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. 2016 Mar;101(3):945-52.
doi: 10.1210/jc.2015-3444. Epub 2015 Dec 16.

Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies

A Katrina Loomis  1 , Shaum Kabadi  1 , David Preiss  1 , Craig Hyde  1 , Vinicius Bonato  1 , Matthew St Louis  1 , Jigar Desai  1 , Jason M R Gill  1 , Paul Welsh  1 , Dawn Waterworth  1 , Naveed Sattar  1
Affiliations

Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies

A Katrina Loomis et al. J Clin Endocrinol Metab. 2016 Mar.

Abstract

Context: The relationship between rising body mass index (BMI) and prospective risk of nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) is virtually absent.

Objective: Determine the extent of the association between BMI and risk of future NAFLD diagnosis, stratifying by sex and diabetes.

Design: Two prospective studies using Humedica and Health Improvement Network (THIN) with 1.54 and 4.96 years of follow-up, respectively.

Setting: Electronic health record databases.

Participants: Patients with a recorded BMI measurement between 15 and 60 kg/m(2), and smoking status, and 1 year of active status before baseline BMI. Patients with a diagnosis or history of chronic diseases were excluded.

Interventions: None.

Main outcome measure: Recorded diagnosis of NAFLD/NASH during follow-up (Humedica International Classification of Diseases, Ninth Revision code 571.8, and read codes for NAFLD and NASH in THIN).

Results: Hazard ratios (HRs) were calculated across BMI categories using BMI of 20-22.5 kg/m(2) as the reference category, adjusting for age, sex, and smoking status. Risk of recorded NAFLD/NASH increased linearly with BMI and was approximately 5-fold higher in Humedica (HR = 4.78; 95% confidence interval, 4.17-5.47) and 9-fold higher in THIN (HR = 8.93; 7.11-11.23) at a BMI of 30-32.5 kg/m(2) rising to around 10-fold higher in Humedica (HR = 9.80; 8.49-11.32) and 14-fold higher in THIN (HR = 14.32; 11.04-18.57) in the 37.5- to 40-kg/m(2) BMI category. Risk of NAFLD/NASH was approximately 50% higher in men and approximately double in those with diabetes.

Conclusions: These data quantify the consistent and strong relationships between BMI and prospectively recorded diagnoses of NAFLD/NASH and emphasize the importance of weight reduction strategies for prevention and management of NAFLD.

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Figures

Figure 1.
Figure 1.
Patient analytical sample for THIN (A) and Humedica (B).
Figure 2.
Figure 2.
HRs for diagnosis of NAFLD or NASH based on BMI category in Humedica (A) and THIN (B). HRs with 95% CI are presented compared with the reference BMI category of 20 to less than 22.5 kg/m2.
Figure 3.
Figure 3.
HRs for diagnosis of NAFLD or NASH based on BMI category stratified by sex in Humedica (A) and THIN (B). HRs with 95% CI are presented compared with the reference BMI category of 20 to less than 22.5 kg/m2 in females.
Figure 4.
Figure 4.
HRs for diagnosis of NAFLD or NASH based on BMI category stratified by diabetes status in Humedica (A and B) and THIN (C and D). HRs with 95% CI are presented compared with the reference BMI category of 20 to less than 22.5 kg/m2. In plots A and C, HRs are based on the reference BMI category within that group. In plots B and D, HRs are based on the nondiabetic reference BMI category.
See this image and copyright information in PMC

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