Impact of Body Mass Index and Waist-to-Height Ratio on Mortality in Non-Alcoholic Fatty Liver Disease
Author Information
Author(s): Jiang Hao, Li Mingkai, Yu Hongsheng, Huang Yinan, Yang Bilan, Wu Bin, Yang Yidong
Primary Institution: Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
Hypothesis
Does the obesity paradox in non-alcoholic fatty liver disease persist after accounting for smoking and reverse causation?
Conclusion
The obesity paradox in NAFLD patients can be explained by smoking and reverse causation, with waist-to-height ratio being a better predictor of mortality than BMI.
Supporting Evidence
- Over a median follow-up period of 20.3 years, 1832 participants passed away.
- Individuals classified as overweight or obese presented reduced mortality risks compared to normal weight individuals.
- The obesity paradox vanished upon adjustments for smoking and exclusion of the initial 5-year follow-up period.
- WHtR was a better predictor of mortality than BMI.
Takeaway
This study found that being overweight or obese might not be as bad for people with liver disease as we thought, but it’s important to consider other factors like smoking.
Methodology
Data from NHANES III was analyzed using multivariate Cox regression to assess mortality risk associated with BMI and WHtR.
Potential Biases
Potential biases from smoking and reverse causation were significant confounding factors.
Limitations
The study did not account for changes in weight or waist circumference during follow-up and had a small number of underweight participants.
Participant Demographics
Median age was 45.25 years, with 49.62% male and 72.31% classified as overweight or obese.
Statistical Information
P-Value
p<0.05
Confidence Interval
95% CI 0.925–0.927 for overweight; 95% CI 0.981–0.984 for obesity class I
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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