Joint Associations of Adiposity and Alcohol Consumption With Liver Disease-Related Morbidity and Mortality Risk: Findings From the UK Biobank
Abstract
Background
The incidence of both non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD) are expected to grow as a consequence of the ongoing obesity and alcohol consumption trends.
Objective
This study examined the joint associations of adiposity (body mass index (BMI) and waist circumference (WC)) and alcohol consumption on ALD, NAFLD and liver disease incidence and mortality (n = 465,437).
Methods
Alcohol consumption was categorised based on current UK guidelines (14 units/week). Data were analysed using Cox proportional hazard models. A total of 1090 liver disease deaths, 230 ALD deaths and 192 NAFLD deaths occurred over an average follow-up length of 10.5 ± 1.7 years.
Results
In multivariate models, the researchers observed greater point estimates for risk of ALD, NAFLD and liver disease incidence and mortality among overweight/obese participants who consumed alcohol at the same level as normal weight participants. The study found that overweight/obese participants who reported alcohol consumption above the guidelines had a greater HR for liver disease incidence and mortality (HR 1.52, 95% CI 1.32, 1.75 and HR 2.20, 95% CI 1.41, 3.44, respectively) than normal weight individuals (HR 0.95, 95% CI 0.83, 1.09 and HR 1.24, 95% CI 0.8, 1.93, respectively). The results for the associations of alcohol consumption and WC with ALD, NAFLD and liver disease mortality were similar. Participants with high WC who reported alcohol consumption above the guidelines had a greater HR for liver disease incidence (HR 1.59, 95% CI 1.35, 1.87) than normal WC individuals (HR 0.85, 95% CI 0.72, 1.01).
Conclusions
This study found evidence that being overweight/obese amplified the harmful effect of alcohol on the liver incidence and mortality.
Research in context
This study found that people who are obese or overweight and use alcohol are at a greater risk of suffering from liver disease and mortality as a result of their alcohol use than their healthy weight counterparts who used alcohol at the same level. The risk was 50% greater for obese and overweight people even when they had alcohol within the low-risk alcohol use guidelines.
Even for people who drank within alcohol guidelines, participants classified as obese were at over 50 percent greater risk of liver disease,” said Professor Emmanuel Stamatakis, senior author and research program director from the Charles Perkins Centre and the Faculty of Medicine and Health, as per The University of Sydney News.
Professor Emmanuel Stamatakis, senior author, research program director, Charles Perkins Centre and the Faculty of Medicine and Health
The data come from the UK bio-bank, but researchers say they can safely be applied in the Australian context.
Researchers say the National Health and Medical Research Council (NHMRC) low-risk alcohol use guidelines need to place emphasis on the increased risks from alcohol on obese and overweight people. Specifically considering data that show two in three Australians are in the overweight or obesity range.
The researchers say the findings of the study emphasize how low-risk alcohol use guidelines and doctor’s advice may need to consider the year-on-year increasing trend of obesity and overweight prevalence in Australia and its compounding health impacts.
The current guidelines revised in 2020, state no more than 10 alcoholic beverages per week and no more than four per day for healthy adults. While the guidelines state alcohol could worsen pre-existing health conditions it does not mention increased risks due obesity and being overweight.
The current alcohol guidelines are based on reviews of available evidence, but future updates must take into account overweight as a liver disease risk amplifying factor,” said Professor Emmanuel Stamatakis, senior author and research program director from the Charles Perkins Centre and the Faculty of Medicine and Health, as per The University of Sydney News.
Briefly mentioning obesity in the current guidelines may not be enough. Overweight and obesity affect over two-thirds of Australians, which raises the need to develop a specific alcohol [limit] recommendation for this population majority group.”
Based on our study’s findings, people who are in the overweight range, not only obese, should consume alcohol cautiously, and perhaps aim for an amount well below the generic NHMRC guidelines.”
Professor Emmanuel Stamatakis, senior author, research program director, Charles Perkins Centre and the Faculty of Medicine and Health
