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Effect of cumulative body mass index exposure and long-term related change on incident non-alcoholic fatty liver disease.

BACKGROUND
To evaluate the association between cumulative body mass index (BMI) and long-term BMI change with non-alcoholic fatty liver disease (NAFLD).


METHODS
We included 19 477 adult participants (12 556 men and 6 921 women) from the Kailuan study from Jan. 2006 to Dec. 2013. Cumulative BMI was assessed using a quadratic mixed-effects method by sex before the index year; then, the NAFLD outcome was followed till Dec. 2019. The long-term BMI change was calculated as the percentage change in average cumulative BMI from the baseline BMI.


RESULTS
During a median follow-up of 5.63 years, 6 229 individuals developed incident NAFLD. Independent of baseline BMI, the NAFLD risk escalated with the cumulative BMI with adjusted hazard ratios (HRs) (95% confidence interval [CI]) of 1.60 (1.48-1.73) and 2.28 (2.06-2.53) for the intermediate tertile and the highest tertile (P trend < 0.001). The association is amplified in women and the young. Compared to a stable weight (BMI change: -3% to 3%), NAFLD risk increased in the baseline BMI < 24 kg/m2 group with weight gain (BMI change: > 3%) and decreased in BMI ≥ 24 kg/m2 group with weight loss (BMI change: < -3%) for men and women. However, we only observed a decreased NAFLD risk in men (HR: 0.82, 95% CI: 0.69-0.97) with BMI < 24 kg/m2 and weight loss.


CONCLUSIONS
Monitoring cumulative BMI may help to identify high-risk NAFLD populations. The association between weight gain or loss varies by sex and baseline BMI, suggesting the importance of individualized weight management for NAFLD prevention.