Highlights
- •Early adulthood weight gain was independently associated with an increased risk of developing NAFLD in mid-life.
- •The trajectory of body shape between early- and mid-life was significantly associated with incident NAFLD.
- •Maintaining both lean and stable weight throughout life may offer the greatest benefit for the prevention of NAFLD.
Abstract
Background & aims
Obesity is established as a major risk factor for the development of nonalcoholic
fatty liver disease (NAFLD). However, the influence of dynamic changes in adiposity
over the life course on NAFLD risk remains poorly understood.
Methods
We collected data from 110,054 women enrolled in the Nurses' Health Study II cohort.
Early adulthood weight was ascertained at age 18 years, and weight gain since early
adulthood was defined prospectively every 2 years. We used a group-based modeling
approach to identify five trajectories of body shape from age 5 years up to age 50 years.
NAFLD was defined by physician-confirmed diagnoses of fatty liver, after excluding
excess alcohol intake and viral hepatitis, using validated approaches.
Results
We documented 3798 NAFLD cases over a total of 20 years of follow-up. Compared to
women who maintained stable weight (±2 kg), women with ≥20 kg of adulthood weight
gain had the multivariable aHR of 6.96 (95% CI, 5.27–9.18), and this remained significant
after further adjusting for early adulthood BMI and updated BMI (both P trend <0.0001). Compared to women with a medium-stable body shape trajectory, the
multivariable aHRs for NAFLD were, 2.84 (95% CI, 2.50–3.22) for lean-marked increase,
2.60 (95% CI, 2.27–2.98) for medium-moderate increase, and 3.39 (95% CI, 2.95–3.89)
for medium-marked increase.
Conclusions
Both early adulthood weight gain and lifetime body shape trajectory were significantly
and independently associated with excess risk of developing NAFLD in mid-life. Maintaining
both lean and stable weight throughout life may offer the greatest benefit for the
prevention of NAFLD.
Keywords
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References
- Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross-sectional analysis of 2011-2014 National Health and Nutrition Examination Survey.Aliment Pharmacol Ther. 2017; 46: 974-980
- Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States.Gastroenterology. 2015; 148: 547-555
- Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009.Hepatology (Baltimore, Md). 2015; 62: 1723-1730
- Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States.Hepatology (Baltimore, Md). 2013; 57: 1357-1365
- Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study.Gastroenterology. 2011; 140: 124-131
- Non-alcoholic fatty liver disease: is iron relevant?.Hepatol Int. 2012; 6: 332-341
- Obesity and nonalcoholic fatty liver disease: from pathophysiology to therapeutics.Metab Clin Exp. 2019; 92: 82-97
- Complications, morbidity and mortality of nonalcoholic fatty liver disease.Metab Clin Exp. 2020; 154170
- Recent research trends and updates on nonalcoholic fatty liver disease.Clin Mol Hepatol. 2019; 25: 1-11
- Associations of weight gain from early to middle adulthood with major health outcomes later in life.JAMA. 2017; 318: 255-269
- New York.Oxford University Press, NY2008
- Weight, diet, and the risk of symptomatic gallstones in middle-aged women.N Engl J Med. 1989; 321: 563-569
- Adulthood weight change and risk of colorectal Cancer in the Nurses' health study and health professionals follow-up study.Cancer Prev Res (Phila). 2015; 8: 620-627
- Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.Hepatology (Baltimore, Md). 2016; 64: 73-84
- Visceral fat: a key mediator of steatohepatitis in metabolic liver disease.Hepatology (Baltimore, Md). 2008; 48: 449-457
- Trajectory of body shape across the lifespan and cancer risk.Int J Cancer. 2016; 138: 2383-2395
- Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies.BMJ (Clinical research ed). 2016; 353: i2195
- Life course evolution of body size and breast cancer survival in the E3N cohort.. 2018; 142: 1542-1553
- Group-based trajectory of body shape from ages 5 to 55 years and Cardiometabolic disease risk in 2 US cohorts.Am J Epidemiol. 2017; 186: 1246-1255
- Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk.Jama. 2011; 306: 1884-1890
- Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease.Gastroenterology. 2015; 149 (e10): 389-397
- Obesity and Weight Gain Since Early Adulthood Are Associated With a Lower Risk of Microscopic Colitis.Clin Gastroenterol Hepatol. 2019; 17 (e1): 2523-2532
- The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.. 2018; 67: 328-357
- Validity of self-reported waist and hip circumferences in men and women.Epidemiology (Cambridge, Mass). 1990; 1: 466-473
- Genomic correlates of immune-cell infiltrates in colorectal carcinoma.Cell Rep. 2016; 15: 857-865
- Adiposity throughout adulthood and risk of sudden cardiac death in women.JACC Clin Electrophysiol. 2015; 1: 520-528
- The validity of recalled weight among younger women.Int J Obes Relat Metab Disord. 1995; 19: 570-572
Ma W, Jovani M, Liu PH, Nguyen LH, Cao Y, Tam I, et al. Association Between Obesity and Weight Change and Risk of Diverticulitis in Women. Gastroenterology. 2018;155:58–66.e4.
