The combined effect of alcohol and body mass index on risk of chronic liver disease: A systematic review and meta-analysis of cohort studies.
alcohol
chronic liver disease
cirrhosis
meta-analysis
obesity
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
25
11
2020
received:
17
08
2020
accepted:
01
12
2020
pubmed:
8
12
2020
medline:
29
6
2021
entrez:
7
12
2020
Statut:
ppublish
Résumé
Increasingly populations are both overweight/obese and consume alcohol. The risk of liver disease from the combination of these factors is unclear. We performed a systematic review and meta-analysis to address this important gap in evidence. Protocol registered with PROSPERO(CRD42016046508). We performed electronic searches of Ovid Medline, Embase Classic + Embase, until 17th June 2020 for cohort studies of adults without pre-existing liver disease. Primary outcome was morbidity/mortality from chronic liver disease. Exposures were alcohol consumption categorised as within or above UK recommended limits (14 units/112 g per week) and BMI categorised as normal, overweight or obese. Non-drinkers were excluded. A Poisson regression log-linear model was used to test for statistical interaction between alcohol and BMI and to conduct a one-stage meta-analysis. Searches identified 3129 studies-16 were eligible. Of these, nine cohorts (1,121,514 participants) had data available and were included in the analysis. The Poisson model showed no significant statistical interaction between alcohol consumption and BMI on the risk of chronic liver disease. Compared to normal weight participants drinking alcohol within UK recommended limits, relative risk of chronic liver disease in overweight participants drinking above limits was 3.32 (95% CI 2.88 to 3.83) and relative risk in obese participants drinking above limits was 5.39 (95% CI 4.62 to 6.29). This meta-analysis demonstrated a significantly increased risk of chronic liver disease in participants who were both overweight/obese and consumed alcohol above UK recommended limits. This evidence should inform advice given to patients and risk stratification by healthcare professionals.
Sections du résumé
BACKGROUND & AIMS
Increasingly populations are both overweight/obese and consume alcohol. The risk of liver disease from the combination of these factors is unclear. We performed a systematic review and meta-analysis to address this important gap in evidence. Protocol registered with PROSPERO(CRD42016046508).
METHODS
We performed electronic searches of Ovid Medline, Embase Classic + Embase, until 17th June 2020 for cohort studies of adults without pre-existing liver disease. Primary outcome was morbidity/mortality from chronic liver disease. Exposures were alcohol consumption categorised as within or above UK recommended limits (14 units/112 g per week) and BMI categorised as normal, overweight or obese. Non-drinkers were excluded. A Poisson regression log-linear model was used to test for statistical interaction between alcohol and BMI and to conduct a one-stage meta-analysis.
RESULTS
Searches identified 3129 studies-16 were eligible. Of these, nine cohorts (1,121,514 participants) had data available and were included in the analysis. The Poisson model showed no significant statistical interaction between alcohol consumption and BMI on the risk of chronic liver disease. Compared to normal weight participants drinking alcohol within UK recommended limits, relative risk of chronic liver disease in overweight participants drinking above limits was 3.32 (95% CI 2.88 to 3.83) and relative risk in obese participants drinking above limits was 5.39 (95% CI 4.62 to 6.29).
CONCLUSIONS
This meta-analysis demonstrated a significantly increased risk of chronic liver disease in participants who were both overweight/obese and consumed alcohol above UK recommended limits. This evidence should inform advice given to patients and risk stratification by healthcare professionals.
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1216-1226Subventions
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
World Health Organisation. Disease burden and mortality estimates: cause specific mortality 2000-2016. Geneva, 2018.
Williams R, Aspinall R, Bellis M, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014;384:1953-1997.
Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018;69(3):718-735.
Foundation for liver research. Financial case for action on liver disease. In: Lancet Commission on Liver Disease. London, 2017.
Younossi Z, Koenig A, Abdelatif D, et al. Global epidemiology of non-alcoholic fatty liver disease - meta-analytic assessment of prevalence. Incidence and Outcomes. Hepatol. 2016;64(1):73-84.
Rehm J, Shield KD. Global burden of alcohol use disorders and alcohol liver disease. Biomedicines. 2019;7(4):99.
European Association for the Study of Liver. HEPAMAP: A roadmap for hepatology research in Europe 2014. [Available from: www.easl.eu.]
Buck D, Frosini F. Clustering of Unhealthy Behaviours Over Time implications for Policy and Practice. London: The King's Fund; 2012.5-13.
Jepsen P, Ott P, Anderson PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatol. 2010;51(5).
Miele L, Liguori A, Marrone G, et al. Clinical impact of comorbidities in an Italian NAFLD cohort. Digest Liver Dis. 2019;51:e32.
Mueller S, Millonig G, Seitz HK. Alcoholic liver disease and hepatitis C: a frequently underestimated combination. World J Gastroenterol. 2009;15(28):3462-3471.
Newsome P, Cramb R, Davison S, et al. Guidelines on the management of abnormal liver blood tests. Gut. 2018;67:6-19.
Hart C, Morrison D, Batty G, Mitchell R, Davey SG. Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies. BMJ. 2010;340:c1240.
Loomba R, Yang H, Su J, et al. Synergism between obesity and alcohol in increasing the risk of hepatocellular carcinoma: a prospective cohort study. Am J Epidemiol. 2013;177.
Diehl AM. Obesity and alcoholic liver disease. Alcohol. 2004;34:81-87.
