5 years ago

Body Mass Index Trajectories in Young Adulthood Predict Nonalcoholic Fatty Liver Disease in Middle Age: The CARDIA Cohort Study

Lisa B. VanWagner, Norrina B. Allen, J. Jeffrey Carr, Donald M. Lloyd-Jones, Cora E. Lewis, Juned Siddique, Mary E. Rinella, Norah A. Terrault, Miriam B. Vos, Hongyan Ning, Sadiya S. Khan, Elizabeth Speliotes
Background & Aims Nonalcoholic Fatty Liver Disease (NAFLD) is an epidemic. Identifying modifiable risk factors for NAFLD development is essential to design effective prevention programs. We tested whether 25-year patterns of body mass index (BMI) change are associated with midlife NAFLD. Methods 4423 participants from CARDIA, a prospective population-based biracial cohort (age 18-30), underwent BMI measurement at baseline (1985-1986) and three or more times over 25 years. At Year 25, 3115 had liver fat assessed by noncontrast CT. NAFLD was defined as liver attenuation ≤40 Hounsfield Units after exclusions. Latent mixture modeling identified 25-year trajectories in BMI percent change (%Δ) from baseline. Results We identified 4 distinct trajectories of BMI%Δ: stable (26.2% of cohort, 25-year BMI %Δ = 3.1%), moderate increase (46.0%, BMI%Δ = 21.7%), high increase (20.9%, BMI%Δ = 41.9%), and extreme increase (6.9%, BMI%Δ = 65.9%). Y25 NAFLD prevalence was higher in groups with greater BMI%Δ: 4.1%, 9.3%, 13.0%, and 17.6%, respectively (P-trend <0.0001). In multivariable analyses, participants with increasing BMI%Δ had increasingly greater odds of NAFLD compared to the stable group: OR: 3.35 (95% CI, 2.07-5.42), 7.80 (4.60-13.23), and 12.68 (6.68-24.09) for moderate, high and extreme BMI increase, respectively. Associations were only moderately attenuated when adjusted for baseline or Y25 BMI. Conclusions Trajectories of weight gain during young adulthood are associated with greater NAFLD prevalence in midlife independent of metabolic covariates and baseline or concurrent BMI highlighting the importance of weight maintenance throughout adulthood as a target for primary NAFLD prevention. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/liv.13603

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