Combination of Alcohol and High BMI Linked to Liver Injury Biomarkers Interview with:
Alice R Carter MSc
Doctor of Philosophy Student
MRC Integrative Epidemiology Unit
Population Health Science, Bristol Medical School
University of Bristol What is the background for this study?  

Response: Higher body mass index and alcohol intake have been shown to increase the risk of liver disease. Some studies have looked at their combined effect by comparing the risk of liver disease between individuals with both high BMI and high alcohol intake and individuals with low BMI and low alcohol intake. However, these studies have produced mixed results. Some possible reasons for that are errors in self-reported BMI and alcohol intake, other factors confounding the association of BMI & alcohol intake with liver disease risk and changes in lifestyle that individuals with ill health may have been advised to adopt.

One way to overcome these limitations is to use a technique called Mendelian randomisation. This method uses genetic differences between individuals that influence their characteristics (e.g. their body mass and how much alcohol they drink) to help understand whether these characteristics are causally related to diseases.

Our study used this method to explore the joint effects of BMI and alcohol consumption on liver disease and biomarkers of liver injury. What are the main findings?

Response: In this analysis individuals with both a low BMI and low alcohol consumption had the lowest levels of liver injury biomarkers than those with either high for both BMI and alcohol, or high for one. Those who had either high BMI or high alcohol consumption had increased biomarker levels compared with those who were low for both, but lower levels compared with those high for both.

When we looked at cases of liver disease, we found little difference in risk by BMI and alcohol groups. However, it is important to emphasise that we had very few cases of liver disease in the population and larger sample sizes may be required to identify whether BMI and alcohol act together to increase risk of liver disease. What should readers take away from your report?

Response: Interventions to lower both BMI and alcohol consumption would likely lead to the greatest reductions in liver injury. In an individual with both a high BMI and high alcohol consumption, lowering at least one of these would be beneficial. What recommendations do you have for future research as a result of this work?

Response: These findings highlight the need to address both high BMI and high alcohol intake to reduce the burden of liver injury in the population. These analyses would benefit from being replicated in larger cohorts with greater numbers of liver disease cases. 

Any disclosures?

This study was supported by Herlev and Gentofte Hospital, Copenhagen University Hospital, The Copenhagen County Research Fund, and The Danish Medical Research Council. ARC is funded by a UK Medical Research Council PhD Studentship (R0158114); MCB is funded by a UK Medical Research Council Skills Development Fellowship (MR/P014054/1) and DAL’s contribution to this paper was supported by European Research Council under the European Union’s Seventh Framework Programme (FP/2007-2013) / ERC Grant Agreement (Grant number 669545; DevelopObese). ARC, MCB, GDS and DAL work in at Unit that receives funds from the University of Bristol and UK Medical Research Council (MC_UU/12013/1 MC_UU_12013/5). None of the funding bodies had any influence on the study design, analyses or interpretation of results. The work is that of the authors and does not necessarily reflect the opinions of any funding body. DAL currently receives funds or support in kind from Wellcome, EU Horizon 2020, UK Medical Research Council, UK Economic and Social Research Council, US National Institute of Health, Roche Diagnostics and Medtronic for research that is unrelated to the research presented here.

No conflicts of interest: ARC, MCB, MB, ATH, GDS, BGN


Carter AR, Borges M, Benn M, et al. Combined Association of Body Mass Index and Alcohol Consumption With Biomarkers for Liver Injury and Incidence of Liver Disease: A Mendelian Randomization Study. JAMA Netw Open. 2019;2(3):e190305. doi:10.1001/jamanetworkopen.2019.0305

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Last Updated on March 12, 2019 by Marie Benz MD FAAD