Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use
Abstract Background: Obesity is associated with liver disease, but the best obesity-related predictor remains undefined. Controversy exists regarding possible synergism between obesity and alcohol use for liver-related outcomes (LRO). We assessed the predictive performance for LROs, and synergism wi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-09-01
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| Series: | Communications Medicine |
| Online Access: | https://doi.org/10.1038/s43856-023-00353-2 |
| _version_ | 1827708732654485504 |
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| author | Fredrik Åberg Martti Färkkilä Veikko Salomaa Antti Jula Satu Männistö Markus Perola Annamari Lundqvist Ville Männistö |
| author_facet | Fredrik Åberg Martti Färkkilä Veikko Salomaa Antti Jula Satu Männistö Markus Perola Annamari Lundqvist Ville Männistö |
| author_sort | Fredrik Åberg |
| collection | DOAJ |
| description | Abstract Background: Obesity is associated with liver disease, but the best obesity-related predictor remains undefined. Controversy exists regarding possible synergism between obesity and alcohol use for liver-related outcomes (LRO). We assessed the predictive performance for LROs, and synergism with alcohol use, of abdominal obesity (waist-hip ratio, WHR), and compared it to overall obesity (body mass index, BMI). Methods: Forty-thousand nine-hundred twenty-two adults attending the Finnish health-examination surveys, FINRISK 1992–2012 and Health 2000 studies, were followed through linkage with electronic healthcare registries for LROs (hospitalizations, cancers, and deaths). Predictive performance of obesity measures (WHR, waist circumference [WC], and BMI) were assessed by Fine-Gray models and time-dependent area-under-the-curve (AUC). Results: There are 355 LROs during a median follow-up of 12.9 years (509047.8 person-years). WHR and WC emerge as more powerful predictors of LROs than BMI. WHR shows significantly better 10-year AUC values for LROs (0.714, 95% CI 0.685–0.743) than WC (0.648, 95% CI 0.617–0.679) or BMI (0.550, 95% CI 0.514–0.585) both overall and separately among men and women. WHR is predictive also in BMI strata. Absolute 10-year risks of LROs are more dependent on WHR than BMI. Moreover, WHR shows a significant supra-additive interaction effect with harmful alcohol use for liver-related outcomes (excess 10-year cumulative incidence of 2.8% from the interaction), which is not seen between BMI and harmful alcohol use. Conclusions: WHR is a better predictor than BMI or WC for LROs, and WHR better reflects the synergism with harmful alcohol use. WHR should be included in clinical assessment when evaluating obesity-related risks for liver outcomes. |
| first_indexed | 2024-03-10T17:08:38Z |
| format | Article |
| id | doaj.art-45e1087043234fd18641cf9205d75817 |
| institution | Directory Open Access Journal |
| issn | 2730-664X |
| language | English |
| last_indexed | 2024-03-10T17:08:38Z |
| publishDate | 2023-09-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Communications Medicine |
| spelling | doaj.art-45e1087043234fd18641cf9205d758172023-11-20T10:43:00ZengNature PortfolioCommunications Medicine2730-664X2023-09-01311810.1038/s43856-023-00353-2Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol useFredrik Åberg0Martti Färkkilä1Veikko Salomaa2Antti Jula3Satu Männistö4Markus Perola5Annamari Lundqvist6Ville Männistö7Transplantation and Liver Surgery, Helsinki University Hospital and University of HelsinkiAbdominal Center, Helsinki University and Helsinki University HospitalFinnish Institute for Health and WelfareFinnish Institute for Health and WelfareFinnish Institute for Health and WelfareFinnish Institute for Health and WelfareFinnish Institute for Health and WelfareDepartments of Medicine, University of Eastern Finland and Kuopio University HospitalAbstract Background: Obesity is associated with liver disease, but the best obesity-related predictor remains undefined. Controversy exists regarding possible synergism between obesity and alcohol use for liver-related outcomes (LRO). We assessed the predictive performance for LROs, and synergism with alcohol use, of abdominal obesity (waist-hip ratio, WHR), and compared it to overall obesity (body mass index, BMI). Methods: Forty-thousand nine-hundred twenty-two adults attending the Finnish health-examination surveys, FINRISK 1992–2012 and Health 2000 studies, were followed through linkage with electronic healthcare registries for LROs (hospitalizations, cancers, and deaths). Predictive performance of obesity measures (WHR, waist circumference [WC], and BMI) were assessed by Fine-Gray models and time-dependent area-under-the-curve (AUC). Results: There are 355 LROs during a median follow-up of 12.9 years (509047.8 person-years). WHR and WC emerge as more powerful predictors of LROs than BMI. WHR shows significantly better 10-year AUC values for LROs (0.714, 95% CI 0.685–0.743) than WC (0.648, 95% CI 0.617–0.679) or BMI (0.550, 95% CI 0.514–0.585) both overall and separately among men and women. WHR is predictive also in BMI strata. Absolute 10-year risks of LROs are more dependent on WHR than BMI. Moreover, WHR shows a significant supra-additive interaction effect with harmful alcohol use for liver-related outcomes (excess 10-year cumulative incidence of 2.8% from the interaction), which is not seen between BMI and harmful alcohol use. Conclusions: WHR is a better predictor than BMI or WC for LROs, and WHR better reflects the synergism with harmful alcohol use. WHR should be included in clinical assessment when evaluating obesity-related risks for liver outcomes.https://doi.org/10.1038/s43856-023-00353-2 |
| spellingShingle | Fredrik Åberg Martti Färkkilä Veikko Salomaa Antti Jula Satu Männistö Markus Perola Annamari Lundqvist Ville Männistö Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use Communications Medicine |
| title | Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use |
| title_full | Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use |
| title_fullStr | Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use |
| title_full_unstemmed | Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use |
| title_short | Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use |
| title_sort | waist hip ratio is superior to bmi in predicting liver related outcomes and synergizes with harmful alcohol use |
| url | https://doi.org/10.1038/s43856-023-00353-2 |
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