title: Metabolic risk factors are a major comorbidity in patients with cirrhosis independent of the presence of hepatocellular carcinoma.
abstract: BACKGROUND
  Recent studies have identified cases of hepatocellular carcinoma (HCC) arising in cryptogenic cirrhosis and proposed that many of them may be attributable to nonalcoholic fatty liver disease (NAFLD).
  
  
  OBJECTIVE
  To evaluate the prevalence of NAFLD-associated metabolic risk factors among HCC patients to determine whether NAFLD could have played a role in the development of HCC.
  
  
  METHODS
  Patients with HCC in the setting of hepatic cirrhosis and age-matched, sex-matched, and Child-Pugh-matched cirrhotic patients were included in this study. A verbal interview regarding family and personal history of metabolic risk factors; a complete physical examination, including morphometric measurements; and a blood analysis evaluating liver function and cirrhosis etiology were conducted with each patient.
  
  
  RESULTS
  Seventy HCC patients and 64 tumor-free cirrhotics were included. Sixty-six patients (49%) were overweight and 37 (28%) obese, with a median body mass index of 27.6 (range: 19-41). Fifty-six patients (42%) had central adiposity, 62 (46%) had hypertension, 46 (34%) had type 2 diabetes, seven (5%) had coronary artery disease, and 48 (36%) had dyslipidemia. There were no significant differences in the distribution of metabolic risk factors between the groups. The main cause of cirrhosis was HCV in 83 patients (62%). In only two patients (1.4%), no cirrhosis etiology could be determined; both of them had HCC and metabolic risk factors.
  
  
  CONCLUSIONS
  Metabolic risk factors are a major health issue in patients with liver disease, regardless of the presence of HCC. Metabolic factors may have been risk factors for the development of liver disease and cirrhosis, even when other established causes of cirrhosis were present.
authors.affiliation: BCLC Group, Liver Unit, Hospital Clinic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Catalonia, Spain.
authors.forename: Amelia J
authors.initials: AJ
authors.lastname: Hessheimer
authors.forename: Alejandro
authors.initials: A
authors.lastname: Forner
authors.forename: María
authors.initials: M
authors.lastname: Varela
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruix
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism; D050171:Dyslipidemias / Q000453:epidemiology / Q000378:metabolism; D005234:Fatty Liver / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000378:metabolism*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors