Diabetes and obesity as risk factors for the development of Hepatocellular carcinoma in the hispanic population



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Hepatocellular 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