Original article—liver, pancreas, and biliary tract
Obesity Is an Independent Risk Factor for Hepatocellular Carcinoma Development in Chronic Hepatitis C Patients

https://doi.org/10.1016/j.cgh.2008.02.012Get rights and content

Background & Aims: It is not fully elucidated whether obesity enhances hepatocarcinogenesis in patients with chronic hepatitis C. The aim of this study was to investigate the relationship between body weight and risk of hepatocarcinogenesis in chronic hepatitis C patients. Methods: We enrolled 1431 patients with chronic hepatitis C who visited our liver clinic between 1994 and 2004, excluding those with hepatocellular carcinoma (HCC) at their visit or with a previous history of HCC. They were divided into 4 groups according to body mass index (BMI): underweight (≤18.5 kg/m2, N = 112); normal (18.5 to less than 25 kg/m2, N = 1023); overweight (25 to less than 30 kg/m2, N = 265); and obese (>30 kg/m2, N = 31). We assessed the impact of obesity on the hepatocarcinogenesis adjusted by multivariate Cox proportional hazard regression with other risk factors found significant in univariate analysis. Results: During the follow-up period (mean, 6.1 y), HCC developed in 340 patients, showing cumulative incidence rates of 10.5%, 19.7%, and 36.8% at 3, 5, and 10 years, respectively. The incidence differed significantly among the BMI groups (P = .007). Adjusting for other significant factors, overweight and obesity were shown to be an independent risk factor of HCC, with a hazard ratio of 1.86 (95% confidence interval, 1.09–3.16; P = .022) and 3.10 (95% confidence interval, 1.41–6.81; P = .005) as compared with the underweight patients. Conclusions: The risk of HCC in patients with chronic hepatitis C increases in proportion to BMI in a wide range of its values, from underweight to obese.

Section snippets

Patients

Between January 1994 and December 2004, a total of 1954 HCV RNA–positive patients, excluding those with HCC or a past history of it, visited the liver clinic of the Department of Gastroenterology at the University of Tokyo Hospital. We analyzed 1431 of these patients, excluding 87 patients with concomitant hepatitis B virus surface antigen positivity and 423 patients who visited only for consultation purposes. Thirteen patients with intractable ascites also were excluded because this study was

Patient Profiles

Baseline characteristics of patients, 727 men and 704 women, are shown in Table 1. There were 112 underweight patients, 1023 normal-range BMI patients, 265 overweight patients, and 31 obese patients. Heavy alcohol consumption was noted in 70 patients (4.9%) and diabetes mellitus was detected in 133 patients (9.3%). There were 271 patients whose AFP level exceeded 20 ng/mL (>100 ng/mL in 46 patients and >400 ng/mL in 8 patients).

We compared age, sex, heavy alcohol consumption, comorbidity with

Discussion

The increasing prevalence of obesity, which leads to various morbidities, is now a major concern in the health care system in developed countries.16, 17, 31, 32, 33, 34 It is well documented that obesity contributes to the development of various diseases including diabetes, hypertension, cardiovascular, and cerebrovascular with increased mortality. In addition, obesity is also known as a risk factor of cancers. Calle et al17 reported that obesity was associated with increased mortality from

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