Is obesity a risk factor for cirrhosis-related death or hospitalization? A population-based cohort study

Background & Aims: Our aim was to determine whether increased body mass index (BMI) in the general population is associated with cirrhosis-related death or hospitalization. Methods: Participants included 1:1,465 persons aged 25-74 years without evidence of cirrhosis at entry into the study, or during the first 5 years of follow-up, who subsequently were followed-up for a mean of 12.9 years. The BMI was used to categorize participants into normal-weight (BMI < 25 kg/m(2), N = 5752), overweight (BMI 25 to < 30 kg/m(2), N = 3774), and obese categories (BMI greater than or equal to 30 kg/m(2), N = 1939). Results: Cirrhosis resulted in death or hospitalization of 89 participants during :150,233 person-years of follow-up (0.59/1000 person-years). Cirrhosis-related deaths or hospitalizations were more common in obese persons (0.81/1000 person-years, adjusted hazard ratio 1.69, 95% confidence interval [CI] 1.0-3.0) and in overweight persons (0.71/1000 person-years, adjusted hazard ratio 1.16, 95% CI 0.7-1.9) compared with normal-weight persons (0.45/1000 person-years). Among persons who did not consume alcohol, there was a strong association between obesity (adjusted hazard ratio 4.1, 95% Cl 1.4-11.4) or being overweight (adjusted hazard ratio 1.93, 95% Cl 0.7-5.3) and cirrhosis-related death or hospitalization. In contrast, this association was weaker among persons who consumed up to 0.3 alcoholic drinks/day (adjusted hazard ratio 2.48, 95% Cl 0.7-8.4 for obesity; adjusted hazard ratio 1.31, 95% Cl 0.4-4.2 for overweight) and no association was identified among those who consumed more than 0.3 alcoholic drinks/day. Conclusion : Obesity appears to be a risk factor for cirrhosis-related death or hospitalization among persons who consume little or no alcohol.