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Obesity Early in Adulthood Increases Risk but Does Not Affect Outcomes of Hepatocellular Carcinoma
Open accessAbstract
Background & aims Despite the significant association between obesity and several cancers, it has been difficult to establish an association between obesity and hepatocellular carcinoma (HCC). Patients with HCC often have ascites, making it a challenge to determine body mass index (BMI) accurately, and many factors contribute to the development of HCC. We performed a case-control study to investigate whether obesity early in adulthood affects risk, age of onset, or outcomes of patients with HCC.Methods We interviewed 622 patients newly diagnosed with HCC from January 2004 through December 2013, along with 660 healthy controls (frequency-matched by age and sex) to determine weights, heights, and body sizes (self-reported) at various ages before HCC development or enrollment as controls. Multivariable logistic and Cox regression analyses were performed to determine the independent effects of early obesity on risk for HCC and patient outcomes, respectively. BMI was calculated, and patients with a BMI of 30 kg/m(2) or greater were considered obese.Results Obesity in early adulthood (age, mid-20s to mid-40s) is a significant risk factor for HCC. The estimated odds ratios were 2.6 (95% confidence interval [CI], 1.4-4.4), 2.3 (95% CI, 1.2-4.4), and 3.6 (95% CI, 1.5-8.9) for the entire population, for men, and for women, respectively. Each unit increase in BMI at early adulthood was associated with a 3.89-month decrease in age at HCC diagnosis (P < .001). Moreover, there was a synergistic interaction between obesity and hepatitis virus infection. However, we found no effect of obesity on the overall survival of patients with HCC.Conclusions Early adulthood obesity is associated with an increased risk of developing HCC at a young age in the absence of major HCC risk factors, with no effect on outcomes of patients with HCC.
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“The early onset of obesity has a meaningful impact on the development of HCC, as shown in a case-control study comparing 622 individuals with newly diagnosed HCC and 660 healthy controls, where obesity in early adulthood was associated with HCC development.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [48]
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The Incidence and Epidemiology of Hepatocellular Carcinoma: A Global and Regional Perspective
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Kim, M., Jun, B. G., Shin, H. S., Yi, J., Kim, S. G., & Yi, S. (2024) · Research Square · doi:10.21203/rs.3.rs-3855645/v1
Chun, H. S., Lee, M., & Kim, T. H. (2024) · Journal of Digestive Cancer Research · doi:10.52927/jdcr.2024.12.3.184
Bokhary, R., & Almohammadi, N. H. (2025) · Research Square · doi:10.21203/rs.3.rs-6234231/v1
A Gastroenterologist’s Approach to Improving Metabolic Health in MASLD
Razzak, I. A., Razzak, I. A., Noureddin, M., & Trivedi, H. D. (2025) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000002210 · Cited by 1
Hepatocellular Carcinoma in the Setting of Metabolic Dysfunction Associated Steatotic Liver Disease
Su, A., Clark, J. M., & Kim, A. K. (2026) · Current Hepatology Reports · doi:10.1007/s11901-025-00707-5
Trajectory Modelling of Prognostic Biomarkers Linked to Liver Cancer Risk: A Systematic Review
Aldawsari, B., Bonnett, L. J., Sudell, M., Johnson, P., & Hughes, D. M. (2026) · Liver Cancer · doi:10.1159/000551202
Marqueurs diagnostiques et pronostiques de la stéatohépatite métabolique
Coilly, A. (2019) · theses.fr (ABES) · doi:10.70675/488abf31z3acfz4f13z88e2zd974ef8b9b7b
Bokhary, R. (2026) · Hepatic Oncology · doi:10.1080/20450923.2026.2731863
Metadata
- Authors
- Hassan, M. M., Abdel-Wahab, R., Kaseb, A., Shalaby, A., Phan, A. T., El-Serag, H. B., Hawk, E., Morris, J., Singh Raghav, K. P., Lee, J.-S., Vauthey, J.-N., Bortus, G., Torres, H. A., Amos, C. I., Wolff, R. A., & Li, D.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Houston Methodist (US)
- Dartmouth College (US)
- Corresponding author
- Hassan, Manal M.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 149
- Issue
- 1
- Pages
- 119-129
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC4778392
- OpenAlex
- W2052145855
- Cited by
- 110
- References
- 66
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 9 · 2023: 10 · 2022: 6 · 2021: 9 · 2020: 15 · 2019: 7 · 2018: 15 · 2017: 11 · 2016: 11 · 2015: 8
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (CA106458-01, K07CA106458, P30CA023108, P30CA016672)
- National Institute of Environmental Health Sciences (R03ES11481, R03ES011481)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- hepatocellular carcinoma, obesity, early adulthood, body mass index, cancer risk, age at diagnosis, hepatitis virus infection, overall survival, sex differences
- MeSH terms
- Adult, Aged, Aging, Female, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Male, Middle Aged, Obesity, Risk Factors, Body Mass Index, Case-Control Studies, Age of Onset, Young Adult
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