.28, 95% confidence interval 1.19 to 1.38; P<0.001) for every 5 unit increase in BMI. Although the relative increase in the risk of liver cirrhosis per 5 unit increase in BMI did not differ significantly according to the amount of alcohol consumed, the absolute risk did. Among women who reported drinking less than 70 g alcohol per week, the absolute risk of liver cirrhosis per 1000 women over five years was 0.8 (0.7 to 0.9) for those with a BMI between 22.5 and 25 and 1.0 (0.9 to 1.2) for those with a BMI of 30 or more. Among women who reported drinking 150 g alcohol or more per week, the corresponding figures were 2.7 (2.1 to 3.4) and 5.0 (3.8 to 6.6). Conclusions Excess body weight increases the incidence of liver cirrhosis. In middle aged women in the UK, an estimated 17% of incident or fatal liver cirrhosis is attributable to excess body weight. This compares with an estimated 42% attributable to alcohol.

Ectopic Fat, Insulin Resistance, and Nonalcoholic Fatty Liver Disease

“…[1][2][3][4] The liver is a key visceral organ that is affected by ectopic fat accumulation, 1,2 and when excess body weight is present, the incidence of cirrhosis is markedly increased. 5,6 When liver fat accumulation >5% occurs that is not caused by excessive alcohol consumption or other known pathogenic factors, the presence of liver fat defines nonalcoholic fatty liver disease (NAFLD).…”

Diagnosis of Liver Cirrhosis in England, a Cohort Study, 1998–2009: A Comparison With Cancer

“…Given that patients in HES-linked practices are representative of the whole CPRD population and the latter is broadly similar in terms of demographics to that of England, we believe we have a representative population ( 10,16 ). Our defi nition of cirrhosis in secondary care, compared with that used by other studies, which included codes for chronic hepatitis and alcoholic liver disease ( 4,17 ), ensures that we are only including patients who have good evidence of cirrhosis. Although we have assigned a diagnosis date as the incident date of disease in our study (so as to be able to calculate rates of occurrence from a defi ned denominator), we appreciate that given the long sojourn time for cirrhosis to develop this will not be the onset of disease.…”

Body Mass Index, Surgery, and Risk of Venous Thromboembolism in Middle-Aged Women

“…2,18,19 In brief, it is a prospective cohort study that recruited 1.3 million women (mean age, 56.1 years) between 1996 and 2001, through the National Health Service (NHS) Breast Screening Pro-gramme in England and Scotland. At recruitment, women completed a questionnaire that enquired about current weight and height, use of hormone replacement therapy, smoking status, physical activity, alcohol consumption, medical and reproductive history, history of oral contraceptive use, and educational attainment (questionnaire available from www.millionwomenstudy.org).…”

“…22 Incidence rates for the complete cohort were subsequently reported with the mean measured values for each body mass index category by use of methods described previously. 19 Million Women Study participants were excluded from the present analysis if they reported a history of blood clots or treatment for clotting problems at recruitment; or if, before recruitment, they had a hospital admission for venous thromboembolism (see online-only Data Supplement Appendix for International Classifications of Diseases codes), had surgery in the previous 12 weeks, or had a previous cancer registration (excluding nonmelanoma skin cancer). Women were classified as having had surgery during follow-up if the hospital data included 1 or more Classification of Surgical Operations and Procedures of the Office of Population Censuses and Surveys, fourth revision, codes (other than those related to the diagnosis and treatment of venous thromboembolism and those identified as nonoperative procedures in NHS coding guidelines, 23 as listed in the online-only Data Supplement Appendix).…”