Body mass index in school-aged children and the risk of routinely diagnosed non-alcoholic fatty liver disease in adulthood: a prospective study based on the Copenhagen School Health Records Register

Abstract

Objective: The relation between childhood overweight and adult non-alcoholic fatty liver disease (NAFLD) is largely unknown. We investigated if weight and weight gain in childhood increases the risk of being diagnosed with NAFLD in routine clinical settings in adulthood.

Participants: We studied 244,464 boys and girls, born between 1930 and 1989, who attended school in Copenhagen, Denmark. Their heights and weights were measured by physicians or nurses at mandatory school health examinations at ages 7-13 years. Body mass index (BMI) z-scores were calculated from an internal age-specific and sex-specific reference.

Outcome measures: NAFLD reported in the National Patient Register and the National Register of Pathology at 18 years of age or older. HRs with 95% CIs were estimated.

Results: During follow-up, 1264 and 1106 NAFLD cases, respectively, occurred in men and women. In both sexes, childhood BMI z-score was not consistently associated with adult NAFLD. Change in BMI z-score between 7 and 13 years of age was positively associated with NAFLD in both sexes. When adjusted for BMI z-score at age 7 years, the HRs of adult NAFLD were 1.15 (95% CI 1.05 to 1.26) and 1.12 (95% CI 1.02 to 1.23) per 1-unit gain in BMI z-score in men and women, respectively. Associations were similar when adjusted for BMI z-score at age 13 years, and were consistent across birth years.

Conclusions: A BMI gain in school-aged children is associated with adult NAFLD. Intriguingly, BMI gain appears to have an effect on adult NAFLD irrespective of either the initial or the attained BMI. Taken together, our results suggest that BMI gain in childhood, rather than the level of BMI per se, is important in the development of adult NAFLD.

Keywords: EPIDEMIOLOGY; GASTROENTEROLOGY; PATHOLOGY; PUBLIC HEALTH.

Figure 1

Incidence rate of routinely diagnosed adult non-alcoholic fatty liver disease (NAFLD) per 1000 person years according to age at diagnosis. The incidence rates of routinely diagnosed NAFLD was estimated as the number of individuals registered with a diagnosis of NAFLD for the first time divided by the number of person years at risk in 5-year-age-intervals.

Figure 2

HRs and 95% CI according to change in BMI z-score between the ages of 7 and 13 years, adjusted for BMI z-score at 7 years of age, in relation to routinely diagnosed NAFLD in adulthood for (A) boys and (B) girls. (A) Boys: HR of adult NAFLD per 1-unit increase in BMI z-score between 7 and 13 years of age among boys: 1.15 (95% CI 1.05 to 1.26). (B) Girls: HR of adult NAFLD per 1-unit increase in BMI z-score between 7 and 13 years of age among girls: 1.12 (95% CI 1.02 to 1.23). The associations are adjusted for BMI z-score at 7 years of age and stratified by birth cohort. The HRs in figure 2 are estimated by Cox regression including change in body mass index (BMI) z-score between the ages of 7 and 13 years, as a restricted cubic spline, with a reference point in change in BMI z-score equal to 0, and truncated to depict the inner 99% part of the distribution. NAFLD, non-alcoholic fatty liver disease.

Figure 3

HRs and 95% CI according to change in BMI z-score between the ages of 7 and 13 years, adjusted for BMI z-score at 13 years of age, in relation to routinely diagnosed NAFLD in adulthood for (A) boys and (B) girls. (A) Boys: HR of adult NAFLD per 1-unit increase in BMI z-score between 7 and 13 years of age among boys: 1.16 (95% CI 1.06 to 1.26). (B) Girls: HR of adult NAFLD per 1-unit increase in BMI z-score between 7 and 13 years of age among girls: 1.06 (95% CI 0.97 to 1.16). The associations are adjusted for BMI z-score at 13 years of age and stratified by birth cohort. The HRs in figure 3 are estimated by Cox regression including change in body mass index (BMI) z-score between the ages of 7 and 13 years, as a restricted cubic spline, with a reference point in change in BMI z-score equal to 0 and truncated to depict the inner 99% part of the distribution. NAFLD, non-alcoholic fatty liver disease.