Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies
Open accessAbstract
OBJECTIVE: To investigate whether alcohol consumption and raised body mass index (BMI) act together to increase risk of liver disease. DESIGN: Analysis of data from prospective cohort studies. SETTING: Scotland. PARTICIPANTS: Data were from two of the Midspan prospective cohort studies (9559 men): "Main" study 1965-8, participants from workplaces across central belt of Scotland, population of island of Tiree, and mainland relatives, and "Collaborative" study, 1970-3, participants from 27 workplaces in Glasgow, Clydebank, and Grangemouth. Follow-up was to 31 December 2007 (median 29 years, range 0.13-42). We divided participants into nine groups based on measures of body mass index (BMI) (underweight/normal weight <25, overweight 25 to <30, and obese >or=30) and alcohol consumption (none, 1-14, and >or=15 units per week). MAIN OUTCOME MEASURES: Liver disease morbidity and mortality. RESULTS: 80 (0.8%) men died with liver disease as the main cause and 146 (1.5%) with liver disease as any cause. In the Collaborative study, 196 men (3.3%) had liver disease defined by a death, admission, or cancer registration. BMI and alcohol consumption were strongly associated with liver disease mortality in analyses adjusted for other confounders (P=0.001 and P<0.0001 respectively). Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers. Drinkers of 15 or more units per week had adjusted relative rates for liver disease mortality of 3.16 (95% confidence interval 1.28 to 7.8) for underweight/normal weight men, 7.01 (3.02 to 16.3) for overweight, and 18.9 (6.84 to 52.4) for obese men. The relative rate for obese men who consumed 1-14 units per week was 5.3 (1.36 to 20.7). The relative excess risk due to interaction between BMI and alcohol consumption was 5.58 (1.09 to 10.1); synergy index=2.89 (1.29 to 6.47). CONCLUSIONS: Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two. The occurrence of both factors in the same populations should inform health promotion and public health policies.
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After adjustment for different confounders, the increased risk of liver-related mortality in overweight or obese men starts at 15 drinks per week (roughly 30 g of alcohol per day).
“After adjustment for different confounders, the increased risk of liverrelated mortality in overweight or obese men starts at 15 drinks per week (roughly 30 g of alcohol per day).”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [86]
The Results report elevated adjusted liver-disease mortality among overweight and obese men consuming at least 15 units per week. But they also report elevated rates among obese men consuming 1–14 units, so the risk does not uniformly start at 15. The Methods define a UK unit as 8 g of ethanol; 15 units per week is about 17 g per day, not 30 g. (LLM, conf=0.91)
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- Authors
- Hart, C. L., Morrison, D. S., Batty, G. D., Mitchell, R. J., & Davey Smith, G.
- Affiliations
- University of Glasgow (GB)
- Medical Research Council (GB)
- Corresponding author
- Hart, C. L
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2010-03-11
- Volume
- 340
- Issue
- mar11 1
- Pages
- c1240-c1240
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2837144
- OpenAlex
- W2160759928
- Cited by
- 422
- References
- 44
- Citations by year
- 2026: 9 · 2025: 38 · 2024: 31 · 2023: 33 · 2022: 24 · 2021: 31 · 2020: 39 · 2019: 42 · 2018: 37 · 2017: 29 · 2016: 19 · 2015: 23 · 2014: 12 · 2013: 12 · 2012: 7
- FWCI
- 11.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Wellcome Trust (U.1300.00.006.00012.01)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- liver disease, body mass index, alcohol consumption, obesity, liver disease mortality, men, relative excess risk due to interaction, alcoholic liver disease, liver cancer, liver transplantation, liver cirrhosis
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Alcohol Drinking, Humans, Liver Diseases, Male, Middle Aged, Obesity, Prospective Studies, Risk Factors, Scotland, Body Mass Index, Overweight, Young Adult
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