title: Obesity Early in Adulthood Increases Risk but Does Not Affect Outcomes of Hepatocellular Carcinoma.
abstract: OBJECTIVE
  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 determine body mass index (BMI) accurately, 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 of 30 kg/m(2) or greater 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 were 2.6 (95% confidence interval [CI], 1.4-4.4), 2.3 (95% CI, 1.2-4.4), and 3.6 (95% CI, 1.5-8.9) for the entire population, for men, and for 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 was a synergistic interaction between obesity and hepatitis virus infection. However, we found no effect of obesity on the overall survival of patients with HCC.
  
  
  CONCLUSIONS
  Early adulthood obesity is associated with an 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.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: mhassan@mdanderson.org.
authors.forename: Manal M
authors.initials: MM
authors.lastname: Hassan
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt.
authors.forename: Reham
authors.initials: R
authors.lastname: Abdel-Wahab
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kaseb
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shalaby
authors.affiliation: Houston Methodist Hospital, Houston, Texas.
authors.forename: Alexandria T
authors.initials: AT
authors.lastname: Phan
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.affiliation: Division of Cancer Prevention and Population Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ernest
authors.initials: E
authors.lastname: Hawk
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jeff
authors.initials: J
authors.lastname: Morris
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Kanwal Pratap
authors.initials: KP
authors.lastname: Singh Raghav
authors.affiliation: Department of System Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ju-Seog
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Gehan
authors.initials: G
authors.lastname: Bortus
authors.affiliation: Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Harrys A
authors.initials: HA
authors.lastname: Torres
authors.affiliation: Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Amos
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Donghui
authors.initials: D
authors.lastname: Li
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000375:Aging / Q000378:metabolism / Q000473:pathology; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors; D055815:Young Adult
keywords: Case-Control; HCC; Obesity; Risk Factor
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