Is obesity an independent risk factor for hepatocellular carcinoma in cirrhosis?
Abstract
Recently, several epidemiologic observations have suggested that obesity might be an independent risk factor for certain malignancies such as breast cancer, colon cancer, renal cell carcinoma, and esophageal adenocarcinoma. However, there are no studies examining the risk of hepatocellular carcinoma (HCC) in obesity. The aim of the present study was to determine whether obesity is an independent risk factor for HCC in patients with cirrhosis. Explanted liver specimens from a national database on patients undergoing liver transplantation were examined for HCC, and the incidence was compared among patients with varying body mass indices according to the etiology of cirrhosis. A multivariate analysis was used for controlling other potentially confounding variables such as age and sex. Among 19,271 evaluable patients, the overall incidence of HCC was 3.4% (n = 659) with a slightly higher prevalence among obese patients compared with lean patients. Obesity was an independent predictor for HCC in patients with alcoholic cirrhosis (odds ratio [OR], 3.2; 95% CI, 1.5-6.6; P =.002) and cryptogenic cirrhosis (OR, 11.1; 95% CI, 1.5-87.4; P =.02). Obesity was not an independent predictor in patients with hepatitis C, hepatitis B, primary biliary cirrhosis, and autoimmune hepatitis. The higher risk of HCC in obese patients is confined to alcoholic liver disease and cryptogenic cirrhosis. In conclusion, more frequent surveillance for HCC may be warranted in obese patients with alcoholic and cryptogenic cirrhosis. However, as this study is based on patients with advanced cirrhosis, our findings need to be confirmed in a broader population of individuals with cirrhosis.
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The association between obesity and HCC was found in persons with cryptogenic cirrhosis and alcohol-related cirrhosis but not in individuals with liver diseases of other aetiologies.
“This association was found in persons with cryptogenic cirrhosis and alcoholrelated cirrhosis but not in individuals with liver diseases of other aetiologies.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [47]
Obesity increases the risk of HCC in individuals with alcohol-related cirrhosis.
“Conversely, obesity increases the risk of HCC in individuals with alcohol-related cirrhosis.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [47]
Cites
WISEMAN, H., & HALLIWELL, B. (1996) · Biochemical Journal · doi:10.1042/bj3130017 · Cited by 2,345 · see citing works
Prevalence of and Risk Factors for Hepatic Steatosis in Northern Italy
Bellentani, S., Saccoccio, G., Masutti, F., Crocè, L. S., Brandi, G., Sasso, F., Cristanini, G., & Tiribelli, C. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-132-2-200001180-00004 · Cited by 1,261 · see citing works
Cryptogenic Cirrhosis: Clinical Characterization and Risk Factors for Underlying Disease
Caldwell, S. H., Oelsner, D. H., Iezzoni, J. C., Hespenheide, E. E., Battle, E. H., & Driscoll, C. J. (1999) · Hepatology · doi:10.1002/hep.510290347 · Cited by 1,138 · see citing works
Association between Body Mass and Adenocarcinoma of the Esophagus and Gastric Cardia
Lagergren, J., Bergström, R., & Nyrén, O. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-11-199906010-00003 · Cited by 675 · see citing works
Obesity, Hypertension, and the Risk of Kidney Cancer in Men
Chow, W., Gridley, G., Fraumeni, J. F., & Järvholm, B. (2000) · New England Journal of Medicine · doi:10.1056/nejm200011023431804 · Cited by 667 · see citing works
Wideroff, L., Gridley, G., Chow, W. H., Linet, M., Mellemkjaer, L., Olsen, J. H., Keehn, S., & Borch-Johnsen, K. (1997) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/89.18.1360 · Cited by 627 · see citing works
