Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies

Loomis, A. Katrina; Kabadi, Shaum; Preiss, David; Hyde, Craig; Bonato, Vinícius; Louis, Matthew St; Desai, Jigar; Gill, Jason M.R.; Welsh, Paul; Waterworth, Dawn; Sattar, Naveed

doi:10.1210/jc.2015-3444

Cited by 202 publications

(180 citation statements)

References 24 publications

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“…Increased BMI is an established risk factor of NAFLD/NASH . Similarly, even in this population that could be considered lean relative to Western population, we also observed a higher risk of cirrhosis mortality in those with higher BMI.…”

Section: Discussionsupporting

confidence: 58%

“…The first postulation is that earlier medical care and aggressive risk factor screening/treatment targeted on heavier participants with diabetes may have contributed to better outcomes. Secondly, others have suggested that normal weight or lean diabetic patients may have different pathogeneses or genetic profiles, which may be associated with a predilection for liver injury and phenotypically, a more aggressive liver disease progression . Thirdly, studies have also suggested that BMI is an imperfect surrogate marker for measurement of adiposity, as it cannot discriminate between lean body mass and fat mass.…”

Section: Discussionmentioning

confidence: 99%

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Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study

Goh

Pan

Chow

et al. 2016

Liver International

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Background and Aim Diabetes mellitus has been linked to liver cirrhosis-related mortality in Western populations, but less is known about this relationship in Asian populations. We studied the impact of diabetes on the risk of cirrhosis mortality in a population-based cohort among Chinese in Singapore. Methods We used data collected and analysed from the Singapore Chinese Health Study, a prospective community based cohort of 63,275 subjects aged 45 to 74 years during enrolment between 1993 and 1998. Information on diet, lifestyle and medical history was collected via structured questionnaire. Mortality cases from cirrhosis in the cohort were identified via linkage with nationwide death registry up to 31 December 2014. Cox proportional regression models were used to estimate the associations with adjustment for risk factors of cirrhosis. Results After a mean follow-up of 16.9 years, there were 133 deaths from cirrhosis. Diabetes was associated with an increased risk of cirrhosis mortality [hazard ratio (HR): 2.80; 95% confidence interval (CI): 2.04-3.83], and for both viral (HR: 2.20; 95% CI: 1.18-4.11) and non-viral hepatitis related cirrhosis mortality (HR: 3.06; 95% CI: 2.13-4.41). The association between diabetes and non-viral hepatitis-related cirrhosis mortality was stronger among participants of body mass index less than 23 kg/m2 (HR: 7.11; 95% CI: 3.42-14.79) compared to heavier individuals (HR: 2.28; 95% CI: 1.20-4.35) (Pinteraction=0.02). Conclusion Diabetes is a risk factor for cirrhosis mortality, especially for non- viral hepatitis related cirrhosis in population with body mass index considered low or normal in Asia.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study

Goh

Pan

Chow

et al. 2016

Liver International

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“…Obesity is the most important risk factor for NAFLD, which affects as much as 74% of obese individuals[5]. Two large electronic databases have demonstrated a clear association between a higher body mass index (BMI), diabetes and male gender and the risk for NAFLD[6]. Furthermore, among morbidly obese patients, who are candidates for bariatric surgeries, the prevalence is even higher and reaches 96%[7-10].…”

Section: Introductionmentioning

confidence: 99%

Predictors for advanced fibrosis in morbidly obese non-alcoholic fatty liver patients

