CHI-LING CHENYang HwaiI.WEI-SHIUNG YANGCHUN-JEN LIUPEI-JER CHENYou S.Wang L.Sun C.Lu S.DING-SHINN CHENChen C.2021-07-022021-07-0220080016-5085https://www.scopus.com/inward/record.uri?eid=2-s2.0-84984548367&doi=10.1053%2fj.gastro.2008.03.073&partnerID=40&md5=b833910181769f52fd651ba5f9ca3247https://scholars.lib.ntu.edu.tw/handle/123456789/567655Background & Aims: This study investigated whether obesity, diabetes, and other metabolic factors are independently associated with hepatocellular carcinoma (HCC), stratified by hepatitis B virus (HBV) and hepatitis C virus (HCV) serostatus, and explored the possible joint influence of obesity/diabetes and HBV/HCV infections on the risk of HCC. Methods: A total of 23,820 residents in Taiwan were recruited and followed up for 14 years. All analyses were stratified by hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) at enrollment, and 218 subjects positive for both seromarkers were excluded. Incident HCC cases were identified via linkage to the national cancer registry. Multivariate-adjusted relative risk (RRa) and 95% confidence interval (95% CI) were estimated using Cox proportional hazards models. Results: Extreme obesity (body mass index ?30 kg/m2) was independently associated with a 4-fold risk of HCC (RRa, 4.13; 95% CI, 1.38-12.4) among anti-HCV-seropositive subjects and a 2-fold risk (RRa, 2.36; 95% CI, 0.91-6.17) in persons without HBV and HCV infections, after controlling for other metabolic components, but not in HBsAg-seropositive subjects (RRa, 1.36; 95% CI, 0.64-2.89). Diabetes was associated with HCC in all 3 groups, with the highest risk in those with HCV infection (RRa, 3.52; 95% CI, 1.29-9.24) and lowest in HBV carriers (RRa, 2.27; 95% CI, 1.10-4.66). We found more than 100-fold increased risk in HBV or HCV carriers with both obesity and diabetes, indicating synergistic effects of metabolic factors and hepatitis. Conclusions: The finding that both obesity and diabetes are predictors of HCC risk, possibly differently depending on HBV and HCV infection status, may shed some light in preventing HCC. ? 2008 AGA Institute.[SDGs]SDG3hepatitis B surface antigen; hepatitis C antibody; adult; aged; article; cancer risk; diabetes mellitus; disease association; female; follow up; hepatitis B; Hepatitis B virus; hepatitis C; Hepatitis C virus; human; human tissue; liver cell carcinoma; major clinical study; male; obesity; priority journal; risk factor; Taiwanjournal article10.1053/j.gastro.2008.03.073185056902-s2.0-84984548367