A high BMI in late adolescent men is associated with an increased risk of future severe liver disease, including hepatocellular carcinoma (HCC), and that risk is higher in those who also have type 2 diabetes mellitus (T2DM), according to a study published in Gut.

Hannes Hagström, MD, from Karolinska University Hospital, Stockholm, and colleagues studied the association between BMI and future severe liver disease using a large, population-based cohort. The study included males born in Sweden between 1951 and 1976 who underwent conscription into military service between 1969 and 1996. The sample with complete data consisted of 1,220,261 men aged 17 to 19 years.

Diagnoses of liver cirrhosis, HCC, decompensated liver disease or liver failure, malignancies of the bile ducts and gall bladder, portal hypertension, liver transplantation and paracentesis, or death from the above diagnoses as underlying or contributory cause of death in the Cause of Death Registry were used to define the primary end point of severe liver disease. The secondary end point was a diagnosis of T2DM before or at the time of diagnosis of severe liver disease.

Mean BMI at conscription was 26.1 kg/m2 with 104,137 men being overweight (22.5 kg/m2 – 25 kg/m2, 8.5%) and 19,671 men being obese (>30 kg/m2, 1.6%). Mean BMI increased from 20.9 kg/m2 for men born in 1951 to 22.3 kg/m2 in men born in 1976. During the same period, the prevalence of overweight increased from 5.7% to 12.0% and obesity from 0.8% to 2.8%.

The cohort was followed for a mean of 28.5 years, corresponding to 34,800,419 person-years with respect to severe liver disease. During this time, there were 5281 cases of severe liver disease, including 251 cases with HCC. A total of 38,557 men (3.2%) died from causes other than severe liver disease. BMI was associated with an increased risk of severe liver disease in men with a BMI of 22.5 – 25 kg/m2 (hazard ratio [HR] 1.17), BMI 25 – 30 kg/m2 (HR 1.49), and BMI >30 kg/m2 (HR 2.17). 

A diagnosis of T2DM was obtained in 16,451 (1.3%) men during follow-up. An increased risk of severe liver disease was seen across all BMI categories in men who received a T2DM diagnosis. The risk of severe liver disease in men without a T2DM diagnosis and a BMI of >30 kg/m2 was increased (HR 2.09), but for men with a BMI of >30 kg/m2 and a T2DM diagnosis, the risk of severe liver disease was even higher (HR 3.28).  

The risk of HCC increased with a higher BMI, observed in the BMI 22.5 – 25 kg/m2 category (HR 1.28), the 25 – 30 kg/m2 category (HR 1.57), and for the >30 kg/m2 category (HR 3.59). In general, most cases of HCC were found in the oldest birth cohort (1951 to 1959).

“In this large population-based study of more than 1.2 million men, higher BMI in young adulthood was strongly associated with an increased risk of subsequent liver disease and HCC,” the authors said. “The risk was most pronounced in men with concurrent type 2 diabetes mellitus.”


  1. Hagström H, Tynelius P, Rasmussen F. High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men. Gut. 20 March 2017. doi: 10.1136/gutjnl-2016-313622