Epidemiology

Diabetes, overweight not linked to liver cancer in Taiwan

Last Updated: 2010-02-09 9:43:26 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Diabetes and overweight are not risk factors for hepatocellular carcinoma (HCC) in areas where hepatitis B and C are endemic, a paper from Taiwan suggests.

As senior author Dr. Sheng-Nan Lu from Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan, told Reuters Health in an email, "Chronic hepatitis B and C virus (HBV and HCV) infections are the two definite, unequivocal, strong causal factors of HCC."

Even after controlling for HBV and HCV status, however, diabetes and overweight were insignificant factors in all the multivariate analyses.

In an online report January 5th in the American Journal of Gastroenterology, Dr. Lu and colleagues observe that while up to 96% of patients with cirrhosis may be glucose intolerant and up to 30% are diabetic, "the complex relationship between diabetes, hepatitis, and cirrhosis makes it difficult to answer whether diabetes mellitus and overweight are true risk factors for HCC or just confounding factors associated with viral hepatitis or cirrhosis."

Their cross-sectional analyses involved 72 HCC cases and 56,193 community-based controls, with subsets of the control group used for matched analyses.

In case-controlled analyses, only thrombocytopenia and high alanine aminotransferase (ALT) emerged as independent risk factors.

In the community-based cross-sectional analysis, independent risk factors for HCC were male gender, age 65 or greater, hepatitis B surface antigen positivity, anti-HCV antibodies, thrombocytopenia, and high ALT - but not diabetes or overweight.

"As the etiology of HCC varies geographically, mostly because of different HBV, HCV, and alcoholism prevalence, the significance of diabetes and overweight with HCC in low viral hepatitis prevalence countries remains to be determined," the researchers conclude.

Dr. Lu said that the team now has a prospective study underway and that the results will likely confirm the current findings.

Am J Gastroenterol 2010.