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

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.

[1]  R. Collins,et al.  Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies , 2009, Lancet.

[2]  V. Beral,et al.  Moderate alcohol intake and cancer incidence in women. , 2009, Journal of the National Cancer Institute.

[3]  V. Beral,et al.  Separate and joint effects of alcohol and smoking on the risks of cirrhosis and gallbladder disease in middle-aged women. , 2008, American journal of epidemiology.

[4]  A. Edwards,et al.  Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence , 2007, Gut.

[5]  R. Spiller.  Gut in 2007 , 2006, Gut.

[6]  G. Farrell,et al.  Nonalcoholic fatty liver disease: From steatosis to cirrhosis , 2006, Hepatology.

[7]  Jim McCambridge,et al.  Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data , 2006, The Lancet.

[8]  N. Weiss,et al.  Is central obesity associated with cirrhosis-related death or hospitalization? A population-based, cohort study. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[9]  H. El‐Serag,et al.  Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. , 2004, Gastroenterology.

[10]  T. Key,et al.  Validity of self-reported height and weight in 4808 EPIC–Oxford participants , 2002, Public Health Nutrition.

[11]  C. Westhoff,et al.  Oral contraceptives and venous thromboembolism: should epidemiologic associations drive clinical decision making? , 1996, Contraception.

[12]  M. C. Leske,et al.  Breast cancer and hormonal contraceptives: further results , 1996 .

[13]  S. Kendrick,et al.  The Scottish Record Linkage System. , 1993, Health bulletin.

[14]  A. Klatsky,et al.  Alcohol, Smoking, Cofee, and Cirrhosis , 1992 .

[15]  A. Klatsky,et al.  Alcohol, smoking, coffee, and cirrhosis. , 1992, American journal of epidemiology.

[16]  A G Babiker,et al.  Floating absolute risk: an alternative to relative risk in survival and case-control analysis avoiding an arbitrary reference group. , 1991, Statistics in medicine.

[17]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context , 1990, The Lancet.

[18]  R. Collins,et al.  Blood pressure, stroke, and coronary heart disease Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias , 1990, The Lancet.

[19]  D. Black.  HEALTH AND DEPRIVATION: Inequality and the north , 1988 .

[20]  P. Townsend,et al.  Health and Deprivation: Inequality and the North , 1987 .

[21]  F. Schaffner,et al.  Nonalcoholic fatty liver disease. , 1986, Progress in liver diseases.