Digestive Diseases and Sciences

, Volume 61, Issue 2, pp 636–645 | Cite as

Diabetes Mellitus Increases Risk of Hepatocellular Carcinoma in Chronic Hepatitis C Virus Patients: A Systematic Review

  • Harleen K. Dyal
  • Maria Aguilar
  • Gabriella Bartos
  • Edward W. Holt
  • Taft Bhuket
  • Benny Liu
  • Ramsey Cheung
  • Robert J. Wong



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.


To perform a systematic review evaluating the impact of DM, body mass index (BMI), or steatosis on HCC risk among chronic HCV patients.


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.


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).


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.


Fatty liver Liver cancer Obesity 


Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose as described by Digestive Diseases and Sciences.

Supplementary material

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Supplementary material 1 (DOCX 15 kb)
10620_2015_3983_MOESM2_ESM.docx (16 kb)
Supplementary material 2 (DOCX 15 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Harleen K. Dyal
    • 1
  • Maria Aguilar
    • 2
  • Gabriella Bartos
    • 2
  • Edward W. Holt
    • 3
  • Taft Bhuket
    • 1
  • Benny Liu
    • 1
  • Ramsey Cheung
    • 4
    • 5
  • Robert J. Wong
    • 1
  1. 1.Division of Gastroenterology and HepatologyAlameda Health System – Highland HospitalOaklandUSA
  2. 2.Department of MedicineAlameda Health System – Highland HospitalOaklandUSA
  3. 3.Division of Hepatology, Department of TransplantationCalifornia Pacific Medical CenterSan FranciscoUSA
  4. 4.Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA
  5. 5.Division of Gastroenterology and HepatologyVeterans Affairs Palo Alto Health Care SystemPalo AltoUSA

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