Overweight substantially worsens liver-damaging effects of excessive alcohol use

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People in the overweight or obese range who drink alcohol to levels beyond UK guidelines are at significantly greater risk of liver disease and mortality, found largest study of its kind, published in the European Journal of Clinical Nutrition.

  • People who drank above UK alcohol guidelines had, compared to within guideline drinkers:
  • A nearly 600%higher risk of being diagnosed with alcoholic fatty liver disease (5.83 hazard ratio).
  • A nearly 700% higher risk of death caused by alcoholic fatty liver disease (6.94 hazard ratio).

Led by the University of Sydney's Charles Perkins Centre, the study looked at medical data from nearly half a million people and found having overweight or obesity considerably amplified the harmful effects of alcohol on liver disease and mortality.

"People in the overweight or obese range who drank were found to be at greater risk of liver diseases compared with participants within a healthy weight range who consumed alcohol at the same level," said senior author and research program director Professor Emmanuel Stamatakis from the Charles Perkins Centre and the Faculty of Medicine and Health.

"Even for people who drank within alcohol guidelines, participants classified as obese were at over 50 percent greater risk of liver disease."

The researchers drew upon data from the UK Biobank. According to the researchers, this is one of the first and largest studies looking at increased adiposity and level of alcohol consumption together, in relation to future liver disease. Information was examined from 465,437 people aged 40 to 69 years, with medical and health details collected over an average of 10.5 years.

Study details

Joint associations of adiposity and alcohol consumption with liver disease-related morbidity and mortality risk: findings from the UK Biobank

Authors: Elif Inan-Eroglu, Bo-Huei Huang, Matthew N. Ahmadi, Nathan Johnson, Emad M. El-Omar, Emmanuel Stamatakis.

Published in European Journal of Clinical Nutrition on 2 June 2021


The incidence of both non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (ALD) are expected to grow as a consequence of the ongoing obesity and alcohol consumption trends.

We examined the joint associations of adiposity (body mass index (BMI) and waist circumference (WC)) and alcohol consumption on ALD, NAFLD and liver disease incidence and mortality (n = 465,437).

Alcohol consumption was categorised based on current UK guidelines (14 units/week). Data were analysed using Cox proportional hazard models. A total of 1090 liver disease deaths, 230 ALD deaths and 192 NAFLD deaths occurred over an average follow-up length of 10.5 ± 1.7 years.

In multivariate models, we observed greater point estimates for risk of ALD, NAFLD and liver disease incidence and mortality among overweight/obese participants who consumed alcohol at the same level as normal weight participants. We found that overweight/obese participants who reported alcohol consumption above the guidelines had a greater HR for liver disease incidence and mortality (HR 1.52, 95% CI 1.32, 1.75 and HR 2.20, 95% CI 1.41, 3.44, respectively) than normal weight individuals (HR 0.95, 95% CI 0.83, 1.09 and HR 1.24, 95% CI 0.8, 1.93, respectively). The results for the associations of alcohol consumption and WC with ALD, NAFLD and liver disease mortality were similar. Participants with high WC who reported alcohol consumption above the guidelines had a greater HR for liver disease incidence (HR 1.59, 95% CI 1.35, 1.87) than normal WC individuals (HR 0.85, 95% CI 0.72, 1.01).

We found evidence that being overweight/obese amplified the harmful effect of alcohol on the liver incidence and mortality.


Full study in European Journal of Clinical Nutrition (Open access)


See also from the MedicalBrief archives:


International studies identify risk factors linked to alcohol-related cirrhosis


Changes in blood metabolite profile visible years before alcohol-related disease

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