Zelber‐Sagi

Shoham

Zvibel

et al. 2017

WJH

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AIMTo investigate predictors for fibrosis specifically in a high risk population of morbidly obese patients, including detailed evaluation of lifestyle.METHODSWe conducted a cross-sectional study among morbidly obese patients attending the bariatric clinic at the Tel-Aviv Medical Center between the years 2013-2014 with body mass index (BMI) above 40 or above 35 with co-morbidity. Patients with serum hepatitis B surface antigen or anti-hepatitis C virus antibodies, genetic liver diseases, autoimmune disease or high alcohol intake (≥ 30 g/d in men or ≥ 20 g/d in women) were excluded from the study. Liver fibrosis was estimated by transient elastography (FibroScan®), using the ‘‘XL’’ probe. We collected data on age and gender, education, smoking status and amount, medical history, nutrition and lifestyle habits. All these data were collected using structured and validated questionnaires. Fasting blood test were available for a subsample.RESULTSFibroscan was performed on a total of 91 patients, of which 77 had a valid examination according to the accepted criteria. Of those, 21% had significant fibrosis (F2) and 39% had advanced or severe fibrosis (F3 or F4). In multivariate analysis, male gender and BMI had a positive association with advanced fibrosis; the OR for fibrosis F ≥ 2 was 7.93 (95%CI: 2.36-26.64, P = 0.001) for male gender and 1.33 (1.11-1.60 kg/m2, P = 0.002) for BMI. The OR for fibrosis F ≥ 3 was 2.92 (1.08-7.91, P = 0.035) for male gender and 1.17 (1.03-1.33, P = 0.018) for BMI. Subjects were categorized to subgroups based on the combination of male gender and BMI of 40 and above. A significant dose response association with stiffness level was noted across these categories, with the highest stiffness among men with a higher BMI (P = 0.001). In addition, a significant positive correlation between pack-years cigarette smoking and liver stiffness was demonstrated among men (r = 0.54, P = 0.012).CONCLUSIONIn the morbidly obese population, a higher BMI, male gender and degree of smoking in men bears a greater risk for advanced nonalcoholic fatty liver disease.

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“…[5] Increase in body mass index (BMI) has been shown to increase the risk of NAFLD by 5-14 fold, [6] a unit increase in waist circumference (WC) has been shown to increase the risk of NAFLD by 0.07, [7] and hypertension has been shown to have a 1.8 higher odds of developing NAFLD. [8] Patients with at least one allele of the gene palatin-like phospholipase 3 display a favorable metabolic profile with normal insulin sensitivity [5] and these individuals are considered as having lean NAFLD.…”

Section: Introductionmentioning

confidence: 99%

Case-control study evaluating relationship of blood pressure and anthropometric parameters with non-alcoholic fatty liver disease

Joseph¹,

George²,

Prasannarajan³

et al. 2018

Natl J Physiol Pharm Pharmacol

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Background:The prevalence of non-alcoholic fatty liver disease (NAFLD) has increased over the last decade. India is one of the countries with highest prevalenceof NAFLD. High prevalence of lifestyle disorders among Keralites and their association with NAFLD necessitates studies on the subject. Aims and Objective: Owing to the scarcity of studies evaluating the association of NAFLD with anthropometric and clinical parameters in Kerala, the present study was conducted. Materials and Methods: Our case-control study enrolled 81 cases (with NAFLD) and 79 controls (without NAFLD) who were undergoing voluntary health checkup over a period of 2 years. Institutional Ethics Committee approved the study and written informed consent was obtained from all the study participants. Sociodemographic, anthropometric parameters and blood pressure (BP) were recorded and categorized based on gender, body mass index (BMI), and BP (JNC-8). Data were analyzed using free software R™. Independent sample t-test, Mann-Whitney U-test, and Chi-square test were used for statistical analysis and P < 0.05 was considered statistically significant. Results: 15% and 11% of the study participants were having normal BMI and BP, respectively. Cases were significantly taller (P = 0.003), were having higher BMI (P = 0.04), weight (P < 0.001), waist circumference (WC) (P = 0.02), and systolic BP (SBP) (P = 0.02) compared to controls.Significant association was observed between NAFLD and stage 2 hypertension (P = 0.04). Our study did not demonstrate any association between NAFLD and BMI (P = 0.2) and between NAFLD and WC (P = 0.7). Conclusion: High prevalence of weight-related and BP disorders were seen in participants undergoing voluntary health checkup. NAFLD was associated with a significantly higher weight, BMI, height, SBP, and WC. Significantly higher odds of NAFLD were seen in participants with Stage 2 hypertension.

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Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies

Abstract: These data quantify the consistent and strong relationships between BMI and prospectively recorded diagnoses of NAFLD/NASH and emphasize the importance of weight reduction strategies for prevention and management of NAFLD.

Cited by 202 publications

References 24 publications

Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study

Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study

Predictors for advanced fibrosis in morbidly obese non-alcoholic fatty liver patients

Case-control study evaluating relationship of blood pressure and anthropometric parameters with non-alcoholic fatty liver disease

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