title: Diabetes, hepatitis virus infection and hepatocellular carcinoma: A case-control study in hepatitis endemic area.
abstract: OBJECTIVE
  In spite of numerous studies on the association between diabetes mellitus (DM) and hepatocellular carcinoma (HCC), the results are inconsistent and whether and how the effect of DM on the risk for HCC is modified or synergistically exerted by hepatitis virus infection are still unclear. We aimed to elucidate and quantify the effect modification and synergism between hepatitis B and C virus (HBV and HCV, respectively) and DM leading to the risk for HCC and also assess the independent contribution of DM to the risk for HCC at population level (population attributable fraction) in a high prevalence area of hepatitis virus infection.
  
  
  METHODS
  A hospital-based case-control study was conducted from one medical center. Information on hepatitis B and C virus infection and DM status (defined by 8-h fasting blood glucose level ≥126 mg/dL, current use of oral hyperglycemic agent or insulin injection) was collected to assess interaction of hepatitis virus infection with DM on the risk for HCC.
  
  
  RESULTS
  The association between DM and the risk for HCC was significant regardless of the presence of HBV infection, whereas a significant positive association was noted for HCV negativity. Synergistic interactions between DM and HBV infection were significant. In the absence of both hepatitis virus infections, the independent effect of DM accounted for 7.5% risk for HCC from the underlying population.
  
  
  CONCLUSIONS
  The effect of DM on the risk for developing HCC is higher in HCV negative patients and synergistic with HBV infection. The independent effect of DM provides a new insight to the prevention of HCC other than virus-related mechanism.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital             College of Medicine, Taipei Medical University             Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei             Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Wei-Hsu
authors.initials: WH
authors.lastname: Ko
authors.forename: Sherry Yueh-Hsia
authors.initials: SY
authors.lastname: Chiu
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yang
authors.forename: Hsiu-Hsi
authors.initials: HH
authors.lastname: Chen