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High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men
Hannes Hagström1,2, Per Tynelius3,4, Finn Rasmussen5
Author affiliations
Centre for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm, Sweden
Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Stockholm, Sweden
Department of Health Sciences, Lund University, Lund, Sweden
Correspondence to Dr Hannes Hagström, Centre for Digestive Diseases, Division of Hepatology, Karolinska University Hospital, Stockholm 141 86, Sweden; [email protected]
Abstract
Objective A high body mass index (BMI) is associated with an increased risk for severe liver disease. It is unclear if this risk differs across BMI categories, and if the association is partially attributed to development of type 2 diabetes mellitus (T2DM).
Design
We used register data from more than 1.2 million Swedish men enlisted for conscription between 1969 and 1996. Data regarding new events of severe liver disease and T2DM during follow-up were obtained by record-linkage of population-based registers. We used Cox regression to estimate adjusted HRs for future inpatient care and mortality in severe liver disease and incidence of hepatocellular carcinoma (HCC) across BMI categories, using BMI of 18.5–22.5 kg/m2 as reference.
Results
During a follow-up of more than 34 million person-years, 5281 cases of severe liver disease including 251 cases of HCC were identified. An association with severe liver disease was found for overweight (HR 1.49, 95% CI 1.35 to 1.64) and for obese men (HR 2.17, 95% CI 1.82 to 2.59). Development of T2DM further increased the risk for severe liver disease across all BMI categories, for instance, men with obesity and T2DM had a higher risk of severe liver disease (HR 3.28, 95% CI 2.27 to 4.74) than men with obesity free of T2DM (HR 1.72, 95% CI 1.72 to 2.54).
Conclusions
A high BMI in late adolescent men was associated with an increased risk of future severe liver disease, including HCC. Development of T2DM during follow-up was associated with a further increased risk of severe liver disease, independent of baseline BMI.
http://dx.doi.org/10.1136/gutjnl-2016-313622
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Significance of this study
What is already known on this subject?
Overweight and obesity is increasing in prevalence worldwide.
A high body mass index (BMI) is associated with an increased risk for future severe liver disease and hepatocellular carcinoma in adults.
A high BMI also increases the risk for type 2 diabetes mellitus (T2DM), which in turn is associated with an increased risk of severe liver disease.
What are the new findings?
High BMI in late adolescence is associated with future severe liver disease in a non-linear relationship.
This risk is even higher in men who also develops T2DM, but also relevant in men who do not develop T2DM.
High BMI in late adolescence is also associated with an increased risk of subsequent hepatocellular carcinoma.
How might it impact on clinical practice in the foreseeable future?
Men who are overweight in young adulthood should be informed about an increased risk of future severe liver disease, including hepatocellular carcinoma. This could affect future public health decisions.
Men who develop T2DM, independent of BMI early in young adulthood or midlife, is at increased risk of severe liver disease, should be informed of this risk and possibly screened for presence of manifest liver disease to prevent future mortality in liver disease. |
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发表于 2018-7-11 19:50