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In their article "Adverse Childhood Experiences and Self-reported Liver Disease," Dong and colleagues¹ report an association between adverse childhood experiences (ACEs) and the risk of self-reported liver diseases including "yellow jaundice, hepatitis, or any liver trouble." Previous work from this cohort indicated an association between ACEs and severe obesity.² Obesity-related liver diseases such as nonalcoholic steatohepatitis and nonalcoholic fatty liver disease are among the most common liver disorders seen in the primary care population and a significant cause of cryptogenic cirrhosis.³ Can the authors comment as to whether their data suggest that obesity is an intervening variable between ACEs and liver problems experienced later in life?

Keith H. Bachman, MD
Clackamas, Ore

1. Dong M, Dube SR, Fellitti VF, Giles WH, Anda RF. Adverse childhood experiences and self-reported liver disease. Arch Intern Med. 2003;163:1949-1956. FREE FULL TEXT 2. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med. 1998;14:245-258. FULL TEXT | ISI | PUBMED 3. Clark JM, Diehl AM. Nonalcoholic fatty liver disease. JAMA. 2003;289:3000-3004. FREE FULL TEXT

Arch Intern Med. 2004;164:460.

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