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)

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

doi:10.1186/s12889-017-4518-y

Abstract

BackgroundWe investigated the risk of chronic liver disease (CLD) due to alcohol consumption and body mass index (BMI) and the effects of their interaction in a prospective cohort study of women recruited to the UKCTOCS trial.Methods95,126 post-menopausal women without documented CLD were stratified into 12 groups defined by combinations of BMI (normal, overweight, obese) and alcohol consumption (none, <1–15, 16–20 and ≥21 units/week), and followed for an average of 5.1 years. Hazard ratios (HR) were calculated for incident liver-related events (LRE).ResultsFirst LREs were reported in 325 (0.34%) participants. Compared to women with normal BMI, HR = 1.44 (95% CI; 1.10–1.87) in the overweight group and HR = 2.25 (95% CI; 1.70–2.97) in the obese group, adjusted for alcohol and potential confounders. Compared to those abstinent from alcohol, HR = 0.70 (95% CI; 0.55–0.88) for <1–15 units/week, 0.93 (95% CI; 0.50–1.73) for 16–20 units/week and 1.82 (95% CI; 0.97–3.39) for ≥21 units/week adjusted for BMI and potential confounders. Compared to women with normal BMI drinking no alcohol, HR for LRE in obese women consuming ≥21 units/week was 2.86 (95% CI; 0.67–12.42), 1.58 (95% CI; 0.96–2.61) for obese women drinking <1–15 units/week and 1.93 (95% CI; 0.66–5.62) in those with normal BMI consuming ≥21 units/week after adjustment for potential confounders. We found no significant interaction between BMI and alcohol.ConclusionHigh BMI and alcohol consumption and abstinence are risk factors for CLD in post-menopausal women. However, BMI and alcohol do not demonstrate significant interaction in this group.Trial registrationUKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.

Highlights

We investigated the risk of chronic liver disease (CLD) due to alcohol consumption and body mass index (BMI) and the effects of their interaction in a prospective cohort study of women recruited to the UKCTOCS trial
A synergistic interaction between steatosis and alcohol consumption in the progression of fibrosis in patients with chronic hepatitis C has been demonstrated in histological studies [13]
Baseline characteristics are shown in Table 1. 97.1% of the participants were white. 36% were smokers. 55% were either overweight (37%) or obese (19%). 23.4% reported drinking no alcohol and 1.5% reported drinking more than 21 units/week

Summary

Introduction

We investigated the risk of chronic liver disease (CLD) due to alcohol consumption and body mass index (BMI) and the effects of their interaction in a prospective cohort study of women recruited to the UKCTOCS trial. The precise influence of body mass index (BMI) on the risk of liver disease in women, is not conclusive and previous studies using smaller subsets of ICD-10 codes to identify liver-related morbidity and mortality may have underestimated the impact of BMI and alcohol [9, 10]. Regardless of the etiology of liver disease, the clinicopathological outcome in those who develop CLD is cirrhosis [11] and the there may be common pathways in which alcohol and high BMI damage the liver [12]. A synergistic interaction between steatosis and alcohol consumption in the progression of fibrosis in patients with chronic hepatitis C has been demonstrated in histological studies [13]

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Results

Discussion

Conclusion