title: The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence.
abstract: OBJECTIVE
  We conducted a systematic review and a meta-analysis to estimate the magnitude and determinants of association between diabetes and hepatocellular carcinoma (HCC).
  
  
  METHODS
  MEDLINE searches were conducted for published full studies (between January 1966 and February 2005) that provided risk estimates and met criteria concerning the definition of exposure and outcomes. Two investigators independently performed standardized search and data abstraction. Unadjusted and adjusted odds ratios for individual outcomes were obtained or calculated for each study and were synthesized using a random-effects model.
  
  
  RESULTS
  A total of 26 studies met our inclusion and exclusion criteria. Among 13 case-control studies, diabetes was associated significantly with HCC in 9 studies (pooled odds ratio, 2.5; 95% confidence interval, 1.8-3.5). Among 13 cohort studies, diabetes was associated significantly with HCC in 7 studies (pooled risk ratio, 2.5; 95% confidence interval, 1.9-3.2). The results were relatively consistent in different populations, different geographic locations, and a variety of control groups. The significant association between HCC and diabetes was independent of alcohol use or viral hepatitis in the 10 studies that examined these factors. Few studies adjusted for diet and obesity.
  
  
  CONCLUSIONS
  Diabetes is associated with an increased risk for HCC. However, more research is required to examine issues related to the duration and treatment of diabetes, and confounding by diet and obesity.
authors.affiliation: Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center at Baylor College of Medicine, Houston, Texas 77030, USA. hasheme@bcm.tmc.edu
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: Howard
authors.initials: H
authors.lastname: Hampel
authors.forename: Fariba
authors.initials: F
authors.lastname: Javadi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*