Obesity Early in Adulthood Increases Risk but Does Not Affect Outcomes of Hepatocellular Carcinoma

Abstract

BACKGROUND & AIMS Despite the significant association between obesity and several cancers, it has been difficult to establish an association between obesity and hepatocellular carcinoma (HCC). Patients with HCC often have ascites, making it a challenge to accurately determine body mass index (BMI), and many factors contribute to the development of HCC. We performed a case–control study to investigate whether obesity early in adulthood affects risk, age of onset, or outcomes of patients with HCC. METHODS We interviewed 622 patients newly diagnosed with HCC from January 2004 through December 2013, along with 660 healthy controls (frequency-matched by age and sex) to determine weights, heights, and body sizes (self-reported) at various ages before HCC development or enrollment as controls. Multivariable logistic and Cox regression analyses were performed to determine the independent effects of early obesity on risk for HCC and patient outcomes, respectively. BMI was calculated, and patients with a BMI ≥30 kg/m2 were considered obese. RESULTS Obesity in early adulthood (age, mid-20s to mid-40s) is a significant risk factor for HCC. The estimated odds ratios (OR) and 95% confidence intervals (CI) were 2.6 (1.4–4.4), 2.3 (1.2–4.4), and 3.6 (1.5–8.9) for the entire population, men, and women, respectively. Each unit increase in BMI at early adulthood was associated with a 3.89-month decrease in age at HCC diagnosis (P<.001). Moreover, there is a synergistic interaction between obesity and hepatitis virus infection. However, we found no effect of obesity on the overall survival of patients with HCC. CONCLUSION Early adulthood obesity is associated with increased risk of developing HCC at a young age in the absence of major HCC risk factors, with no effect on outcomes of patients with HCC.

High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men

“…Obesity in early adulthood (mid-20s to mid-40s) has also been shown to be associated with HCC 31. However, this study is also built on self-reported BMI.…”

85 Overweight or Obese Individuals at Eighteen Years of Age Develop Pancreatic Adenocarcinoma at a Significantly Earlier Age

“…Since then, mounting evidence has further affirmed the association between obesity and PC, including the National Institutes of Health-AARP Diet and Health Study, which concluded excess adiposity at any adult age was associated with an increased risk of PC and that morbidly obese adults (BMI ≥ 35) had a 45% greater PC risk compared with those with a normal BMI [20,21]. Obesity may not only increase risk for developing PC but also [23], gastric [24], colorectal [15,25], liver [13], and pancreatic [16,26,27]. Our conclusion that overweight and obese individuals at age 18 are diagnosed with PC 3 and 7 years younger is similar to the findings reported by Li et al, in which overweight or obese individuals between the ages of 20 and 49 years were diagnosed with PC approximately 2 and 6 years earlier [16].…”

“…Obesity is associated with an increased risk for at least 13 types of cancer [6], including colorectal [7], breast [8], endometrial [9], kidney [10], thyroid [11], esophageal [12], liver [13], and pancreatic [14]. Additionally, growing evidence has also specifically associated adolescent and early adulthood obesity with an increased cancer risk [13,15].…”

“…Additionally, growing evidence has also specifically associated adolescent and early adulthood obesity with an increased cancer risk [13,15]. In 2009, a case-control study involving 841 patients with PC demonstrated individuals who were overweight between the ages of 14 and 39 years or obese between the ages of 20 and 49 years were at increased risk of developing PC [16].…”

The role of bariatric surgery in the management of nonalcoholic fatty liver disease and metabolic syndrome

“…An association between early-onset obesity and subsequent risk of HCC has been reported [67]. However, confounding variables have been not been well controlled.…”