title: Is central obesity associated with cirrhosis-related death or hospitalization? A population-based, cohort study.
abstract: OBJECTIVE
  We aimed to determine the interaction between body fat distribution (central versus peripheral) and increased body mass index (BMI) with regards to the risk of cirrhosis-related death or hospitalization.
  
  
  METHODS
  Participants included 11,434 persons aged 25-74 years without evidence of cirrhosis at entry into the study or during the first 5 years of follow-up who were subsequently followed for a mean of 12.9 years as part of the first National Health and Nutrition Examination Survey. Participants were categorized into "normal-weight" (BMI < 25 kg/m 2 , N = 5750), "overweight" (BMI 25 to < 30 kg/m 2 , N = 3770), and "obese" (BMI > or = 30 kg/m 2 , N = 1914). The subscapular to triceps skinfold thickness ratio (SFR) was used to categorize body fat distribution into central (SFR > 1, N = 5211) and peripheral (SFR < or = 1, N = 6223).
  
  
  RESULTS
  Cirrhosis resulted in death or hospitalization of 88 participants during 149,888 person-years of follow-up (59/100,000 person-years). Among persons with a central body fat distribution, cirrhosis-related deaths or hospitalizations were more common in obese persons (115/100,000 person-years, adjusted hazard ratio 2.2, 95% confidence interval [CI] 1.1-4.6) and in overweight persons (94/100,000 person-years, adjusted hazard ratio 1.5, 95% CI 0.8-3.0) compared to normal-weight persons (59/100,000 person-years). However, among persons with a peripheral fat distribution, there was no association between obesity (adjusted hazard ratio 0.7, 95% CI 0.3-1.6) or overweight (adjusted hazard ratio 0.8, 95% CI 0.2-2.8) and cirrhosis-related death or hospitalization.
  
  
  CONCLUSIONS
  The risk of cirrhosis-related death or hospitalization appears to be increased in the presence of cirrhosis, but only among persons with a central fat distribution. The excess risk associated with central obesity might be related to insulin resistance and hepatic steatosis.
authors.affiliation: Health Services Research and Development and Northwest Hepatitis C Resource Centers, Veterans Affairs Puget Sound System, Seattle, Washington, USA. georgei@medicine.washington.edu
authors.forename: George N
authors.initials: GN
authors.lastname: Ioannou
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Kris V
authors.initials: KV
authors.lastname: Kowdley
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
authors.forename: Robert L
authors.initials: RL
authors.lastname: Carithers
authors.forename: Elaine C
authors.initials: EC
authors.lastname: Tsai
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
mesh_terms: D000328:Adult; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000150:complications*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012885:Skinfold Thickness; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D049629:Waist-Hip Ratio