Impact of high body mass index on hepatocellular carcinoma risk in chronic liver disease: population-based prospective cohort study

Abstract

Abstract We investigated associations between body mass index (BMI) and hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) and C (HCV) virus infections, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), and liver cirrhosis. We followed 350,608 Korean patients with liver disease from 2003–2006 until December 2018 using national hospital discharge records. Adjusted hazard ratios (HRs) per 5-kg/m2 BMI (≥ 25-kg/m2) increase for HCC risk were calculated using Cox models. HRs (95% confidence intervals) were 1.17 (1.06–1.28), 1.08 (0.87–1.34), 1.34 (1.14–1.58), 1.51 (1.17–1.94), and 1.11 (1.00-1.23) for HBV, HCV, ALD, NAFLD, and liver cirrhosis, respectively. HRs for HBV and liver cirrhosis in women vs men were 1.45 (1.23–1.70) vs 1.06 (0.95–1.19) and 1.27 (1.07–1.50) vs 1.02 (0.90–1.16), respectively. HRs for HBV, HCV, and NAFLD were 1.17 (1.07–1.29), 1.33 (1.03–1.73), and 1.20 (0.87–1.64) in < 65-year-olds and 1.05 (0.70–1.59), 0.74 (0.50–1.10), and 2.40 (1.62–3.54) in ≥ 65-year-olds, respectively. Overweight BMI showed significantly higher HCC risks with HBV, ALD, NAFLD, and liver cirrhosis. Higher BMIs increased HCC risks with HBV, ALD, NAFLD, and liver cirrhosis. Women with HBV and liver cirrhosis had stronger BMI-HCC associations than men. High BMI effect was stronger at older ages with NAFLD and at younger ages with viral hepatitis.