Clinical-liver, pancreas, and biliary tractDiabetes increases the risk of chronic liver disease and hepatocellular carcinoma
Section snippets
Databases
The study population was assembled from hospitalized veterans registered within the nationwide Patient Treatment File. The Patient Treatment File comprises a multitude of annual data files of which the main files contain discharge diagnoses recorded for each hospitalization since 1970. Individual patients can be traced through the annual files of the Patient Treatment File through their unique social security numbers. Each hospitalization record contains 1 primary discharge diagnosis and up to
Results
We identified 257,649 patients with diabetes and 772,947 patients without diabetes who were hospitalized in VA facilities between October 1985 and October 1990. Of these, 216,831 patients with diabetes and 765,853 patients without diabetes did not have liver disease in their hospitalization records as far back as 1980. After excluding all patients in whom liver disease was recorded during the first year of follow-up after the index hospitalization, 173,643 patients with diabetes and 650,620
Discussion
In this large prospective cohort study, we found that DM doubled the risk of CNLD as well as HCC. A causal relationship is further suggested by finding a temporal association in which diabetes preceded the diagnosis of CNLD and HCC and a significant duration-response in which the risk of these conditions with diabetes was highest among patients with more than 10 years of follow-up during the study. The increased risk was not explained by the presence of underlying liver disease or concomitant
References (51)
- et al.
Burden of liver disease in the United Statessummary of a workshop
Hepatology
(2002) - et al.
Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States
Gastroenterology
(2003) Nonalcoholic steatohepatitisa study of 49 patients
Hum Pathol
(1989)- et al.
The role of diabetes in hepatocellular carcinomaa case-control study among United States veterans
Am J Gastroenterol
(2001) - et al.
Nonalcoholic fatty liver diseasea spectrum of clinical and pathological severity
Gastroenterology
(1999) - et al.
Association of nonalcoholic fatty liver disease with insulin resistance
Am J Med
(1999) - et al.
Insulin resistance in obesitymetabolic mechanisms and measurement methods
Mol Genet Metab
(1998) - et al.
Nonalcoholic steatohepatitis and hepatocellular carcinomanatural history?
Am J Gastroenterol
(2000) - et al.
Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis
J Hepatol
(2002) - et al.
Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus
J Chronic Dis
(1982)
Diabetes mellitus in chronic active hepatitis and cirrhosis
Gastroenterology
Attributable risks for hepatocellular carcinoma in Northern Italy
Eur J Cancer
Risk factors for hepatocellular carcinomasynergism of alcohol with viral hepatitis and diabetes mellitus
Hepatology
Vital status ascertainment through the files of the department of Veterans Affairs and the social security administration
Ann Epidemiol
Adapting a clinical comorbidity index for use of the ICD-9-CM in administrative databases
J Clin Epidemiol
Prevalence of obesity and diabetes in patients with cryptogenic cirrhosisa case-control study
Hepatology
Glucose tolerance and diabetes in chronic liver disease
Lancet
Liver disease, carbohydrate metabolism and diabetes
Bailleres Clin Endocrinol Metab
Metabolic and nutritional considerations in nonalcoholic fatty liver
Hepatology
Rising incidence of hepatocellular carcinoma in the United States
N Engl J Med
Risk factors for the rising rates of primary liver cancer in the United States
Arch Intern Med
Cirrhosis of undefined pathogenesisabsence of evidence for unknown or autoimmune processes
Hepatology
The natural history of nonalcoholic steatohepatitisa follow-up study of forty-two patients for up to 21 years
Hepatology
Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis
Hepatology
Hepatocellular carcinoma
Hepatology
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Dr. El-Serag is a VA HSR&D Awardee (RCD00-013-2).