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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS)

Authors: P. M. Trembling, S. Apostolidou, A. Gentry-Maharaj, J. Parkes, A. Ryan, S. Tanwar, M. Burnell, U. Menon, W. M. Rosenberg

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

We investigated the association between self-reported skirt size (SS) and change in SS, and incidence of chronic liver disease (CLD) in a prospective cohort study of women recruited to the UKCTOCS trial.

Methods

Women recruited to UKCTOCS in England without documented CLD self-reported their current UK SS during trial participation and were asked to recall their SS when aged in 20s (via completion of a questionnaire 3–5 years after recruitment). Participants were followed up via electronic health record linkage and hazard ratios (HR) calculated for incident liver-related events (LRE).

Results

Three hundred twenty-two (0.3%) of 94,124 women experienced a first LRE. Compared to SS ≤ 16, rates of LRE were higher in the SS ≥ 18 groups (both when aged in 20s and at questionnaire completion). Event rates were higher if there was no change in SS or an increase in SS, compared to a decrease in SS.
In the models adjusted for potential confounders, HRs for LRE were higher in the groups of women reporting SS ≥ 18 both when aged in 20s (HR = 1.39 (95% CI; 0.87–2.23)) and at questionnaire completion (HR = 1.37 (95% CI; 1.07–1.75)). Compared to a decrease in SS, HRs were higher in the no change (HR = 1.78 (95% CI; 0.95–3.34)) and increase (HR = 1.80 (95% CI; 1.01–3.21)) groups.

Conclusion

CLD is associated with high SS and an increase in SS over time. These data suggest SS can be used in simple public health messages about communicating the risk of liver disease.

