The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

The combined effect of alcohol and obesity on risk of liver disease: a systematic review and meta-analysis

The combined effect of alcohol and obesity on risk of liver disease: a systematic review and meta-analysis
The combined effect of alcohol and obesity on risk of liver disease: a systematic review and meta-analysis
Background: liver disease caused by alcohol and obesity is preventable by risk factor modification. Evidence from individual studies on risk in patients who have both risk factors is inconsistent. We performed a systematic review and meta-analysis to quantify the risk of liver disease associated with combinations of BMI and alcohol consumption.

Methods: the full study protocol is registered with PROSPERO (CRD42016046508). Inclusion criteria were: English language publications in peer-reviewed journals; adults from general population cohorts without pre-existing liver disease; BMI and alcohol quantifiably measured; follow-up at least 10 years duration. Outcomes were incident morbidity/mortality from cirrhosis and/or hepatocellular carcinoma. A one-stage meta-analysis was performed on original count data, using a Poisson regression log-linear model. The log-linear model has the property that joint effects are multiplicative. Reference categories were normal weight (BMI<25) and alcohol consumption above zero but within UK limits (<112 g/wk).
Results: the search identified 2589 studies. 50 underwent full text review. Eight cohorts (Two from the USA, six from Europe) were included in the meta-analysis, totalling 1,029,962 participants. There was no interaction between alcohol and obesity in the model. Risks of liver disease in those with both increased BMI and alcohol consumption were significantly increased and were multiplicative, as per the properties of the log-linear model (figure 1). Compared to normal weight participants drinking <112 g/wk (UK recommended limit), the relative risk of liver disease in those who were overweight and drinking above limits was 3.60 (95%CI 3.22-4.02) and the relative risk in those who were obese and drinking above limits was 5.84 (95%CI 5.09–6.70).

Conclusion: overweight and obese patients drinking >112 g/wk are at significantly increased risk of liver disease. This risk should inform lifestyle advice given to patients and risk stratification by healthcare professionals. Alcohol thresholds imposed in NAFLD criteria and pathways may mean that patients with both increased BMI and alcohol risk factors, at risk of Both Alcohol and Fatty Liver Disease (BAFLD), are not receiving appropriate risk assessment or clinical care. The current guidelines for alcohol consumption may not be appropriate for obese patients
chronic liver disease, body mass index (bmi), alcohol consumption, relative risk, meta-analysis, cohort studies
0270-9139
753a
Glyn-Owen, Kate Anne
5973f869-c528-4c3e-96fa-f17636e17022
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Bohning, Dankmar
1df635d4-e3dc-44d0-b61d-5fd11f6434e1
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Buchanan, Ryan
9499f713-f684-4046-be29-83cd9d6f834d
Glyn-Owen, Kate Anne
5973f869-c528-4c3e-96fa-f17636e17022
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Bohning, Dankmar
1df635d4-e3dc-44d0-b61d-5fd11f6434e1
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Buchanan, Ryan
9499f713-f684-4046-be29-83cd9d6f834d

Glyn-Owen, Kate Anne, Parkes, Julie, Bohning, Dankmar, Roderick, Paul and Buchanan, Ryan (2019) The combined effect of alcohol and obesity on risk of liver disease: a systematic review and meta-analysis. Hepatology, 70 (S1), 753a. (doi:10.1016/S0168-8278(19)30205-3).

Record type: Meeting abstract

Abstract

Background: liver disease caused by alcohol and obesity is preventable by risk factor modification. Evidence from individual studies on risk in patients who have both risk factors is inconsistent. We performed a systematic review and meta-analysis to quantify the risk of liver disease associated with combinations of BMI and alcohol consumption.

Methods: the full study protocol is registered with PROSPERO (CRD42016046508). Inclusion criteria were: English language publications in peer-reviewed journals; adults from general population cohorts without pre-existing liver disease; BMI and alcohol quantifiably measured; follow-up at least 10 years duration. Outcomes were incident morbidity/mortality from cirrhosis and/or hepatocellular carcinoma. A one-stage meta-analysis was performed on original count data, using a Poisson regression log-linear model. The log-linear model has the property that joint effects are multiplicative. Reference categories were normal weight (BMI<25) and alcohol consumption above zero but within UK limits (<112 g/wk).
Results: the search identified 2589 studies. 50 underwent full text review. Eight cohorts (Two from the USA, six from Europe) were included in the meta-analysis, totalling 1,029,962 participants. There was no interaction between alcohol and obesity in the model. Risks of liver disease in those with both increased BMI and alcohol consumption were significantly increased and were multiplicative, as per the properties of the log-linear model (figure 1). Compared to normal weight participants drinking <112 g/wk (UK recommended limit), the relative risk of liver disease in those who were overweight and drinking above limits was 3.60 (95%CI 3.22-4.02) and the relative risk in those who were obese and drinking above limits was 5.84 (95%CI 5.09–6.70).

Conclusion: overweight and obese patients drinking >112 g/wk are at significantly increased risk of liver disease. This risk should inform lifestyle advice given to patients and risk stratification by healthcare professionals. Alcohol thresholds imposed in NAFLD criteria and pathways may mean that patients with both increased BMI and alcohol risk factors, at risk of Both Alcohol and Fatty Liver Disease (BAFLD), are not receiving appropriate risk assessment or clinical care. The current guidelines for alcohol consumption may not be appropriate for obese patients

Text
The combined effect of alcohol and obesity on risk of liver disease: a systematic review and meta-analysis - Version of Record
Restricted to Repository staff only
Request a copy

More information

Published date: 1 October 2019
Keywords: chronic liver disease, body mass index (bmi), alcohol consumption, relative risk, meta-analysis, cohort studies

Identifiers

Local EPrints ID: 445419
URI: http://eprints.soton.ac.uk/id/eprint/445419
ISSN: 0270-9139
PURE UUID: 87228777-ba72-41ef-89cb-edacd63f3937
ORCID for Kate Anne Glyn-Owen: ORCID iD orcid.org/0000-0001-7934-2684
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X
ORCID for Dankmar Bohning: ORCID iD orcid.org/0000-0003-0638-7106
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 08 Dec 2020 17:31
Last modified: 18 Feb 2021 17:29

Export record

Altmetrics

Contributors

Author: Kate Anne Glyn-Owen ORCID iD
Author: Julie Parkes ORCID iD
Author: Dankmar Bohning ORCID iD
Author: Paul Roderick ORCID iD
Author: Ryan Buchanan

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×