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We thank Dr Bachman for his comments on our study. He has raised the interesting possibility that obesity may potentially mediate the relationship between ACEs¹ and nonalcoholic fatty liver disease² that we had not previously considered. Therefore, we reanalyzed our data to examine whether severe obesity (body mass index [calculated as weight in kilograms divided by the square of height in meters] 35, as in our study¹) is a mediator between ACE and liver problems in adulthood.

Overall, we found that 113 respondents (8.5%) with severe obesity reported liver problems compared with 1063 (6.7%) of those without severe obesity. Among 6780 persons who did not drink alcohol, 669 severely obese respondents (9.7%) reported an even higher prevalence of liver problems compared with those without severe obesity (7.4%).

After we adjusted for demographic variables (age at survey, sex, race, and education attainment) using logistic regression, the likelihood of . . . [Full Text of this Article]

Maxia Dong, MD, PhD; Shanta R. Dube, MPH
Atlanta, Ga

Vincent J. Felitti, MD
San Diego, Calif

Wayne H. Giles, MD, MS; Robert F. Anda, MD, MS
Atlanta

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