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Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies

BMJ 2010; 340 doi: (Published 12 March 2010) Cite this as: BMJ 2010;340:c1240
  1. Carole L Hart, research fellow1,
  2. David S Morrison, clinical senior lecturer in cancer epidemiology1,
  3. G David Batty, Wellcome trust fellow2,
  4. Richard J Mitchell, professor of health and environment1,
  5. George Davey Smith, professor of clinical epidemiology3
  1. 1Public Health and Health Policy, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow G12 8RZ
  2. 2Medical Research Council Social and Public Health Sciences Unit, Glasgow
  3. 3Department of Social Medicine, University of Bristol, Bristol
  1. Correspondence to: C L Hart c.hart{at}
  • Accepted 24 February 2010


Objective To investigate whether alcohol consumption and raised body mass index (BMI) act together to increase risk of liver disease.

Design Analysis of data from prospective cohort studies.

Setting Scotland.

Participants Data were from two of the Midspan prospective cohort studies (9559 men): “Main” study 1965-8, participants from workplaces across central belt of Scotland, population of island of Tiree, and mainland relatives, and “Collaborative” study, 1970-3, participants from 27 workplaces in Glasgow, Clydebank, and Grangemouth. Follow-up was to 31 December 2007 (median 29 years, range 0.13-42). We divided participants into nine groups based on measures of body mass index (BMI) (underweight/normal weight <25, overweight 25 to <30, and obese ≥30) and alcohol consumption (none, 1-14, and ≥15 units per week).

Main outcome measures Liver disease morbidity and mortality.

Results 80 (0.8%) men died with liver disease as the main cause and 146 (1.5%) with liver disease as any cause. In the Collaborative study, 196 men (3.3%) had liver disease defined by a death, admission, or cancer registration. BMI and alcohol consumption were strongly associated with liver disease mortality in analyses adjusted for other confounders (P=0.001 and P<0.0001 respectively). Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers. Drinkers of 15 or more units per week had adjusted relative rates for liver disease mortality of 3.16 (95% confidence interval 1.28 to 7.8) for underweight/normal weight men, 7.01 (3.02 to 16.3) for overweight, and 18.9 (6.84 to 52.4) for obese men. The relative rate for obese men who consumed 1-14 units per week was 5.3 (1.36 to 20.7). The relative excess risk due to interaction between BMI and alcohol consumption was 5.58 (1.09 to 10.1); synergy index=2.89 (1.29 to 6.47).

Conclusions Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two. The occurrence of both factors in the same populations should inform health promotion and public health policies.


  • Contributors: All authors contributed to the design of the study. CLH analysed the data and wrote the first draft of the manuscript. All authors contributed to the redrafting of the manuscript and approved the final version. CLH is the guarantor, had full access to the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. The other authors had full access to all the results. Victor Hawthorne carried out the original Midspan studies. Pauline MacKinnon is the Midspan administrator.

  • Funding: This research was supported by the Chief Scientist Office of the Scottish Government, grant number CZG/2/421. They had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. They did see a copy of the manuscript before it was submitted for publication, in line with their requirements. DB is a Wellcome Trust Fellow (WBS U.1300.00.006.00012.01). The Medical Research Council Social and Public Health Sciences Unit receives funding from the UK Medical Research Council and the Chief Scientist Office at the Scottish Government Health Directorates. The researchers were independent of the funders.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that (1) CLH, DSM, and RJM have support from the Chief Scientist Office of the Scottish Government, grant number CZG/2/42 for the submitted work; (2) no relationships with any companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: Not required at the time of the studies. The Privacy Advisory Committee of NHS Scotland Information Services gave permission for the linked data to be used in the current study.

  • Data sharing: No additional data.

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