Diabetes and Obesity Greatly Contribute to Hepatocellular Carcinoma

Summary and Comment |
September 11, 2013

Diabetes and Obesity Greatly Contribute to Hepatocellular Carcinoma

  1. Atif Zaman, MD, MPH

These two highly correlated conditions accounted for 37% of HCC cases in a U.S. Medicare population.

  1. Atif Zaman, MD, MPH

Hepatitis C virus (HCV) and alcohol are typically cited as the major risk factors for cirrhosis and hepatocellular carcinoma (HCC). However, risk estimate calculations do not account for the prevalence of the exposure in the population, only the strength of the association. To better characterize the contributions of individual risk factors to the burden of HCC in the population, researchers calculated the population attributable fraction (PAF) for viral hepatitis, alcohol-related liver disorders, diabetes and obesity, and metabolic disorders.

Data were from the Surveillance Epidemiology and End Results (SEER)-Medicare linked database. Cases were 6,991 patients aged ≥68 years who were diagnosed with HCC between 1994 and 2007. Controls comprised a 5% random sample of Medicare beneficiaries without a diagnosis of HCC.

The risk factor of diabetes, obesity, or both had the highest PAF, both overall (36.6%) and in gender-specific analyses (men, 36.4%; women, 36.7%). The next highest PAF was for alcohol-related liver disorders (23.5%), followed by HCV infection (22.4%), hepatitis B virus infection (6.3%), and rare genetic disorders (3.2%). Results varied by race/ethnicity group. The combined PAF for all risk factors considered was highest in the Asian population (70.1%) and lowest in the black population (52.4%).


These findings emphasize that despite the low relative risk of developing hepatocellular carcinoma because of diabetes and obesity (RR in this study, 2.47) compared with other factors such as hepatitis C virus infection (RR in this study, 39.9), the high prevalence of diabetes and obesity in the U.S. results in more cases of HCC attributable to these conditions than to HCV infection. Therefore, from a population standpoint, the elimination of diabetes and obesity would have the greatest effect on reducing the incidence of HCC than the elimination of any other risk factor.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex


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