Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease

Obes Sci Pract, 2023 · DOI: 10.1002/osp4.643 · Published: March 1, 2023

Simple Explanation

This study investigates the relationship between body mass index (BMI) and the risk of developing nonalcoholic fatty liver disease (NAFLD) in individuals with spinal cord injury (SCI) compared to those without SCI. The research found that the probability of developing NAFLD increases as BMI increases in both groups, but the risk is significantly higher for individuals with SCI at every BMI level. The study suggests that individuals with SCI may need closer monitoring and screening for NAFLD, and that BMI thresholds for assessing metabolic risk should be adjusted for this population.

Study Duration

10 years

Participants

14,890 individuals with SCI and 29,780 Non‐SCI individuals

Evidence Level

Longitudinal cohort study

Key Findings

1
The probability of developing NAFLD increases as BMI increases in both SCI and Non-SCI cohorts.
2
The probability of developing NAFLD was significantly higher in the SCI cohort at each BMI threshold compared to the Non-SCI cohort.
3
The positive predictive value for developing NAFLD was higher in the SCI group for any given BMI threshold from 19 kg/m2 to 45 kg/m2.

Research Summary

This study demonstrates that the risk of NAFLD increases with increasing BMI, supporting the understanding of the metabolic effects of obesity. The risk for developing a diagnosis of NAFLD was higher for the population with SCI at any BMI level, compared to matched controls without SCI. There are no clearly defined BMI thresholds that define zones of risk for metabolic disease, and BMI thresholds need to be adjusted for the population with SCI.

Practical Implications

Screening Protocols for SCI Patients

Healthcare systems should employ screening protocols specific to patients with SCI to detect NAFLD.

Aggressive Management of Metabolic Disease

The population with SCI may benefit from aggressive management of metabolic disease, irrespective of BMI.

Adjusted BMI Thresholds

Standard mapping of BMI to risk of NAFLD should be adjusted to account for SCI status.

Study Limitations

1
NAFLD is likely under‐diagnosed by our study methods, due to lack of routine screening in VHA.
2
The sample size decreased significantly at the highest BMI levels.
3
The care of individuals with SCI in VHA is likely different than individuals with SCI from the general population, thus our findings may not be generalizable.

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