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)

Trembling, Paul M.; Apostolidou, Sophia; Gentry‐Maharaj, Aleksandra; Parkes, Julie; Ryan, Andy; Tanwar, Sudeep; Burnell, Matthew; Jacobs, Ian; Menon, Usha; Rosenberg, William

doi:10.1186/s12889-017-4518-y

Cited by 14 publications

(13 citation statements)

References 48 publications

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“…Trembling et al found in a large cohort of postmenopausal women that those who were overweight or obese and drank the most alcohol had the highest risk of developing liver related events. However also abstainers had an increased risk 30. This last observation highlights the controversial issue of moderate amounts of alcohol having the potential to be protective as several studies suggest 31 32…”

Section: Epidemiologymentioning

confidence: 85%

Recent advances in alcohol-related liver disease (ALD): summary of a Gut round table meeting

Avila

Dufour

Gerbes³

et al. 2019

Gut

149

106

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Alcohol-related liver disease (ALD), which includes a range of disorders of different severity and is one of the most prevalent types of liver disease worldwide, has recently regained increased attention. Among other reasons, the realisation that any alcohol intake, regardless of type of beverage represents a health risk, and the new therapeutic strategies tested in recently published or undergoing clinical trials spur scientific interest in this area.In April 2019, Gut convened a round table panel of experts during the European Association for the Study of the Liver International Liver Congress in Vienna to discuss critical and up-to-date issues and clinical trial data regarding ALD, its epidemiology, diagnosis, management, pathomechanisms, possible future treatments and prevention. This paper summarises the discussion and its conclusions.

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Section: Epidemiologymentioning

confidence: 85%

Recent advances in alcohol-related liver disease (ALD): summary of a Gut round table meeting

Avila

Dufour

Gerbes³

et al. 2019

Gut

149

106

View full text Add to dashboard Cite

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“…We have previously evaluated potential confounding risk factors in univariate Cox proportional hazards models to determine their individual associations with liver disease, confirming that deprivation score and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes were all independently associated with risk [10].…”

Section: Discussionmentioning

confidence: 72%

“…Of the 95,126 participants from UKCTOCS studied (see Trembling et al, 2018 for details of this cohort) [10], 325 participants experienced a first LRE, of which 58 had recorded risk factors and at least three serial serum samples stored. These cases were matched to 116 controls as described above.…”

Section: Resultsmentioning

confidence: 99%

“…We have previously described the association between increasing body mass index (BMI) and liverrelated events (LRE) in a large cohort of women participating in the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS) [10]. In the present study we aimed to investigate the association of the ELF test with LRE in postmenopausal women with risk factors comprising high BMI and / or high alcohol consumption in a case-control study using the PRoBE design (prospective-specimen-collection, retrospective-blinded-evaluation) [11].…”

Section: Introductionmentioning

confidence: 99%

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The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease

et al. 2020

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Background: Chronic liver disease (CLD) is usually asymptomatic but earlier detection is critical to permit lifesaving interventions for those at risk due to high alcohol consumption and increased body mass index (BMI). The aim of this study was to estimate the association between the Enhanced Liver Fibrosis (ELF) test and liver-related events (LRE) and its performance in predicting LRE in postmenopausal women with risk factors in a nested case-control study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS).Methods: In a cohort of 95,126 we performed a case-control study measuring ELF in blinded samples from 173 participants with self-reported high alcohol use and / or BMI ≥25 kg/m 2 comprising all 58 cases who developed LRE and 115 controls matched for age, alcohol and BMI who did not develop LRE during median follow-up of 8.5 years.Results: Using Cox regression at an ELF threshold of 10.51 hazard ratios (HR) for LRE were 4.88 (95% confidence interval (CI) 2.37-10.03) (unadjusted model) and 4.62 (95% CI 2.12-10.08) (adjusted for deprivation and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes). At a threshold of 9.8 HR for LRE were 2.21 (95% CI 1.22-3.97) (unadjusted model) and 2.18 (95% CI 1.19-4.01) (adjusted). ELF was evaluated as a time dependent variable by generating time-dependent Cox models; HRs at an ELF threshold of 10.51 were 1.94 (95% CI 1.10-3.39) (unadjusted) and 2.05 (95% CI 1.16-3.64) (adjusted) and at a threshold of 9.8 HRs were 1.85 (95% CI 1.09-3.15) (unadjusted) and 1.80 (95% CI 1.04-3.13) (adjusted). Area under the receiver operating characteristic curve for recruitment ELF predicting LRE was 0.58 (95% CI 0.49-0.68), and for second subsequent ELF 0.61 (95% CI 0.52-0.71). Conclusion:This study demonstrates the association between ELF and CLD in postmenopausal women with risk factors for liver disease, creating the opportunity to intervene to reduce liver-related mortality and morbidity. Although larger studies are required, these results demonstrate the potential of ELF as a prognostic tool in health checks in primary care.(Continued on next page)

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“…In a large cohort of post-menopausal women we observed more clinical events attributable to cirrhosis amongst women who were overweight or obese compared to those with a normal BMI. Although there was no evidence of significant interaction between alcohol and BMI, the highest risk of liver disease was seen in women who were overweight or obese and consumed the most alcohol [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS)

et al. 2018

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BackgroundWe investigated the association between self-reported skirt size (SS) and change in SS, and incidence of chronic liver disease (CLD) in a prospective cohort study of women recruited to the UKCTOCS trial.MethodsWomen recruited to UKCTOCS in England without documented CLD self-reported their current UK SS during trial participation and were asked to recall their SS when aged in 20s (via completion of a questionnaire 3–5 years after recruitment). Participants were followed up via electronic health record linkage and hazard ratios (HR) calculated for incident liver-related events (LRE).ResultsThree hundred twenty-two (0.3%) of 94,124 women experienced a first LRE. Compared to SS ≤ 16, rates of LRE were higher in the SS ≥ 18 groups (both when aged in 20s and at questionnaire completion). Event rates were higher if there was no change in SS or an increase in SS, compared to a decrease in SS.In the models adjusted for potential confounders, HRs for LRE were higher in the groups of women reporting SS ≥ 18 both when aged in 20s (HR = 1.39 (95% CI; 0.87–2.23)) and at questionnaire completion (HR = 1.37 (95% CI; 1.07–1.75)). Compared to a decrease in SS, HRs were higher in the no change (HR = 1.78 (95% CI; 0.95–3.34)) and increase (HR = 1.80 (95% CI; 1.01–3.21)) groups.ConclusionCLD is associated with high SS and an increase in SS over time. These data suggest SS can be used in simple public health messages about communicating the risk of liver disease.Trial RegistrationUKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5308-x) contains supplementary material, which is available to authorized users.

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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)

Cited by 14 publications

References 48 publications

Recent advances in alcohol-related liver disease (ALD): summary of a Gut round table meeting

Recent advances in alcohol-related liver disease (ALD): summary of a Gut round table meeting

The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease

Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS)

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