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Risk factors for non-alcoholic fatty liver disease are common in patients with non-B non-C hepatocellular carcinoma in India

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Abstract

Aim of the study

The aim of the study was to analyze the prevalence of risk factors for non-alcoholic fatty liver disease (NAFLD) in patients with non-B non-C hepatocellular carcinoma (HCC).

Methods

Between June 2012 and November 2014, patients with HCC, negative for hepatitis B surface antigen and hepatitis C virus antibody, were included in this study. All patients were assessed for risk factors for NAFLD such as diabetes mellitus (DM), hypertension, dyslipidemia, metabolic syndrome, and obesity.

Results

Forty-seven patients with non-B non-C HCC (males, 37; age, 60±10 years; mean±SD) were studied. Model for end-stage liver disease score was 11±4. Twenty-five patients were in Child’s class A. History of significant alcohol intake was noted in 11 (23%) patients. Prevalence of risk factors for NAFLD were obesity 24 (51%), DM 22 (47%), metabolic syndrome 21 (45%), hypertension 16 (34%), and dyslipidemia 13 (28%). Forty (85%) patients had at least one risk factor for NAFLD. The mean duration of at least one NAFLD risk factor was 7.5 years, prior to diagnosis of HCC. Thirteen (28%) patients were positive for anti-HBc; however, none of the study patients had detectable HBV DNA in blood.

Conclusions

Eighty-five percent of the patients with non-B non-C HCC had at least one risk factor for NAFLD. None of the study patients had occult hepatitis B infection. NAFLD is emerging as the major etiological contributing factor for non-B non-C HCC in India.

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References

  1. Fang Y, Shang QL, Liu JY, et al. Prevalence of occult hepatitis B virus infection among hepatopathy patients and healthy people in China. J Inf Secur. 2009;58:383–8.

    Google Scholar 

  2. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36.

    Article  PubMed  Google Scholar 

  3. Nishikawa H, Osaki Y. Non-B, non-C hepatocellular carcinoma. Int J Oncol. 2013;43:1333–42.

    Article  CAS  PubMed  Google Scholar 

  4. Paschos P, Paletas K. Non alcoholic fatty liver disease and metabolic syndrome. Hippokratia. 2009;13:9–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Pollicino T, Saitta C. Occult hepatitis B virus and hepatocellular carcinoma. World J Gastroenterol. 2014;20:5951–61.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kannangai R, Molmenti E, Arrazola L, et al. Occult hepatitis B viral DNA in liver carcinomas from a region with a low prevalence of chronic hepatitis B infection. J Viral Hepat. 2004;11:297–301.

    Article  CAS  PubMed  Google Scholar 

  7. Hatanaka K, Kudo M, Fukunaga T, et al. Clinical characteristics of nonBnonC- HCC: comparison with HBV and HCV related HCC. Intervirology. 2007;50:24–31.

    Article  PubMed  Google Scholar 

  8. Kim MJ, Kwon OS, Chung NS, et al. The significance of anti-HBc and occult hepatitis B virus infection in the occurrence of hepatocellular carcinoma in patients with HBsAg and anti-HCV negative alcoholic cirrhosis. Korean J Hepatol. 2008;14:67–76.

    Article  PubMed  Google Scholar 

  9. Unnikrishnan R, Anjana RM, Mohan V. Diabetes mellitus and its complications in India. Nat Rev Endocrinol. 2016;12:357–70.

    PubMed  Google Scholar 

  10. Jain SR, Shah KH, Acharya HN, Barot K, Sharma KH. Prevalence and predictors of metabolic syndrome in young asymptomatic Gujarati population. Int J Chronic Dis. 2015;2015:365217.

    PubMed  PubMed Central  Google Scholar 

  11. Kleinman NJ, Shah A, Shah S, Phatak S, Viswanathan V. Impact of the Gather mHealth system on A1C: primary results of a multisite randomized clinical trial among people with type 2 diabetes in India. Diabetes Care. 2016;39:e169–70.

    Article  PubMed  Google Scholar 

  12. Amarapurkar DN, Hashimoto E, Lesmana LA, Sollano JD, Chen PJ, Goh KL. How common is non-alcoholic fatty liver disease in the Asia-Pacific region and are there local differences? J Gastroenterol Hepatol. 2007;22:788–93.

    Article  PubMed  Google Scholar 

  13. Pandit K, Goswami S, Ghosh S, Mukhopadhyay P, Chowdhury S. Metabolic syndrome in South Asians. Indian J Endocrinol Metab. 2012;16:44–55.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Oommen AM, Abraham VJ, George K, Jose VJ. Prevalence of risk factors for non-communicable diseases in rural & urban Tamil Nadu. Indian J Med Res. 2017;144:460–71.

    Article  Google Scholar 

  15. Pradeepa R, Anjana RM, Joshi SR, et al. Prevalence of generalized & abdominal obesity in urban & rural India—the ICMR-INDIAB study (Phase-I) [ICMR-NDIAB-3]. Indian J Med Res. 2015;142:139–50.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.

    Article  PubMed  PubMed Central  Google Scholar 

  17. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012:56:908–43.

  18. National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.

  19. Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–70.

    CAS  PubMed  Google Scholar 

  20. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–3.

    Article  PubMed  Google Scholar 

  21. Raimondo G, Allain JP, Brunetto MR, et al. Statements from the Taormina expert meeting on occult hepatitis B virus infection. J Hepatol. 2008;49:652–7.

    Article  PubMed  Google Scholar 

  22. O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2009;105:14–32. quiz 3

    Article  PubMed  Google Scholar 

  23. Pal S, Ramachandran J, Kurien RT, et al. Hepatocellular carcinoma continues to be diagnosed in the advanced stage: profile of hepatocellular carcinoma in a tertiary care hospital in South India. Trop Dr. 2013;43:25–6.

