Overweight in late adolescence predicts development of severe liver disease later in life: a 39 years follow-up study

Background & Aims The increased prevalence of overweight has been suggested to contribute to the worldwide increase in liver diseases. We investigated if body mass index (BMI) in late adolescence predicts development of severe liver disease later in life. Methods We performed a cohort study using data from 44,248 men (18–20 years) conscribed to military service in Sweden between 1969 and 1970. Outcome data were collected from national registers to identify any diagnosis of severe liver disease (i.e., diagnosis of decompensated liver disease, cirrhosis or death in liver disease) until the end of 2009. A Cox regression model was applied using BMI as independent variable. The model was adjusted for use of alcohol, use of narcotics, smoking, high blood pressure and cognitive ability at time of conscription. Results During a follow-up period of a mean of 37.8 years, 393 men were diagnosed with severe liver disease (mean time to diagnosis 24.7 years). BMI (Hazard ratio [HR] = 1.05 for each unit increase in BMI, 95% confidence interval [CI]: 1.01–1.09, p = 0.008) and overweight (HR = 1.64 for BMI 25–30 compared to BMI 18.5–22.5, 95% CI: 1.16–2.32, p = 0.006) were associated with an increased risk of development of severe liver disease. Conclusions Being overweight in late adolescence is a significant predictor of severe liver disease later in life in men. Lay summary We investigated close to 45,000 Swedish men in their late teens enlisted for conscription in 1969–1970. After almost 40 years of follow-up, we found that being overweight was a risk factor for developing severe liver disease, independent of established risk factors such as alcohol consumption.