Characterizing the risk interplay between alcohol intake and body mass index on cirrhosis morbidity

Abstract

Background and Aims It is thought that alcohol intake and body mass index (BMI) interact supra‐additively to modulate the risk of cirrhosis, but evidence for this phenomenon is limited. We investigated the interrelationship between alcohol and BMI on the incidence of cirrhosis morbidity for participants of the United Kingdom Biobank (UKB) study. Approach and Results The primary outcome was the cumulative incidence of cirrhosis morbidity, defined as a first‐time hospital admission for cirrhosis (with noncirrhosis mortality incorporated as a competing risk). All UKB participants without a previous hospital admission for cirrhosis were included in the analysis. We determined the ratio of the 10‐year cumulative incidence in harmful drinkers versus safe drinkers according to BMI. We also calculated the excess cumulative incidence at 10 years for individuals with obesity and/or harmful alcohol compared to safe drinkers with a healthy BMI of 20–25.0 kg/m2. A total of 489,285 UK Biobank participants were included, with mean of 10.7 person‐years’ follow‐up. A total of 2070 participants developed the primary outcome, equating to a crude cumulative incidence of 0.36% at 10 years (95% CI:0.34–0.38). The 10‐year cumulative incidence was 8.6 times higher for harmful (1.38%) versus safe drinkers (0.16%) if BMI was healthy. Conversely, it was only 3.6 times higher for obese participants (1.99% vs. 0.56%). Excess cumulative incidence was 1.22% (95% CI:0.89–1.55) for harmful drinkers with a healthy BMI, 0.40% (95% CI:0.34–0.46) for obese individuals drinking at safe levels, and 1.83% (95% CI:1.46–2.20) for obese harmful drinkers (all compared to safe drinkers with a healthy BMI). Conclusions Alcohol intake and obesity are independent risk factors for cirrhosis morbidity, but they do not interact supra‐additively to modulate the cumulative incidence of this outcome.

Alcohol consumption and metabolic syndrome: Clinical and epidemiological impact on liver disease

“…85 Findings are more mixed regarding supra-additive interactions between hazardous alcohol use and high BMI. 85,[88][89][90] With competing-risk methodology and a cohort from the general population, we recently found that liver-related outcomes were affected by an interaction between harmful alcohol consumption and a high WHR, but not between alcohol and BMI. 91 That finding supported the notion that WHR is a key obesity measure in this context.…”

Noninvasive Algorithms for the Case Finding of “At-Risk” Patients with NAFLD

“…In line with these results, longitudinal prognostic studies have demonstrated the risk of hard liver-related outcomes is additive, even exponential, when overweight/obesity cumulates with harmful alcohol consumption. 26,27 Which Strategy When Using Non-invasive Tests?…”

“…Alcohol and obesity were predictors of advanced disease, particularly drinking greater than 14/21 units/wk ( p < 0.0001), a finding consistent with previous studies. 22 26 27…”

Synergistic Associations of PNPLA3 I148M Variant, Alcohol Intake, and Obesity With Risk of Cirrhosis, Hepatocellular Carcinoma, and Mortality

“…and 1 unit in a measure (25 mL) of spirits. 14,15 We categorized alcohol intake as excessive if the weekly intake reported was at least 36 units for men and at least 25 units for women. These thresholds represent the midpoint between hazardous and harmful drinking in the UK government guidelines.…”