Cerutti, P. (1994) · The Lancet · doi:10.1016/s0140-6736(94)92832-0 · Cited by 566 · see citing works
Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: A case-control study
Poonawala, A., Nair, S. P., & Thuluvath, P. J. (2000) · Hepatology · doi:10.1053/jhep.2000.17894 · Cited by 566 · see citing works
Self-citationTHE EPIDEMIOLOGY OF SERUM SEX HORMONES IN POSTMENOPAUSAL WOMEN
Cauley, J. A., Gutai, J. P., Kuller, L. H., LEDONNE, D., & POWELL, J. G. (1989) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115234 · Cited by 485 · see citing works
Moriya, K., Nakagawa, K., Santa, T., Shintani, Y., Fujie, H., Miyoshi, H., Tsutsumi, T., Miyazawa, T., Ishibashi, K., Horie, T., et al. (2001) · PubMed · Cited by 454 · see citing works
Excess Risk of Primary Liver Cancer in Patients With Diabetes Mellitus
Adami, H., Chow, W.-H., Nyrén, O., Berne, C., Linet, M. S., Ekbom, A., Wolk, A., McLaughlin, J. K., & Fraumeni, J. F. (1996) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/88.20.1472 · Cited by 373 · see citing works
Body Mass Index and Colon Cancer Mortality in a Large Prospective Study
Murphy, T. K. (2000) · American Journal of Epidemiology · doi:10.1093/aje/152.9.847 · Cited by 321 · see citing works
A case-control study of diabetes mellitus and cancer risk
Vecchia, C. L., Negri, E., Franceschi, S., D’Avanzo, B., & Boyle, P. (1994) · British Journal of Cancer · doi:10.1038/bjc.1994.427 · Cited by 320 · see citing works
Figueras, J., Jaurrieta, E., Valls, C., et al. (1997) · Hepatology · doi:10.1002/hep.510250629 · Cited by 272 · see citing works
Hasegawa, Y., Takanashi, S., Kanehira, Y., Tsushima, T., Imai, T., & Okumura, K. (2001) · Cancer · doi:10.1002/1097-0142(20010301)91:5 · Cited by 240 · see citing works
Peroxisomal β-Oxidation and Steatohepatitis
Rao, M. S., & Reddy, J. K. (2001) · Seminars in Liver Disease · doi:10.1055/s-2001-12928 · Cited by 194 · see citing works
Yu, M. C., Henderson, B. E., Tong, M. J., & Govindarajan, S. (1991) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/83.24.1820 · Cited by 190 · see citing works
Abdominal Obesity and Breast Cancer Risk
Schapira, D. V., Kumar, N. B., Lyman, G. H., & Cox, C. E. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-112-3-182 · Cited by 186 · see citing works
Role of Diabetes Mellitus in the Etiology of Hepatocellular Carcinoma
Λάγιου, Π. (2000) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/92.13.1096 · Cited by 162 · see citing works
Yang, S. Q., Lin, H. Z., Hwang, J., Chacko, V. P., & Diehl, A. M. (2001) · PubMed · Cited by 151 · see citing works
Theise, N. D., Schwartz, M. E., Miller, C., et al. (1992) · Hepatology · doi:10.1002/hep.1840160416 · Cited by 136 · see citing works
Tanaka, K., Sakai, H., Hashizume, M., et al. (2000) · PubMed · Cited by 129 · see citing works
Hormonal Abnormalities in Obesity
Zumoff, B. (1987) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1987.tb05939.x · Cited by 110 · see citing works
Su, Q., Liu, Y., Zhang, J., et al. (1994) · Hepatology · doi:10.1002/hep.1840200404 · Cited by 103 · see citing works
Lee, Y. I., Lee, S., Das, G. C., Park, U. S., Park, S. M., & Lee, Y. I. (2000) · Oncogene · doi:10.1038/sj.onc.1203694 · Cited by 94 · see citing works
Implications of the hyperinsulinaemia-diabetes-cancer link for preventive efforts.
Moore, M. A., Park, C. B., & Tsuda, H. (1998) · PubMed · Cited by 86 · see citing works
Diabetes Mellitus and Primary Hepatocellular Carcinoma
Lawson, D. H., Gray, J. M., McKillop, C. A., CLARKE, J., LEE, F. D., & Patrick, R. S. (1986) · QJM · doi:10.1093/oxfordjournals.qjmed.a068053 · Cited by 83 · see citing works
Medical history and primary liver cancer.
