Epidemiology

Excess body weight may be involved in course of hepatitis B

Last Updated: 2008-11-20 13:42:04 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A report in the Journal of Clinical Oncology suggests a role for excess body weight in the transition from healthy hepatitis B virus (HBV) carrier state to hepatoma and liver-related death.

In the issue published online on October 27 in advance of print, Dr. Ming-Whei Yu, of National Taiwan University, Taipei, and colleagues describe a prospective study in 2903 male HBV surface antigen (HBsAg)-positive government employees enrolled between August 1989 and June 1992.

Over a mean follow-up period of 14.7 years, 134 patients developed hepatocellular carcinoma (HCC). Of 218 deaths that occurred during follow-up, 92 (42.2% of total deaths) were attributable to liver-related disease, with deaths due to HCC in 71 patients and to cirrhosis in 21.

Hazard ratios for incident HCC were 1.48 in overweight men (those with body mass index of 25.0 to 29.9 kg/m�) and 1.96 in obese men (at least 30.0 kg/m�), compared with normal-weight men. Hazard ratios for liver-related mortality were 1.74 in overweight men and 1.50 in obese men.

Excess body weight was associated with elevated serum levels of ALT and gamma-glutamyltransferase (GGT) and reduced AST:ALT ratios.

In 257 subjects, cirrhosis was detected by ultrasonography during follow-up. According to the article, the risk of cirrhosis increased with increasing quartiles of BMI (p trend = 0.0005). The adjusted odds ratio for cirrhosis was 2.37 among obese HBsAg carriers compared with those of normal weight.

"The association of higher BMI with increased risk of HCC or death resulting from liver disease is independent of diabetes," the authors note. "The spectrum of liver diseases in relation to excess weight among HBsAg carriers extends from simple fatty liver at the most benign end to chronic hepatitis, cirrhosis and HCC at the opposite end."

J Clin Oncol 2008.