Browsing by Subject "hepatocellular carcinoma"
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Item Biomarkers of Exposure to Foodborne and Environmental Carcinogens: Enterosorbent Intervention in a High Risk Population(2011-10-21) Johnson, Natalie MalekThe need to assess human exposures to foodborne and environmental carcinogens, particularly in populations at high risk for cancer and disease, has led to the development of chemical-specific biomarkers. Sensitive biomarkers for aflatoxin and polycyclic aromatic hydrocarbons (PAHs) have been useful in providing information on population exposure and reducing associated public health impacts. Aflatoxins are fungal metabolites found in a variety of foods. Among these toxins, aflatoxin B1 (AFB1) is the most predominant and hepatocarcinogenic. Acutely, AFB1 can cause disease and death, necessitating safe and effective intervention strategies. Inclusion of NovaSil (NS) clay in the diet represents a practical, sustainable approach. NS has been shown to prevent aflatoxicosis in multiple animal species by binding aflatoxins in the gastrointestinal tract, reducing toxin bioavailability. Co-exposure to PAHs, hazardous environmental contaminants, has been shown to increase the risk for hepatocellular carcinoma (HCC). Therefore, objectives of this research were to utilize biomarkers to assess aflatoxin and PAH exposures in susceptible populations in Ghana and the U.S. and to evaluate the safety and efficacy of NS intervention in Ghana (a population at risk for aflatoxicosis). After 3-month intervention with 3.0g NS/day, median aflatoxin M1 (an AFB1 metabolite) was significantly reduced (up to 58 percent) compared to the placebo group. Furthermore, no significant differences were found in levels of nutrient minerals between NS and placebo groups at baseline and 3-months suggesting NS can be used to effectively sorb AFB1 without affecting serum concentrations of important minerals. PAH biomarker results showed participants in Ghana were significantly exposed to high levels of PAHs based on the presence of 1-hydroxypyrene (1-OHP) in the majority of urines (98.9 percent). NS treatment had no effect on 1-OHP levels, further confirming the preferential binding of aflatoxins by NS. U.S. population data from a Hispanic community in Texas with an elevated incidence of HCC demonstrated a lower percentage and level of aflatoxin and PAH biomarkers. Aflatoxin M1 excretion, however, was associated with increased consumption of certain foods prone to aflatoxin contamination; thus, some individuals may be more vulnerable to exposure and associated interactions that increase the risk for HCC (e.g., PAHs or hepatitis infection).Item Diabetes and obesity as risk factors for the development of Hepatocellular carcinoma in the hispanic population(2008-12-08) Sathya Jaganmohan; Gagan Sood; Karen SzauterHepatocellular carcinoma is the fifth most prevalent cancer in the world with an overall 5-year survival rate of 6.9%. The well known etiological factors for HCC are infection with hepatitis B virus (HBV) and hepatitis C virus (HCV), alcohol abuse and environmental exposure to aflatoxins. The prevalence and mortality from HCC is rising in the U.S. In the U.S, Hispanics have a 2.7 times higher risk for HCC development than non-Hispanic whites and the highest mortality rate next to Asian population. The reason for this increased HCC risk in Hispanics is unknown. While it is conceivable that this disparity could be secondary to the incidence of hepatitis or alcohol abuse in the Hispanic population, the primary objective of this study was to evaluate other non-conventional risk factors in Hispanics such as diabetes and obesity. Diabetes and obesity are widespread health problems in the Hispanic population. Diabetes and obesity are known to predispose to the development of fatty liver disease resulting in Non Alcoholic Steatohepatitis (NASH) and cirrhosis. Primary liver cancer is about 4 times more likely in diabetic patients than non diabetics. Increasing BMI has also been shown to increase cancer risk and HCC risk. There is recent evidence suggesting diabetes and obesity not only accelerate the development of fibrosis in patients with chronic hepatitis, but also promote the molecular carcinogenesis of HCC. \r\nMy hypothesis is that, after controlling for traditionally recognized risk factors, an increased incidence of diabetes and obesity in the Hispanic population plays a causative role in the development of HCC. Using local inpatient and outpatient hospital data, a retrospective case control study was conducted with Hispanic patients afflicted with HCC as cases and patients with cirrhosis grouped as controls. A total of 63 cases and 98 controls were identified. The mean age of controls 52.28 and cases was 57.34. The mean BMI was 29.66 for controls and 28.78 for cases. 20 patients with HCC and 33 patients in the control group had been diagnosed with diabetes.\r\nUnivariate analysis did not show an increase in the odds of HCC development in patients with diabetes or obesity. Multivariate logistic regression analysis was then performed to control for various confounding factors. The adjusted odds ratio for diabetes as predictor for HCC development was 0.74 with CI (0.34-1.61) and was 0.80 for obesity with CI (0.35- 1.77). Neither diabetes nor obesity was a statistically significant factor in predicting the development of HCC in the Hispanic population. The results are subject to usual limitations of a retrospective study. Large prospective cohort studies are required to accurately determine the effect of diabetes and obesity on HCC risk in the Hispanic population.\r\n