Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study LIVER
An ongoing surveyance study of more than 1 million women in the UK suggests that liver cirrhosis is significantly higher among obese women than among women with normal weight. Hence, in addition to alcohol, obesity is a risk factor for cirrhosis.
Professor by R Curtis Ellison comments: This paper is based on a very large number of subjects in the surveillance group (more than 1,000,000), a prospective, cohort study in the UK. There was good ascertainment of liver cirrhosis (made from hospital admission records & death records), and a large number of cases of cirrhosis (1,811 cases). The authors did an excellent job in the analysis. At baseline, the expected inverse associations were seen between obesity and heavy alcohol use, sedentary lifestyle, smoking, and socioeconomic status. There was the expected direct association between baseline obesity and diabetes.
The key findings of the paper are that the risk of cirrhosis increases with obesity, as well as with smoking. The authors state that 77% of women reported drinking some alcohol, and that among the drinkers, the mean reported alcohol consumption was 54 g/week or approximately five and a half standard drinks a week (using 10 grams of alcohol in a typical drink). There were very few heavy drinkers in this group.
No data were available on the pattern of drinking (whether the women were binge drinkers or regular moderate drinkers) or have suffered from hepatitis. Also there were no comparisons with abstainers, as the lowest group included up 70 grams (7 UK drinks) per week. Further, it does not appear that the study had data on previous drinking, so some of the subjects in the lowest category (including abstainers) may have been previous heavy drinkers; rates of cirrhosis among current abstainers in this study are not reported. Thus, while this study did not focus on the effects of alcohol on cirrhosis, the authors estimate that 42% of hospital admissions with cirrhosis or deaths from cirrhosis in the UK can be attributed to alcohol consumption and 17% to excess body weight (body mass index ≥ 25).
Source: Liu B, Balkwill A, Reeves G, Beral V, on behalf of the Million Women Study Collaborators. Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study. BMJ 2010;340:c912; doi:10.1136/bmj.c912