- Use of the Danish adoption register for the study of obesity and thinness.Res Publ Assoc Res Nerv Ment Dis. 1983; 60: 115-120
- Remote recall of childhood height, weight, and body build by elderly subjects.Am J Epidemiol. 1993; 138: 56-64
- Validity of a dietary questionnaire assessed by comparison with multiple weighed dietary records or 24-hour recalls.Am J Epidemiol. 2017; 185: 570-584
- Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance.Am J Clin Nutr. 2002; 76: 1261-1271
- Alternative dietary indices both strongly predict risk of chronic disease.J Nutr. 2012; 142: 1009-1018
Bullon-Vela V, Abete I, Tur JA, Pinto X, Corbella E, Martinez-Gonzalez MA, et al. Influence of lifestyle factors and staple foods from the Mediterranean diet on non-alcoholic fatty liver disease among older individuals with metabolic syndrome features. Nutrition (Burbank, Los Angeles County, Calif). 2019;71:110620.
- Reproducibility and validity of a self-administered physical activity questionnaire.Int J Epidemiol. 1994; 23: 991-999
- A prospective study of cigarette smoking and the risk of inflammatory bowel disease in women.Am J Gastroenterol. 2012; 107: 1399-1406
- Reproducibility and validity of self-reported menopausal status in a prospective cohort study.Am J Epidemiol. 1987; 126: 319-325
- Aspirin use, tumor PIK3CA mutation, and colorectal-cancer survival.N Engl J Med. 2012; 367: 1596-1606
- Multivitamin use, folate, and colon cancer in women in the Nurses' health study.Ann Intern Med. 1998; 129: 517-524
- Diabetes and cancer: a consensus report.CA Cancer J Clin. 2010; 60: 207-221
- Trajectory analysis in obesity epidemiology: a promising life course approach.Curr Opin Endocr Metab Res. 2019; 4: 37-41
DS. N. Group-based modeling of development. . Harvard University Press. 2005.
Engeland A, Bjorge T, Tverdal A, Sogaard AJ. Obesity in adolescence and adulthood and the risk of adult mortality. Epidemiology (Cambridge, Mass). 2004;15:79–85.
- Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard growth study of 1922 to 1935.N Engl J Med. 1992; 327: 1350-1355
- Obesity.Nat Rev Dis Primers. 2017; 3: 17034
- Effect of weight loss on magnetic resonance imaging estimation of liver fat and volume in patients with nonalcoholic steatohepatitis.Clin Gastroenterol Hepatol. 2015; 13 (e1): 561-568
- Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD.Aliment Pharmacol Ther. 2012; 36: 22-29
- Differential responses of visceral and subcutaneous fat depots to nutrients.Diabetes. 2005; 54: 672-678
- Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance.J Clin Invest. 2003; 112: 1821-1830
- Physical activity decreases diverticular complications.Am J Gastroenterol. 2009; 104: 1221-1230
- Obesity increases the risks of diverticulitis and diverticular bleeding.Gastroenterology. 2009; 136 (e1): 115-122
- Nut, corn, and popcorn consumption and the incidence of diverticular disease.Jama. 2008; 300: 907-914
Article info
Publication history
Published online: October 12, 2020
Accepted:
September 24,
2020
Received:
July 30,
2020
Footnotes
☆Grant support
☆UM1 CA186107 (Nurses' Health Study infrastructure grant).
☆K24 DK 098311 (ATC).
☆K23 DK122104 (TGS).
☆ATC is a Stuart and Suzanne Steele MGH Research Scholar
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