Vecchia, C. L., Negri, E., D’Avanzo, B., Boyle, P., & Franceschi, S. (1990) · PubMed · Cited by 64 · see citing works
Estrogen Induction of Hepatocellular Carcinomas in Armenian Hamsters
Coe, J. E., Ishak, K. G., & ROSS, M. J. (1990) · Hepatology · doi:10.1002/hep.1840110408 · Cited by 41 · see citing works
Ferrara, A. M., Barrett-Connor, E. L., Wingard, D. L., et al. (1995) · Diabetes Care · doi:10.2337/diacare.18.2.220 · Cited by 40 · see citing works
Pseudoglandular hepatocellular carcinoma. A morphogenetic study
Kondō, Y., & Nakajima, T. (1987) · Cancer · doi:10.1002/1097-0142(19870901)60:5 · Cited by 33 · see citing works
Liu, P., Terradillos, O., Renard, C., et al. (1997) · Hepatology · doi:10.1002/hep.510250415 · Cited by 32 · see citing works
Detailed microsatellite analysis of chromosome 3p region in non-papillary renal cell carcinomas
Chudek, J. T., Wilhelm, M., Bugert, P., Herbers, J., & Kovács, G. (1997) · International Journal of Cancer · doi:10.1002/(sici)1097-0215(19971009)73:2 · Cited by 32 · see citing works
The radiographic diagnosis and treatment of paraneoplastic central nervous system disease
Glantz, M., Biran, H., Myers, M. E., Gockerman, J. P., & Friedberg, M. H. (1994) · Cancer · doi:10.1002/1097-0142(19940101)73:1 · Cited by 31 · see citing works
Hepatocellular carcinoma incidence in Florida. Ethnic and racial distribution.
Shea, K. A., Fleming, L. E., Wilkinson, J. D., et al. (2001) · PubMed · Cited by 25 · see citing works
[Molecular mechanisms of the action of insulin].
Minchenko, О. H. (1988) · PubMed · Cited by 6 · see citing works
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Cited by
Sorted by citations
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
Mechanisms and disease consequences of nonalcoholic fatty liver disease
Loomba, R., Friedman, S. L., & Shulman, G. I. (2021) · Cell · doi:10.1016/j.cell.2021.04.015 · Cited by 2,002 · see citing works
Michelotti, G. A., Machado, M. V., & Diehl, A. M. (2013) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2013.183 · Cited by 974 · see citing works
Metabolic syndrome and hepatocellular carcinoma: Two growing epidemics with a potential link
Siegel, A. B., & Zhu, A. X. (2009) · Cancer · doi:10.1002/cncr.24687 · Cited by 399 · see citing works
Chen, Y., Wang, X., Wang, J., Yan, Z., & Luo, J. (2012) · European Journal of Cancer · doi:10.1016/j.ejca.2012.02.063 · Cited by 248 · see citing works
Metabolic risk factors and primary liver cancer in a prospective study of 578,700 adults
Borena, W., Strohmaier, S., Lukanova, A., Bjørge, T., Lindkvist, B., Hallmans, G., Edlinger, M., Stocks, T., Nagel, G., Manjer, J., et al. (2012) · International Journal of Cancer · doi:10.1002/ijc.26338 · Cited by 177 · see citing works
Obesity early in adulthood increases risk but does not affect outcomes of hepatocellular carcinoma
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., et al. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.03.044 · Cited by 110 · see citing works
- Authors
- Nair, S., Mason, A., Eason, J., Loss, G., & Perrillo, R. P.
- Affiliations
- Ochsner Medical Center (US)
- Corresponding author
- Nair, Satheesh
- Venue
- Hepatology
- Published
- 2002-07
- Volume
- 36
- Issue
- 1
- Pages
- 150-155
- ISSN
- 0270-9139 (ISSN-L)
- OpenAlex
- W2079146692
- Cited by
- 348
- References
- 36
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 10 · 2023: 11 · 2022: 10 · 2021: 9 · 2020: 11 · 2019: 14 · 2018: 11 · 2017: 18 · 2016: 14 · 2015: 14 · 2014: 21 · 2013: 17 · 2012: 17
- FWCI
- 12.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- obesity, hepatocellular carcinoma, liver cirrhosis, alcoholic cirrhosis, cryptogenic cirrhosis, body mass index, liver transplantation, cancer risk factors, HCC surveillance, hepatitis C, hepatitis B, primary biliary cirrhosis, autoimmune hepatitis
- MeSH terms
- Adult, Analysis of Variance, Female, Hepatitis C, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Cirrhosis, Alcoholic, Liver Neoplasms, Male, Middle Aged, Obesity, Risk Factors, Body Mass Index, Odds Ratio, Liver Transplantation, Racial Groups
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