Trial Registration

UKCTOCS is registered as an International Standard Randomised Controlled Trial, number ISRCTN22488978. Registered 06/04/2000.
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Literature
1.
go back to reference Leon DA, McCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet. 2006;367:52–6.CrossRefPubMed Leon DA, McCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet. 2006;367:52–6.CrossRefPubMed
2.
go back to reference Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014;384:1953–97.CrossRefPubMed Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014;384:1953–97.CrossRefPubMed
3.
go back to reference Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States: a population-based study. J Clin Gastroenterol. 2015;49:690–6.CrossRefPubMed Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States: a population-based study. J Clin Gastroenterol. 2015;49:690–6.CrossRefPubMed
4.
go back to reference Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844–50.CrossRefPubMed Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844–50.CrossRefPubMed
5.
go back to reference Chang H, Simonsick EM, Ferrucci L, Cooper JA. Validation study of the body adiposity index as a predictor of percent body fat in older individuals: findings from the BLSA. J Gerontol A Biol Sci Med Sci. 2014;69:1069–75.CrossRefPubMed Chang H, Simonsick EM, Ferrucci L, Cooper JA. Validation study of the body adiposity index as a predictor of percent body fat in older individuals: findings from the BLSA. J Gerontol A Biol Sci Med Sci. 2014;69:1069–75.CrossRefPubMed
7.
go back to reference Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, et al. Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom collaborative trial of ovarian Cancer screening (UKCTOCS). BMC Public Health. 2017;17(1):603.CrossRefPubMedPubMedCentral Trembling PM, Apostolidou S, Gentry-Maharaj A, Parkes J, Ryan A, Tanwar S, et al. Risk of chronic liver disease in post-menopausal women due to body mass index, alcohol and their interaction: a prospective nested cohort study within the United Kingdom collaborative trial of ovarian Cancer screening (UKCTOCS). BMC Public Health. 2017;17(1):603.CrossRefPubMedPubMedCentral
8.
go back to reference Fourkala EO, Burnell M, Cox C, Ryan A, Salter LC, Gentry-Maharaj A, et al. Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK collaborative trial of ovarian Cancer screening (UKCTOCS). BMJ Open. 2014;24(9):e005400.CrossRef Fourkala EO, Burnell M, Cox C, Ryan A, Salter LC, Gentry-Maharaj A, et al. Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK collaborative trial of ovarian Cancer screening (UKCTOCS). BMJ Open. 2014;24(9):e005400.CrossRef
9.
go back to reference Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK collaborative trial of ovarian Cancer screening (UKCTOCS). Lancet Oncol. 2009;10:327–40.CrossRefPubMed Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK collaborative trial of ovarian Cancer screening (UKCTOCS). Lancet Oncol. 2009;10:327–40.CrossRefPubMed
10.
go back to reference Menon U, Gentry-Maharaj A, Ryan A, Sharma A, Burnell M, Hallett R, et al. Recruitment to multicentre trials--lessons from UKCTOCS: descriptive study. BMJ. 2008;337:a2079.CrossRefPubMedPubMedCentral Menon U, Gentry-Maharaj A, Ryan A, Sharma A, Burnell M, Hallett R, et al. Recruitment to multicentre trials--lessons from UKCTOCS: descriptive study. BMJ. 2008;337:a2079.CrossRefPubMedPubMedCentral
11.
go back to reference Gentry-Maharaj A, Glazer C, Burnell M, Ryan A, Berry H, Kalsi J, et al. Changing trends in reproductive/lifestyle factors in UK women: descriptive study within the UK collaborative trial of ovarian Cancer screening (UKCTOCS). BMJ Open. 2017;7:e011822.CrossRefPubMedPubMedCentral Gentry-Maharaj A, Glazer C, Burnell M, Ryan A, Berry H, Kalsi J, et al. Changing trends in reproductive/lifestyle factors in UK women: descriptive study within the UK collaborative trial of ovarian Cancer screening (UKCTOCS). BMJ Open. 2017;7:e011822.CrossRefPubMedPubMedCentral
12.
go back to reference Menon U, Ryan A, Kalsi J, Gentry-Maharaj A, Dawnay A, Habib M, et al. Risk algorithm using serial biomarker measurements doubles the number of screen-detected cancers compared with a single-threshold rule in the United Kingdom collaborative trial of ovarian Cancer screening. J Clin Oncol. 2015;33:2062–71.CrossRefPubMedPubMedCentral Menon U, Ryan A, Kalsi J, Gentry-Maharaj A, Dawnay A, Habib M, et al. Risk algorithm using serial biomarker measurements doubles the number of screen-detected cancers compared with a single-threshold rule in the United Kingdom collaborative trial of ovarian Cancer screening. J Clin Oncol. 2015;33:2062–71.CrossRefPubMedPubMedCentral
13.
