By Michael Smith, North American Correspondent, MedPage Today
Published: April 26, 2013
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania
AMSTERDAM – Obesity and heavy drinking are each known risk factors for liver disease, but together they appear to be even worse, researchers said here.
Analysis of a large population-based cohort of women in England showed that the risk of liver cirrhosis and decompensation was markedly increased if participants were either obese or heavy drinkers, according to researchers led by William Rosenberg, MBBS, DPhil, of the University College London.
But the combination of the two was "super-additive," Rosenberg told MedPage Today during the meeting of the European Association for the Study of the Liver, more than doubling the risk seen with either of the other risk factors (P<0.001).
"At first glance, (the study finding) doesn't seem very surprising," he said.
But the analysis of 108,000 women ages 50 to 75 taking part in a cancer screening trial is the largest to look at the incidence of advanced liver disease in the context of overweight and alcohol use.
And it did find one surprise, Rosenberg said: that being overweight and being obese have different effects when combined with alcohol use.
In women who were overweight and drank, the two risks simply added up, but in those who were obese – usually defined as a body mass index (BMI) of 30 or higher – the risks were synergistic.
"If you're obese, the damage you can do to yourself (by drinking heavily) is much greater than if you're just overweight," Rosenberg said.
Among the 108,000 women in the analysis, there were 616 events of advanced liver disease over a median follow-up of 9.4 years, the researchers found.
Women with a low body mass index who also had low alcohol intake were at the lowest risk, with a cumulative hazard of less than 0.001. Those who had a high BMI but drank lightly had a similar but slightly higher hazard, they found.
Slimmer women who drank heavily had about double the hazard of those who were low in both categories, but heavy drinkers with a high BMI had a cumulative hazard of greater than 0.004.
"The public health message is enormously important," Rosenberg said. "People are not aware that they are putting themselves at this risk."
The study should be viewed in the context of common heavy drinking in Europe and a 10-fold increase in death from cirrhosis among middle-age women in England from 1970 to 2000, commented Daniele Prati, MD, of the Ospedale Alessandro Manzoni in Lecco, Italy, who was not involved in the study but who moderated a press conference at which some details were discussed.
Prati told MedPage Today that the findings are not surprising, but it's important to see that they've been established in a large population.
Now, it's up to governments to "sensitize the population about risk," he said.
The UKCTOCS study has support from the MRC, Cancer Research UK and National Health Service. Trembling and Rosenberg did not report any additional support or make any disclosures.
Prati reported financial links with Roche, BMS, Novartis, and AbbVie.
Primary source: European Association for the Study of the Liver
Source reference:
Trembling PM, et al "Influence of BMI and alcohol on liver-related morbidity and mortality in a cohort of 108,000 women from the general population from UKCTOCS" EASL 2013; Abstract 115.
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