    Google Scholar 

  24. Paul SB, Chalamalasetty SB, Vishnubhatla S, et al. Clinical profile, etiology and therapeutic outcome in 324 hepatocellular carcinoma patients at a tertiary care center in India. Oncology. 2009;77:162–71.

    Article  PubMed  Google Scholar 

  25. Sarma MP, Asim M, Medhi S, Bharathi T, Diwan R, Kar P. Viral genotypes and associated risk factors of hepatocellular carcinoma in India. Cancer Biol Med. 2012;9:172–81.

    PubMed  PubMed Central  Google Scholar 

  26. Sarin SK, Thakur V, Guptan RC, et al. Profile of hepatocellular carcinoma in India: an insight into the possible etiologic associations. J Gastroenterol Hepatol. 2001;16:666–73.

    Article  CAS  PubMed  Google Scholar 

  27. Abe H, Yoshizawa K, Kitahara T, Aizawa R, Matsuoka M, Aizawa Y. Etiology of non-B non-C hepatocellular carcinoma in the eastern district of Tokyo. J Gastroenterol. 2008;43:967–74.

    Article  PubMed  Google Scholar 

  28. Utsunomiya T, Shimada M, Kudo M, et al. Nationwide study of 4741 patients with non-B non-C hepatocellular carcinoma with special reference to the therapeutic impact. Ann Surg. 2013;259:336–45.

    Article  Google Scholar 

  29. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–40.

    Article  PubMed  Google Scholar 

  30. Marrero JA, Fontana RJ, Su GL, Conjeevaram HS, Emick DM, Lok AS. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology. 2002;36:1349–54.

    Article  PubMed  Google Scholar 

  31. Baffy G. Hepatocellular carcinoma in non-alcoholic fatty liver disease: epidemiology, pathogenesis, and prevention. J Clin Transl Hepatol. 2013;1:131–7.

    PubMed  PubMed Central  Google Scholar 

  32. Kaneda K, Kubo S, Tanaka H, et al. Features and outcome after liver resection for non-B non-C hepatocellular carcinoma. Hepatogastroenterology. 2012;59:1889–92.

    PubMed  Google Scholar 

  33. Pattnaik K, Bhuyan P, Mahapatra S, Mishra B, Kar S, Singh SP. Analysis of risk factors for fibrosis in biopsy proven NAFLD. J Clin Exp Hepatol. 2015;3:S27.

    Article  Google Scholar 

  34. Jain D, Nayak NC, Kumaran V, Saigal S. Steatohepatitic hepatocellular carcinoma, a morphologic indicator of associated metabolic risk factors: a study from India. Arch Pathol Lab Med. 2013;137:961–6.

    Article  PubMed  Google Scholar 

  35. Kumar R, Saraswat MK, Sharma BC, Sakhuja P, Sarin SK. Characteristics of hepatocellular carcinoma in India: a retrospective analysis of 191 cases. QJM. 2008;101:479–85.

    Article  CAS  PubMed  Google Scholar 

  36. Singh SV, Goyal SK, Chowdhury BL. Primary carcinoma of liver in Udaipur. J Assoc Physicians India. 1971;19:693–5.

    CAS  PubMed  Google Scholar 

  37. Yotsuyanagi H, Shintani Y, Moriya K, et al. Virologic analysis of non-B, non-C hepatocellular carcinoma in Japan: frequent involvement of hepatitis B virus. J Infect Dis. 2000;181:1920–8.

    Article  CAS  PubMed  Google Scholar 

  38. Rizvi M, Azam M, Sultan A, et al. Prevalence of genotype D in chronic liver disease patients with occult HBV infection in northern region of India. Indian J Pathol Microbiol. 2014;57:537–41.

    Article  PubMed  Google Scholar 

  39. Ismail AM, Devakumar S, Anantharam R, et al. Low frequency of occult hepatitis B infection in anti-HBc seropositive blood donors: experience from a tertiary care centre in South India. Blood Transfus. 2011;10:230–2.

    PubMed  Google Scholar 

  40. Radhakrishnan S, Abraham P, Raghuraman S, et al. Infrequent occurrence of silent HBV infection among Indian patients with chronic liver disease. Indian J Gastroenterol. 2001;20:87–9.

    CAS  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful for the funds received from the Fluid Research Fund at Christian Medical College, Vellore, India, for this study.

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Authors and Affiliations

  1. Department of Gastroenterology, Division of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, 632 004, India

    Deepu David & C. Bharath Kumar

  2. Department of Virology, Christian Medical College and Hospital, Vellore, 632 004, India

    Anantharam Raghavendran & Priya Abraham

  3. Department of Hepatology, Christian Medical College and Hospital, Vellore, 632 004, India

    Ashish Goel, Jeyamani Ramachandran & C. E. Eapen

  4. Department of Pathology, Christian Medical College and Hospital, Vellore, 632 004, India

    Thomas Alex Kodiatte, Deepak Burad & Banumathi Ramakrishna

  5. Department of Surgery, Christian Medical College and Hospital, Vellore, 632 004, India

    Philip Joseph

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  1. Deepu David
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Correspondence to Deepu David.

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Conflict of interest

DD, AR, AG, CBK, TAK, DB, PA, BR, PJ, JR, and CEE declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

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David, D., Raghavendran, A., Goel, A. et al. Risk factors for non-alcoholic fatty liver disease are common in patients with non-B non-C hepatocellular carcinoma in India. Indian J Gastroenterol 36, 373–379 (2017). https://doi.org/10.1007/s12664-017-0785-x

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  • DOI: https://doi.org/10.1007/s12664-017-0785-x

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