go back to reference Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK. Ovarian cancer screening and mortality in the UK collaborative trial of ovarian Cancer screening (UKCTOCS): a randomised controlled trial. Lancet. 2016;387(10022):945–56.CrossRefPubMedPubMedCentral Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK. Ovarian cancer screening and mortality in the UK collaborative trial of ovarian Cancer screening (UKCTOCS): a randomised controlled trial. Lancet. 2016;387(10022):945–56.CrossRefPubMedPubMedCentral
14.
go back to reference Han TS, Gates E, Truscott E, Lean ME. Clothing size as an indicator of adiposity, ischaemic heart disease and cardiovascular risks. J Hum Nutr Diet. 2005;18:423–30.CrossRefPubMed Han TS, Gates E, Truscott E, Lean ME. Clothing size as an indicator of adiposity, ischaemic heart disease and cardiovascular risks. J Hum Nutr Diet. 2005;18:423–30.CrossRefPubMed
15.
go back to reference British Standards Institution. BS 3666:1982 Specification for size designation of women’s wear. London. British Standards Institution. BS 3666:1982 Specification for size designation of women’s wear. London.
17.
go back to reference Burnell M, Gentry-Maharaj A, Ryan A, Apostolidou S, Habib M, Kalsi J, et al. Impact on mortality and cancer incidence rates of using random invitation from population registers for recruitment to trials. Trials. 2011;12:61.CrossRefPubMedPubMedCentral Burnell M, Gentry-Maharaj A, Ryan A, Apostolidou S, Habib M, Kalsi J, et al. Impact on mortality and cancer incidence rates of using random invitation from population registers for recruitment to trials. Trials. 2011;12:61.CrossRefPubMedPubMedCentral
18.
19.
go back to reference Donato GB, Fuchs SC, Oppermann K, Bastos C, Spritzer PM. Association between menopause status and central adiposity measured at different cutoffs of waist circumference and waist-to-hip ratio. Menopause. 2006;13:280–5.CrossRefPubMed Donato GB, Fuchs SC, Oppermann K, Bastos C, Spritzer PM. Association between menopause status and central adiposity measured at different cutoffs of waist circumference and waist-to-hip ratio. Menopause. 2006;13:280–5.CrossRefPubMed
20.
go back to reference Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51:1445–9.CrossRefPubMedPubMedCentral Garcia-Tsao G, Friedman S, Iredale J, Pinzani M. Now there are many (stages) where before there was one: in search of a pathophysiological classification of cirrhosis. Hepatology. 2010;51:1445–9.CrossRefPubMedPubMedCentral
22.
go back to reference Health and Social Care Information Centre. Health Survey for England 2015: Adult alcohol consumption. HSIC, 2016. Health and Social Care Information Centre. Health Survey for England 2015: Adult alcohol consumption. HSIC, 2016.
23.
go back to reference Department of Health. Adult alcohol statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 march 2014. London: Department of Health; 2014. Department of Health. Adult alcohol statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2013 to 31 march 2014. London: Department of Health; 2014.
24.
go back to reference Bolton-Smith C, Woodward M, Tunstall-Pedoe H, Morrison C. Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population. J Epidemiol Community Health. 2000;54:143–8.CrossRefPubMedPubMedCentral Bolton-Smith C, Woodward M, Tunstall-Pedoe H, Morrison C. Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population. J Epidemiol Community Health. 2000;54:143–8.CrossRefPubMedPubMedCentral
25.
go back to reference Hill A, Roberts J. Body mass index: a comparison between self-reported and measured height and weight. J Public Health Med. 1998;20(2):206–10.CrossRefPubMed Hill A, Roberts J. Body mass index: a comparison between self-reported and measured height and weight. J Public Health Med. 1998;20(2):206–10.CrossRefPubMed
26.
go back to reference Nieto-Garcia FJ, Bush TL, Keyl PM. Body mass definitions of obesity: sensitivity and specificity using self-reported weight and height. Epidemiology. 1990;1:146–52.CrossRefPubMed Nieto-Garcia FJ, Bush TL, Keyl PM. Body mass definitions of obesity: sensitivity and specificity using self-reported weight and height. Epidemiology. 1990;1:146–52.CrossRefPubMed
27.
go back to reference Roberts RJ. Can self-reported data accurately describe the prevalence of overweight? Public Health. 1995;109(4):275–84.CrossRefPubMed Roberts RJ. Can self-reported data accurately describe the prevalence of overweight? Public Health. 1995;109(4):275–84.CrossRefPubMed
28.
go back to reference Kuskowska-Wolk A, Karlsson P, Stolt M, Rössner S. The predictive validity of body mass index based on self-reported weight and height. Int J Obes. 1989;13:441–53.PubMed Kuskowska-Wolk A, Karlsson P, Stolt M, Rössner S. The predictive validity of body mass index based on self-reported weight and height. Int J Obes. 1989;13:441–53.PubMed
29.
