Obesity and overweight in relation to liver disease mortality in men: 38 year follow-up of the original Whitehall study

Abstract

Obesity has been implicated in the aetiology of liver disease. However, to date, evidence is largely drawn from cross-sectional studies, where interpretation is hampered by reverse causality, and from studies on clinical populations that have limited generalisability. In this prospective cohort study, data on body mass index (BMI) and covariates were collected at baseline on 18 863 male government employees (aged 40-69 years). Respondents were then followed up for a maximum of 38 years of age. Mortality surveillance gave rise to 13 129 deaths, 122 of which were due to liver disease (57 cancers; 65 non-cancers). In ageadjusted analyses, BMI was positively related to total liver disease mortality (hazards ratio per 1 s.d. increase in BMI; 95% confidence interval (CI): 1.36; 1.14, 1.62) in a graded fashion across the weight categories (P-value for trend: 0.01). The magnitude of this association was somewhat stronger for non-cancer liver disease deaths (1.47; 1.16, 1.86) than for cancer liver disease deaths (1.25; 0.96, 1.62). Excluding deaths in the first 10 years of follow-up somewhat strengthened the BMIFnoncancer liver disease association. Adjustment for socioeconomic position, other candidate confounders and mediating factors led to the modest attenuation of these associations. Further investigation in prospective cohort studies with more detailed data on liver disease, for instance using biochemical tests of liver function or hepatic ultrasonography, is warranted.

Overweight in late adolescence predicts development of severe liver disease later in life: A 39years follow-up study

“…These results are consistent with previous data from a number of studies in adults [9][10][11], e.g., by Ioannou and co-workers [9] who implicated obesity as a risk factor for death or hospitalization from cirrhosis. In that study in 11,465 persons aged 25 to 74 years, only obesity and not overweight were statistically significantly associated with death or hospitalization related to cirrhosis.…”

“…During this period, the prevalence of overweight, defined as a body mass index (BMI) above 25, and obesity, defined as a BMI above 30, have increased in both Europe and the USA, as well as globally [6]. Obesity in adults has been linked to an increased risk for liver-related death or hospitalization both in persons with [7,8] and without [9][10][11] known liver disease, as well as a higher risk for hepatocellular carcinoma (HCC) [12,13]. In addition, overweight and obesity are associated with a worse prognosis in several liver diseases, such as NAFLD [14], hepatitis B and C [15,16] and alcoholic liver disease [17,18].…”

Body mass index in early pregnancy and future risk of severe liver disease: a population‐based cohort study

“…Our results confirm that excess body weight is a relevant contributor in the aetiology of severe liver disease particularly in the setting of diabetes also in women, and that the risk is evident from early adulthood. These data are consistent with similar estimates as in previous studies in younger men as well as in older women …”

Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

“…Recent data estimates that over 600,000 adults in the USA have CLD, with over half of affected individuals unaware of the diagnosis [ 4 ]. Overweight and alcohol consumption are major causes of CLD [ 5 – 7 ]. Non-alcoholic fatty liver disease (NAFLD) can be considered the pathological manifestation in the liver of the metabolic syndrome, of which high BMI is a key feature [ 8 ].…”