Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis
Open accessAbstract
UNLABELLED: Obesity is associated with an aggressive course in chronic viral hepatitis; however, its impact in the development of clinical decompensation (CD) in patients with established cirrhosis is uncertain. We evaluated the role of obesity, in relationship to other recognized predictors, in the development of CD in patients with compensated cirrhosis. The study population, a subset of patients included in a randomized trial of beta-blockers in the prevention of varices in whom data on body mass index (BMI) was available, consisted of 161 patients with compensated cirrhosis. Laboratory tests and portal pressure (assessed by the hepatic venous pressure gradient or HVPG) were assessed on inclusion. Patients were followed until CD (ascites, hepatic encephalopathy, or variceal hemorrhage), or until September 2002. Altogether, 29% had a normal BMI, 40% were overweight, and 30% were obese. In a median follow-up of 59 months, CD occurred in 48/161 (30%) patients with an increasingly higher rate according to BMI group (15% in those with normal BMI; 31% in overweight; 43% in obese patients, P=0.011). The actuarial probability of developing CD was significantly higher in the abnormal BMI groups (P=0.022). In a multivariate model that included parameters previously identified as being predictive of CD (HVPG, albumin, Mayo endstage liver disease score), etiology, and treatment group, BMI (hazard ration 1.06; 95% confidence interval 1.01-1.12), P=0.02] was an independent predictor of decompensation, together with HVPG and albumin. CONCLUSION: Obesity has a deleterious effect on the natural history of compensated cirrhosis of all etiologies, independent of portal pressure and liver function. Weight reduction may be a valuable therapeutic measure in this patient population.
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Obesity and sarcopenic obesity are risk factors for clinical decompensation and worsen prognosis.
“Obesity and sarcopenic obesity are risk factors for clinical decompensation and worsen prognosis.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [45]
The Results section reports higher rates of clinical decompensation in obese patients, and the Discussion calls increased BMI an independent predictor in patients with compensated cirrhosis. The Discussion also suggests that obesity accelerates cirrhosis progression, supporting the prognosis point for obesity. The paper does not assess sarcopenic obesity, so it does not support extending these findings to that group. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn individuals with compensated cirrhosis and obesity, a reduction in body weight through lifestyle interventions, including moderate caloric restriction and supervised moderate-intensity physical exercise, has been shown to reduce portal pressure and may prevent clinical decompensation.
“In individuals with compensated cirrhosis and obesity, a reduction in body weight through lifestyle interventions, including moderate caloric restriction and supervised moderate-intensity physical exercise, has been shown to reduce portal pressure and may prevent clinical decompensation.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [45]
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Experimental — accuracy not yet measuredOverweight or obesity in individuals with compensated cirrhosis at baseline is associated with a higher risk of clinical decompensation, independently of liver function, portal pressure and underlying aetiology of liver disease.
“Overweight or obesity in individuals with compensated cirrhosis at baseline are associated with a higher risk of clinical decompensation, independently of liver function, portal pressure and underlying aetiology of liver disease.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [45]
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References 27 · Cited by 325
- Authors
- Berzigotti, A., Garcia-Tsao, G., Bosch, J., Grace, N. D., Burroughs, A. K., Morillas, R., Escorsell, A., Garcia-Pagan, J. C., Patch, D., Matloff, D. S., & Groszmann, R. J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Brigham and Women's Hospital (US)
- The Royal Free Hospital (GB)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES)
- Yale University (US)
- Venue
- Hepatology
- Published
- 2011-08
- Volume
- 54
- Issue
- 2
- Pages
- 555-561
- ISSN
- 0270-9139 (ISSN-L)
- PMC
- PMC3144991
- OpenAlex
- W2088029436
- Cited by
- 325
- References
- 27
- Citations by year
- 2026: 23 · 2025: 28 · 2024: 28 · 2023: 28 · 2022: 23 · 2021: 23 · 2020: 29 · 2019: 34 · 2018: 19 · 2017: 20 · 2016: 18 · 2015: 15 · 2014: 12 · 2013: 12 · 2012: 11
- FWCI
- 7.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Astellas Pharma
- National Institutes of Health (and K24, DK34989)
- Instituto de Salud Carlos III
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK46580, P30 DK 34989, K24DK002727, R01DK046580, K24 DK02727-02, P30DK034989)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- obesity, liver cirrhosis, clinical decompensation, body mass index, portal hypertension, hepatic venous pressure gradient, albumin, hepatic encephalopathy, variceal bleeding, ascites, beta-blockers, weight loss, chronic viral hepatitis
- MeSH terms
- Female, Humans, Liver Cirrhosis, Male, Middle Aged, Obesity, Risk Factors, Body Mass Index, Disease Progression
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