go back to reference Dahl AK, Hassing LB, Fransson EI, Pedersen NL. Agreement between self-reported and measured height, weight and body mass index in old age--a longitudinal study with 20 years of follow-up. Age Ageing. 2010;39:445–51.CrossRefPubMedPubMedCentral Dahl AK, Hassing LB, Fransson EI, Pedersen NL. Agreement between self-reported and measured height, weight and body mass index in old age--a longitudinal study with 20 years of follow-up. Age Ageing. 2010;39:445–51.CrossRefPubMedPubMedCentral
30.
go back to reference Stevens J, Keil JE, Waid LR, Gazes PC. Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol. 1990;132:1156–63.CrossRefPubMed Stevens J, Keil JE, Waid LR, Gazes PC. Accuracy of current, 4-year, and 28-year self-reported body weight in an elderly population. Am J Epidemiol. 1990;132:1156–63.CrossRefPubMed
31.
go back to reference Dahl AK, Reynolds CA. Accuracy of recalled body weight--a study with 20-years of follow-up. Obesity (Silver Spring). 2013;21:1293–8.CrossRef Dahl AK, Reynolds CA. Accuracy of recalled body weight--a study with 20-years of follow-up. Obesity (Silver Spring). 2013;21:1293–8.CrossRef
32.
go back to reference Perry GS, Byers TE, Mokdad AH, Serdula MK, Williamson DF. The validity of self-reports of past body weights by U.S. adults. Epidemiology. 1995;6:61–6.CrossRefPubMed Perry GS, Byers TE, Mokdad AH, Serdula MK, Williamson DF. The validity of self-reports of past body weights by U.S. adults. Epidemiology. 1995;6:61–6.CrossRefPubMed
33.
go back to reference Must A, Willett WC, Dietz WH. Remote recall of childhood height, weight, and body build by elderly subjects. Am J Epidemiol. 1993;138:56–64.CrossRefPubMed Must A, Willett WC, Dietz WH. Remote recall of childhood height, weight, and body build by elderly subjects. Am J Epidemiol. 1993;138:56–64.CrossRefPubMed
35.
go back to reference Aydinoğlu NZ, Krishna A. Imagining thin: why vanity sizing works. J Consum Psychol. 2012;22:565–72.CrossRef Aydinoğlu NZ, Krishna A. Imagining thin: why vanity sizing works. J Consum Psychol. 2012;22:565–72.CrossRef
36.
go back to reference Howard SJ, Davies SC. Chief medical officer urges action to tackle overweight and obesity. BMJ. 2014;348:g2375.CrossRefPubMed Howard SJ, Davies SC. Chief medical officer urges action to tackle overweight and obesity. BMJ. 2014;348:g2375.CrossRefPubMed
37.
go back to reference Li L, Liu DW, Yan HY, Wang ZY, Zhao SH, Wang B. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies. Obes Rev. 2016;17:510–9.CrossRefPubMed Li L, Liu DW, Yan HY, Wang ZY, Zhao SH, Wang B. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies. Obes Rev. 2016;17:510–9.CrossRefPubMed
38.
go back to reference Xu C, Yu C, Ma H, Xu L, Miao M, Li Y. Prevalence and risk factors for the development of nonalcoholic fatty liver disease in a nonobese Chinese population: the Zhejiang Zhenhai study. Am J Gastroenterol. 2013;108:1299–304.CrossRefPubMed Xu C, Yu C, Ma H, Xu L, Miao M, Li Y. Prevalence and risk factors for the development of nonalcoholic fatty liver disease in a nonobese Chinese population: the Zhejiang Zhenhai study. Am J Gastroenterol. 2013;108:1299–304.CrossRefPubMed
39.
go back to reference Loomis AK, Kabadi S, Preiss D, Hyde C, Bonato V, St Louis M, et al. Body mass index and risk of nonalcoholic fatty liver disease: two electronic health record prospective studies. J Clin Endocrinol Metab. 2016;101:945–52.CrossRefPubMed Loomis AK, Kabadi S, Preiss D, Hyde C, Bonato V, St Louis M, et al. Body mass index and risk of nonalcoholic fatty liver disease: two electronic health record prospective studies. J Clin Endocrinol Metab. 2016;101:945–52.CrossRefPubMed
40.
go back to reference Hughes LA, Schouten LJ, Goldbohm RA, van den Brandt PA, Weijenberg MP. Self-reported clothing size as a proxy measure for body size. Epidemiology. 2009;20:673–6.CrossRefPubMed Hughes LA, Schouten LJ, Goldbohm RA, van den Brandt PA, Weijenberg MP. Self-reported clothing size as a proxy measure for body size. Epidemiology. 2009;20:673–6.CrossRefPubMed
41.
go back to reference Battram DS, Beynon C, He M. The reliability and validity of using clothing size as a proxy for waist circumference measurement in adults. Appl Physiol Nutr Metab. 2011;36:183–90.CrossRefPubMed Battram DS, Beynon C, He M. The reliability and validity of using clothing size as a proxy for waist circumference measurement in adults. Appl Physiol Nutr Metab. 2011;36:183–90.CrossRefPubMed
Metadata
Title
Association between skirt size and chronic liver disease in post-menopausal women: a prospective cohort study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS)
Authors
P. M. Trembling
S. Apostolidou
A. Gentry-Maharaj
J. Parkes
A. Ryan
S. Tanwar
M. Burnell
U. Menon
W. M. Rosenberg
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5308-x

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