Waist/Hip Ratio Better Predicts Development of Severe Liver Disease Within 20 Years Than Body Mass Index: A Population-based Cohort Study

Research output: Contribution to journalArticle


Background & Aims Obesity, commonly assessed based on body mass index (BMI), is associated with an increased risk for severe liver disease. It is not known if other measures of body composition are better determinants of risk for severe liver disease, and/or if these differ between women and men. We investigated the body composition measures that best predict the development of severe liver disease. Methods We collected data from the Malmö Diet and Cancer study in Sweden, comprising 16,784 women and 10,833 (mean age, 58.1 years at baseline), and followed patients for a median 19.8 years. We analyzed data on measures of body composition including BMI, waist/hip ratio, and others. We determined whether subjects were diagnosed with severe liver disease, or died from severe liver disease, until the end of 2014 using Swedish national registers. Associations between body composition measures and severe liver disease were assessed using Cox regression models, stratified by sex and adjusted for age, alcohol consumption, smoking, education, and physical activity. Results All studied measures of body composition were significantly associated with severe liver disease. Waist/hip ratio was the best predictor of severe liver disease in women (hazard ratio [HR] per standard deviation increment, 1.30; 95% confidence interval [CI], 1.16–1.46) and men (HR, 1.46; 95% CI, 1.31–1.63). BMI had the lowest HR in women (HR, 1.12; 95% CI, 1.00–1.27) and men (HR, 1.26; 95% CI, 1.12–1.42). The association between waist/hip ratio and development of liver disease was independent of BMI. Conclusions In a Swedish population-based cohort study, we associated all measures of body composition with risk of severe liver disease. However, measures of abdominal obesity were best at predicting development of severe liver disease.


  • Anna Andreasson
  • Axel C. Carlsson
  • Kristina Önnerhag
  • Hannes Hagström
External organisations
  • Karolinska Institutet
  • Macquarie University, Sydney
  • Uppsala University
  • Skåne University Hospital
  • Karolinska University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics
  • Gastroenterology and Hepatology


  • Body Weight, Cirrhosis, Overweight, Waist Size
Original languageEnglish
Pages (from-to)1294-1301.e2
JournalClinical Gastroenterology and Hepatology
Issue number8
Publication statusPublished - 2017 Aug 1
Publication categoryResearch
Externally publishedYes