title: Diabetes Mellitus Increases Risk of Hepatocellular Carcinoma in Chronic Hepatitis C Virus Patients: A Systematic Review.
abstract: BACKGROUND
  Rising rates of obesity, diabetes mellitus (DM), and nonalcoholic fatty liver disease (NAFLD) among chronic hepatitis C (HCV) patients may contribute to higher hepatocellular carcinoma (HCC) risk.
  
  
  OBJECTIVE
  To perform a systematic review evaluating the impact of DM, body mass index (BMI), or steatosis on HCC risk among chronic HCV patients.
  
  
  METHODS
  A structured keyword search of PubMed from January 1, 2001, to July 1, 2014, was performed to identify original articles evaluating the association of DM, BMI, or steatosis with HCC among adults with chronic HCV. Studies involving HCV patients co-infected with human immunodeficiency virus, hepatitis B virus, or other chronic liver diseases with the exception of NAFLD were excluded. Quality assessment utilized the Newcastle-Ottawa scale.
  
  
  RESULTS
  Nine studies (seven cohorts, two case-controls) met inclusion criteria for the final analysis. Five of seven studies analyzing DM demonstrated significantly increased HCC risk associated with concurrent DM with effect sizes ranging from HR 1.73 (95 % CI 1.30-2.30) to RR 3.52 (95 % CI 1.29-9.24). One of three studies analyzing BMI demonstrated a significant association with HCC risk (BMI ≥ 30.0 vs. BMI < 23: RR 4.13, 95 % CI 1.38-12.40). Two of the three studies analyzing steatosis demonstrated significantly higher risk of HCC associated with steatosis ranging from RR 2.81 (95 % CI 1.49-4.41) to OR 6.39 (95 % CI 1.04-39.35).
  
  
  CONCLUSIONS
  Concurrent DM is associated with increased HCC risk among chronic HCV patients. BMI and steatosis may also increase HCC risk, but the limitations of the current studies do not allow us to draw strong conclusions.
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA. harleendyal@gmail.com.
authors.forename: Harleen K
authors.initials: HK
authors.lastname: Dyal
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, 1411 East 31st Street, Oakland, CA, USA. maguilar58@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: Aguilar
authors.affiliation: Department of Medicine, Alameda Health System - Highland Hospital, 1411 East 31st Street, Oakland, CA, USA. gbartos@alamedahealthsystem.org.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Bartos
authors.affiliation: Division of Hepatology, Department of Transplantation, California Pacific Medical Center, 2340 Clay Street, 3rd Floor, San Francisco, CA, 94115, USA. holte@sutterhealth.org.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Holt
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA. tbhuket@alamedahealthsystem.org.
authors.forename: Taft
authors.initials: T
authors.lastname: Bhuket
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA. beliu@alamedahealthsystem.org.
authors.forename: Benny
authors.initials: B
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Stanford, CA, 94305, USA. rcheung@stanford.edu.|Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. rcheung@stanford.edu.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Cheung
authors.affiliation: Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, Highland Hospital - Highland Care Pavilion 5th Floor, Endoscopy Unit, 1411 East 31st Street, Oakland, CA, 94602, USA. rowong@alamedahealthsystem.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wong
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D003920:Diabetes Mellitus; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology*; D012307:Risk Factors
keywords: Fatty liver; Liver cancer; Obesity