Association with Body Mass Index and Risk of Hepatocellular Carcinoma According Liver Disorder Status = Association with Body Mass Index and Risk of Hepatocellular Carcinoma According Liver Disorder Status

다국어 초록 (Multilingual Abstract)

Aims: Body mass index (BMI) is known to be associated with higher risk of hepatocellular carcinoma (HCC) in the general population. However, the association between BMI and risk of HCC in patients with various liver disease is not well understood.
Methods: We used data from National Health Insurance Service (NHIS) that provides compulsory health insurance coverage and national health screening for all citizens in the Republic of Korea. Hazard ratios (HRs) were calculated using Cox regression models to examine associations between body mass index (BMI) and risk of HCC. We included 15016551 adults (aged 18-99 years) who underwent health examinations between 2003 and 2006, in the NHIS database. Participants were classified into six groups according to the liver diseases; liver cirrhosis (LC), hepatitis B or C virus infection (HBVHCV), other liver disease (O-LD), unidentified liver disease with alanine aminotransferase (ALT) ≥40 or aspartate aminotransferase (AST) ≥40 (ALT40), no known liver diseases with 20≤ALT<40 or 20≤AST<40 IU/ml (ALT2040), and ALT<20 and AST<20 (ALT20).
Results: During mean 13.7 years of follow-up. HCC occurred in 71570 individuals. In total population, BMI had a non-linear association with HCC. In BMI above 25 kg/m², BMI was positively associated with risk of HCC regardless of liver disorder. In the multivariable adjusted analysis, the HR per 5 kg/m² increase in BMI above 25 kg/m² was 1.48 (95% CI 1.44-1.52) in total population, 1.11 (95% CI 1.00-1.23) in LC, 1.12 (95% CI 1.44-1.52) in HBVHCV, 1.32 (95% CI 1.22-1.44) in O-LD, 1.07 (95% CI 1.03-1.12) in ALT40, 1.47 (95% CI 1.38-1.57) in ALT2040, 1.67 (95% CI 1.32-2.09) in ALT20. In the subgroup analysis for the HCC high-risk group, the HR of HCC (95% CI) for a 5 kg/m2 increase in BMI was 1.21 in HBV-LC (1.01-1.46), 1.13 in other LC (1.08-1.19) and 1.15 in HBV without LC (1.04- 1.27), 1.14 in HCV without LC (0.92 -1.40) and 1.05 in HCV-LC (0.64-1.74). Associations between BMI and risk of HCC in HBV (HR; 1.46 vs 1.05), HCV (HR; 1.30 vs 0.92) and LC (HR; 1.28 vs 1.02) patients were stronger in female than in male.
Conclusions: Our study showed that BMI was positively associated with risk of HCC regardless of liver disorder in BMI above 25 kg/m². As the severity of liver disease weakened, the association between increased BMI and HCC became stronger. Inpatients with HBV, HCV, and LC, the harmful effects of higher BMI on HCC risk was stronger in women than in men.