Association of central obesity with hepatocellular carcinoma in patients with chronic hepatitis B receiving antiviral therapy

Abstract

Summary Background Obesity is typically associated with metabolic dysfunction, but its impact on hepatocellular carcinoma (HCC) remains unclear in patients with chronic hepatitis B (CHB). Aim To study the effect of obesity on HCC development in patients with CHB receiving antiviral therapy. Methods We included patients from a Chinese multicentre, prospective, observational, treated CHB cohort in this study. General obesity was evaluated by body‐mass index (BMI). Central obesity was evaluated by waist circumference, waist‐to‐hip ratio and waist‐to‐height ratio. Results A total of 5754 nucleos(t)ide analogue treated patients were enrolled in the analysis. The 5‐year cumulative incidence of HCC was 2.9%. Waist‐to‐height ratio performed better in predicting HCC development than BMI, waist circumference or waist‐to‐hip ratio. Patients with central obesity (defined as waist‐to‐height ratio >0.5) had significantly higher 5‐year incidence of HCC than those without central obesity in the overall population (3.9% vs 2.1%, hazard ratio [HR]: 2.06, P = 0.0001) and 745 propensity score matched pairs (4.7% vs 2.3%, HR: 2.04, P = 0.026), respectively. Besides cirrhosis status and aMAP HCC risk score, central obesity was also independently associated with HCC risk (HR: 1.63, P = 0.013). Waist‐to‐height ratio gain within 1 year was associated with a significantly higher HCC risk with an adjusted HR value of 1.88 (95% confidence interval: 1.12‐3.13, P = 0.017). Conclusions Central obesity, evaluated by the waist‐to‐height ratio, was associated with a twofold increase in HCC risk among CHB patients receiving antiviral treatment, highlighting the important role of abnormal metabolic function in the progression of liver disease.

Impact of diabetes, obesity, and dyslipidemia on the risk of hepatocellular carcinoma in patients with chronic liver diseases

“…However, reduction of waist-height ratio and increment were associated with an increased HCC risk. 66 In a small Korean study among 102 chronic HBV patients (7 HCC cases), central obesity, defined by WC, waist-hip ratio, and visceral fat area, was not associated with HCC risk. 67 Despite the potential, it is difficult to conclude whether central obesity is a better predictor and risk factor than general obesity in individuals with CLDs, due to the very small number of studies.…”

“…A recent Chinese study on chronic HBV patients reported that central obesity defined by waist-to-height ratio, not by WC and waist-hip ratio, was associated with an increased risk of HCC (HR, 1.63; 95% CI, 1.11–2.38) compared to non-central obesity. However, the risk of HCC with changes in the waist-to-height ratio was associated with an increased risk of HCC both with a decrease and an increase in the ratio [ 66 ]. In a small Korean study among 102 chronic HBV patients (seven HCC cases), central obesity, defined by WC, waist-hip ratio, and visceral fat area, was not associated with HCC risk [ 67 ].…”

Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B

“…Nevertheless, the impact of coexisting hepatic steatosis on HBV-related disease progression remains complex and controversial[ 20 ]. A recent investigation reported that although coexisting fatty liver was observed in approximately 34.0% of CHB patients receiving HBV antiviral therapy, hepatic steatosis was associated with a low risk of HCC[ 56 ].…”

“…Especially in patients with CHB, there is a need to endorse the definitions and cut-off values for assessing muscle mass (quantity/quality) and function. Regarding issues related to coexisting liver steatosis and myosteatosis[ 8 , 56 ], body composition assessment could shed light on the interplay among muscle, adipose tissue and liver in patients with CHB[ 7 , 8 , 53 ].…”

Precision medicine in the era of potent antiviral therapy for chronic hepatitis B

“…34 In another prospective study that observed the cumulative HCC incidence for 5 years, central obesity (waist-toheight ratio) was associated with the increased risk of HCC (HR 1.63, P = 0.013). 39 Thus, active screening and management of fatty liver and comorbid metabolic risk factors would be worthwhile to decrease the HCC risk and overall long-term outcome in patients with CHB.…”