A high BMI in young adult men was associated with an increased risk for developing severe liver disease and hepatocellular carcinoma, particularly in patients who later developed type 2 diabetes, according to recently published study results.
“The risk of a high BMI for severe liver disease seems to be present from an early age, and is highly accentuated by development of [type 2 diabetes],” Hannes Hagström, MD, PhD, of the Karolinska Institutet, Stockholm, and colleagues wrote. “This could have implications for public health decision-making, strengthening the need of targeted intervention against overweight and obesity at an early age and specifically highlights the risk of [type 2 diabetes] as a risk factor for liver disease.”
The study comprised 1,220,261 men born in Sweden between 1951 and 1976 who underwent conscription into military service between 1969 and 1996. Baseline variables reviewed at the time of conscription included BMI, blood pressure, cognitive ability, cardiovascular fitness and muscular strength, parental socioeconomic status and parental and personal education.
At conscription, mean BMI was 21.6 kg/m2, 104,137 were considered overweight (BMI 25 kg/m2 but < 30 kg/m2) and 19,671 were considered obese (BMI 30 kg/m2). During the mean follow-up period of 28.5 years (range, 0-42 years), there were 5,281 cases of severe liver disease, including 251 cases of HCC.
Compared with the 18.5 kg/m2 to 22.5 kg/m2 BMI category, the risk for severe liver disease increased in men with a BMI of 22.5 kg/m2 to 25 kg/m2 (HR 1.17; 95% CI, 1.09-1.26), BMI of 25 kg/m2 to 30 kg/m2 (HR 1.49; 95% CI, 1.35-1.64) and BMI of 30 kg/m2 or greater (HR 2.17; 95% CI, 1.82-2.59). In the case of HCC specifically, the risk increased in men with a BMI of 22.5 kg/m2 to 25 kg/m2 (HR 1.28; 95% CI, 0.91-1.8), BMI of 25 kg/m2 to 30 kg/m2 (HR 1.57; 95% CI, 1.01-2.45) and BMI of 30 kg/m2 or greater (HR 3.59; 95% CI, 1.85-6.99).
During follow-up, 16,451 men were diagnosed with type 2 diabetes. Compared with the 18.5 kg/m2 to 22.5 kg/m2 BMI category without diabetes, the risk for severe liver disease increased across all BMI categories in the patients diagnosed with diabetes.
Excluding men diagnosed with alcohol use disorder, alcoholic liver disease or hepatitis during follow-up showed a continued risk for liver disease in the overweight (HR 1.66; 95% CI, 1.48-1.86) and obesity (HR 2.22; 95% CI, 1.78-2.76) groups.
“[Type 2 diabetes] has consistently been shown to be associated with an increased risk of cirrhosis, and our results show that this is the case irrespective of the BMI in late adolescence,” the researchers wrote. “However, an increased risk for severe liver disease was also seen in a dose-response manner for a higher BMI in men free of [type 2 diabetes] during the follow-up, suggesting that the association between a high BMI in late adolescence and future severe liver disease cannot solely be explained by development of [type 2 diabetes].”
The researchers concluded that cardiovascular capacity seemed to be protective against severe liver disease and HCC in men with BMI 18.5 kg/m2 to 22.5 kg/m2, which indicated that “excess risk of a high BMI can be somewhat modified by exercise, but not nullified.” – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.