Men and women with high BMI and hepatitis B virus infection are at increased risk for hepatocellular carcinoma, according to study findings.
“Our findings have both clinical and public health implications that support the need for intervention strategies and medical attention for obese patients with chronic HBV infection, especially [among] women,” Kyuwoong Kim, BS, from the department of biomedical sciences at Seoul National University Graduate School in Republic of Korea, and colleagues wrote.
Among the general population, obesity is associated with higher risk for HCC. Previous research showed inconsistencies on whether BMI also increased risk for HCC among individuals with chronic HBV infection.
Kim and colleagues examined data from the National Health Insurance Service — a database that housed health insurance coverage and national health screenings of all citizens in the Republic of Korea — and identified adult men (n = 214,167) and women (n = 156,155) with chronic HBV infection who underwent examinations between January 2002 and December 2006.
Patients were grouped based on BMI according to WHO classification for Asian populations. Among these, 76,392 men and 40,610 women had BMI of 25 kg/m2 to 29.9 kg/m2 and 7,240 men and 5,333 women had BMI greater than 30 kg/m2.
Researchers used Cox proportional hazard models across all BMI groups — using 18.5 kg/m2 to 22.9 kg/m2 as reference — to measure HRs. They used restricted cubic spline models to measure the association between BMI and HCC among men and women for BMI categories and covariates.
All patients were followed from January 2007 to December 2015 and excised at first incidence of HCC, mortality or end of follow-up, whichever occurred first.
During follow-up, 11,241 men and 3,368 women developed HCC. Risk for HCC appeared strongly associated with BMI in a dose-dependent manner among men (P < .01) and women (P < .001).
The risk for HCC appeared strongest among men (HR = 1.22; 95% CI, 1.09-1.36) and women (HR = 1.46; 95% CI,1.24-1.71) with BMI greater than 30 kg/m2 compared with the reference BMI groups.
The association between BMI and HCC appeared greater among overweight women than overweight men (P < .001).
“The difference between male and female patients with chronic HBV found in our study may be partially explained by the sex difference in the relationship of BMI to total body fat,” the researchers wrote.
A limitation of the study included a lack of information on serum HBV DNA levels available in the National Health Insurance Service database.
“[This] is a clinically important predictor for the development of liver cirrhosis and HCC among patients with chronic HBV infection,” the researchers wrote. – by Melinda Stevens
: Kim reports a scholarship from the BK21-plus education program by the National Research Foundation of Korea. The other authors report no relevant financial disclosures.