Characterising the risk interplay between alcohol intake and body mass index on cirrhosis morbidity

Hamish Innes, Colin J. Crooks, Esther Aspinall, Tim R. Card, Victoria Hamill, John Dillon, Neil I. Guha, Peter Hayes, Sharon Hutchinson, Joe West, Joanne R. Morling

Research output: Contribution to journalArticlepeer-review


Background & Aims
It is thought that alcohol intake and BMI interact supra-additively to modulate the risk of cirrhosis; but evidence for this phenomenon is limited. We investigated the interrelationship between alcohol and BMI on the incidence of cirrhosis morbidity for participants of the United Kingdom Biobank study (UKB) study.

Approach & Results
The primary outcome was the cumulative incidence of cirrhosis morbidity, defined as a first-time hospital admission for cirrhosis (with non-cirrhosis mortality incorporated as a competing risk). All UKB participants without a previous hospital admission for cirrhosis were included in the analysis. We determined the ratio of the 10-year cumulative incidence in harmful drinkers versus safe drinkers according to BMI. We also calculated the excess cumulative incidence at 10 years for individuals with obesity and/or harmful alcohol compared to safe drinkers with a healthy BMI of 20-25.0 kg/m2. 489,285 UK Biobank participants were included, with mean of 10.7 person-years follow-up. 2070 participants developed the primary outcome, equating to a crude cumulative incidence of 0.36% at 10years (95% CI:0.34-0.38). The 10-year cumulative incidence was 8.6 times higher for harmful (1.38%) versus safe drinkers (0.16%) if BMI was healthy. Conversely, it was only 3.6 times higher for obese participants (1.99% Vs 0.56%). Excess cumulative incidence was 1.22% (95% CI:0.89-1.55) for harmful drinkers with a healthy BMI, 0.40% (95% CI:0.34-0.46) for obese individuals drinking at safe levels, and 1.83% (95% CI:1.46-2.20) for obese harmful drinkers (all compared to safe drinkers with a healthy BMI).

Alcohol intake and obesity are independent risk factors for cirrhosis morbidity, but they do not interact supra-additively to modulate the cumulative incidence of this outcome.
Original languageEnglish
Publication statusE-pub ahead of print - 28 Aug 2021


  • alcohol drinking
  • liver cirrhosis
  • middle aged
  • epidemiology
  • prognosis
  • risk factors
  • metabolic syndrome
  • obesity


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