National Institute for Health and Care Excellence. Behaviour change: general approaches. Public health guideline PH6, 2007.
Dixon JB, Bhathal PS, Hughes NR, O'Brien PE. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss. Hepatol. 2004;39(6).
Teli MR, Day CP, Burt AD, Bennett MK, James OF. Determinants of progression to cirrhosis or fibrosis in pure alcoholic fatty liver. Lancet. 1995;346(8981):987-990.
Verrill C, Markham H, Templeton A, Carr NJ, Sheron N. Alcohol-related cirrhosis-early abstinence is a key factor in prognosis, even in the most severe cases. Addiction. 2009;104(5):768-774.
Glyn-Owen K, Parkes J, Roderick P, Buchanan R. Risk of liver disease: a systematic review and meta-analysis. PROSPERO CRD42016046508. PROSPERO. 2016.
Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. [Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.aspaccessed28/09/2017.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315.
Deeks JJ, Higgins JP, Altman DG,on behalf of the Cochrane Statistical Methods Group. Chapter 10: Analysing data and undertaking meta-analyses. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, (Editors). Cochrane Handbook for Systematic Reviews of Interventions. 2nd EditionChichester (UK): John Wiley & Sons;. 2019;241-284.
Aberg F, Helenius-Hietala J, Puukka P, Farkkila M, Jula A. Interaction between alcohol consumption and metabolic syndrome in predicting severe liver disease in the general population. Hepatol. 2018;67(6):2141-2149.
Carter AR, Borges MC, Benn M, et al. Combined association of body mass index and alcohol consumption with biomarkers for liver injury and incidence of liver disease: a mendelian randomization study. JAMA Netw Open. 2019;2(3):e190305.
Liu B, Balkwill A, Reeves G, Beral V. Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study. BMJ. 2010;340:c912.
Persson E, Schwartz L, Park Y, et al. Alcohol consumption, folate intake, hepatocellular carcinoma, and liver disease mortality. Cancer Epidemiol Biomarkers Prev. 2013;22(3):415-421.
Schult A, Mehlig K, Bjorkelund C, Wallerstedt S, Kaczynski J. Waist-to-hip ratio but not body mass index predicts liver cirrhosis in women. Scand J Gastroenterol. 2018;53(2):212-217.
Schwartz L, Persson E, Weinstein S, et al. Alcohol consumption, one-carbon metabolites, liver cancer and liver disease mortality. PLoS One. 2013;8(10):e78156.
Setiawan V, Wei P, Hernandez B, et al. Disparity in liver cancer incidence and chronic liver disease mortality by nativity in hispanics: the multiethnic cohort. Cancer. 2016;122(9):1444-1452.
Trembling P, Apostolidou S, Gentry-Maharaj A, et al. 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). BMC Public Health. 2017;17(1):603.
Simpson R, Hermon C, Liu B, et al. Alcohol drinking patterns and liver cirrhosis risk: analysis of the prospective UK million women study. The Lancet Public Health. 2019;4(1):e41-e48.
Loomba R, Bettencourt R, Barrett-Connor E. Synergistic association between alcohol intake and body mass index with serum alanine and aspartate aminotransferase levels in older adults: the rancho bernardo study. Aliment Pharmacol Ther. 2009;30(11-12):1137-1149.
Glyn-Owen K, Parkes J, Harris S, Aspinall R, Roderick P. Redefining risk of liver disease in the general population: analysis of the health survey for England 2016. J Hepatol. 2019;70(Supplement 1S):e35.
Srivastava A, Gailer R, Tanwar S, et al. Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease. J Hepatol. 2019;71(2):371-378.
National Institute for Health and Care Excellence. Cirrhosis in over 16s. assessment and management. 2016.
European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402.
European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol. 2012;57(2):399-420.
Eslam M, Sanyal AJ, George J, International Consensus P. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterol. 2020;158(7):1999-2014 e1.
Eslam M, Newsome PN, Sarin SK, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. J Hepatol. 2020;73(1):202-209.
Fouad Y, Waked I, Bollipo S, et al. What's in a name? Renaming ‘NAFLD’ to ‘MAFLD’. Liver Int. 2020;40(6):1254-1261.
Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: cofactors for progressive fatty liver disease. J Hepatol. 2018;68(2):251-267.
Bellis MA, Hughes K, Nicholls J, et al. The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals. BMC Public Health. 2016;16(111).
Lewer D, Meier P, Beard E, Boniface S, Kaner E. Unravelling the alcohol harm paradox:a population-based study of socialgradients across very heavy drinkingthresholds. BMC Public Health. 2016;16:599.
Michikawa T, Inoue M, Sawada N, et al. Development of a prediction model for 10-year risk of hepatocellular carcinoma in middle-aged Japanese: the Japan Public Health Center-based Prospective Study Cohort II. Prev Med. 2012;55(2):137-143.
Goh G, Chow W, Wang R, Yuan J, Koh W. Coffee, alcohol and other beverages in relation to cirrhosis mortality: the Singapore Chinese Health Study. Hepatology. 2014;60(2):661-669.
Jee S, Ohrr H, Sull J, Samet J. Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea. J Natl Cancer Inst. 2004;96(24):1851-1856.
Burke DL, Ensor J, Riley RD. Meta-analysis using individual participant data: one-stage and two-stage approaches, and why they may differ. Stat Med. 2017;36(5):855-875.
Wood AM, Kaptoge S, Butterworth AS, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet. 2018;391(10129):1513-1523.