Rohit Loomba, MD, MHSc; Marc Ghany, MD
Potential Financial Conflicts of Interest: None disclosed.
Loomba R, Ghany M. Association between Body Mass Index and Diabetes and Hepatocellular Carcinoma. Ann Intern Med. 2008;148:166-167. doi: 10.7326/0003-4819-148-2-200801150-00016
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Published: Ann Intern Med. 2008;148(2):166-167.
TO THE EDITOR:
We read with interest the article by Ikeda and colleagues (1) suggesting an association between antibody to hepatitis B core antigen (anti-HBc) and risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. The investigators conducted a careful multivariable analysis using a Cox proportional hazards model and included several recognized risk factors for the development of HCC, such as age, sex, smoking, alcohol consumption, and response to interferon therapy, in addition to anti-HBc status.
However, several epidemiologic studies and a meta-analysis that included patients from Asia and the West have shown an association of body mass index (BMI) and diabetes mellitus with the development of HCC (2–4). Obesity and diabetes have been closely linked to the development of HCC, perhaps through their association with nonalcoholic steatohepatitis, which is a progressive liver disease (5). Ikeda and colleagues do not provide any information regarding the contribution of metabolic factors, such as BMI and diabetes mellitus, in the risk for HCC in this population. Data on BMI and a history of diabetes should be available from the patient charts. Therefore, readers would be interested in whether risk factors, such as BMI and diabetes mellitus, contribute to the development of HCC in this population and modify the association between anti-HBc positivity and the development of HCC in individuals with hepatitis C virus–related cirrhosis.
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