title: Increased Prevalence of Metabolic Risk Factors in Asian Americans With Hepatocellular Carcinoma.
abstract: BACKGROUND
  We used metabolic risk factors to estimate the prevalence and clinical significance of nonalcoholic fatty liver disease in Asian Americans with hepatocellular carcinoma (HCC).
  
  
  METHODS
  This is a retrospective cohort study of 824 consecutive Asian HCC patients at Stanford University Medical Center from 1998 to 2015. Patients were subdivided as: Chinese, other East Asian (Japanese and Korean), South East Asian (Vietnamese, Thai, and Laotian), Maritime South East Asian (MSEA: Malaysian, Indonesian, Filipino, and Singaporean), and South West Asian (Indian, Pakistani, and Middle Eastern). Metabolic risk factors studied were body mass index, hypertension, type II diabetes, and hyperlipidemia.
  
  
  RESULTS
  Most patients were male (76%) with mean age 63 years. Metabolic risk factors were highly prevalent on presentation and increased over time (P<0.001), as did the prevalence of cryptogenic HCC (P<0.004). Compared with other Asian subgroups, MSEAs had the highest body mass index (26.3) and higher rates of type II diabetes (44% vs. 23% to 35%, P=0.004), hypertension (59% vs. 38% to 55%, P=0.04), and cryptogenic HCC (15% vs. 4% to 10%, P=0.01). They were more likely to be symptomatic on presentation (44% vs. 32% to 58%, P=0.07), less likely to present within Milan criteria (34% vs. 35% to 63%, P<0.0001), and trended toward decreased 10-year survival rates compared with other ethnic subgroups (9% vs. 25% to 32%, P=0.07).
  
  
  CONCLUSIONS
  Metabolic risk factors were increasingly prevalent among Asian Americans with HCC. MSEAs, who had the highest incidence of these risk factors, had more advanced tumor stage and trended toward worse survival.
authors.affiliation: *Department of Medicine §School of Medicine †Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA ‡Washington University in St. Louis, St. Louis, MO ∥Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Alina
authors.initials: A
authors.lastname: Kutsenko
authors.forename: Maya R
authors.initials: MR
authors.lastname: Ladenheim
authors.forename: Nathan
authors.initials: N
authors.lastname: Kim
authors.forename: Pauline
authors.initials: P
authors.lastname: Nguyen
authors.forename: Vincent
authors.initials: V
authors.lastname: Chen
authors.forename: Channa
authors.initials: C
authors.lastname: Jayasekera
authors.forename: Ju Dong
authors.initials: JD
authors.lastname: Yang
authors.forename: Radhika
authors.initials: R
authors.lastname: Kumari
authors.forename: Lewis
authors.initials: L
authors.lastname: Roberts
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D001213:Asian; D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000208:ethnology* / Q000235:genetics / Q000401:mortality; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000208:ethnology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000208:ethnology* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000208:ethnology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors