Epidemiology

Diabetes an "important" risk factor for chronic liver disease and liver cancer

Last Updated: 2004-02-25 16:22:08 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - Men with diabetes have about a two-fold greater risk of developing chronic non-alcoholic liver disease (CNLD) and hepatocellular carcinoma (HCC) compared with nondiabetic men, results of a large prospective cohort study suggest.

"Our study provides evidence that diabetes is an important risk factor for chronic liver disease including HCC," Dr. Hashem B. El-Serag from the Houston VA Medical Center in Texas told Reuters Health.

Using the computerized records of the Department of Veterans Affairs, investigators identified all patients with a hospital discharge diagnosis of diabetes between 1985 and 1990 (n=173,643). They matched each diabetic patient to three nondiabetic patients (n=650,620) and tracked them through 2000. Most of the subjects were men (98%), most of the diabetic patients had type 2 diabetes mellitus (99.5%), and none of them had a recorded history of liver disease prior to entry.

According to a report in the February issue of the journal Gastroenterology, the incidences of CNLD and HCC were significantly higher in diabetic than in the nondiabetic patients (p < 0.0001 for both).

Diabetes was associated with hazard ratios for CNLD and HCC of 1.98 and 2.16, respectively. The increased risk "seems to be independent of age, gender, ethnicity, or comorbid illnesses, Dr. El-Serag noted, and is higher in patients with diabetes for 10 years or more.

Several previous studies have found a statistically significant positive association between diabetes and HCC. "However, it remained unclear until this study whether diabetes preceded the development of significant chronic liver disease and HCC as diabetes could be a result (rather than a cause) of pre-existing severe liver disease," Dr. El-Serag said.

This study, Dr. Adrian M. Di Bisceglie from Saint Louis University School of Medicine points out in an editorial, "provides evidence that long-standing diabetes is followed by the development of liver disease and HCC, suggesting a causative role for diabetes mellitus."

The current study supports the team's earlier findings from the same cohort of patients in which diabetes conferred a 1.44 relative risk of developing acute liver failure. (See Reuters Health report July 12, 2002).

In light of the finding, Dr. El-Serag and colleagues recommend regular testing of liver enzymes in diabetic patients. "For patients with diabetes who receive oral medications, there has been a concern about toxicity in the liver - more reason to test liver enzymes early on and then periodically thereafter," the researcher said in a statement.

Further studies are needed to examine the association between diabetes and liver disease in women and to clarify the mechanisms behind the link, the authors note.

Gastroenterology 2004;126:460-468,604-605.