**Risk factors for hepatocellular carcinoma in the USA**

*The latest issue of the American Journal of Gastroenterology investigates population-attributable fractions of risk factors for hepatocellular carcinoma in the United States.*

Risk factors for hepatocellular carcinoma include hepatitis B and C viruses (HBV, HCV), excessive alcohol consumption, rare genetic disorders and diabetes/obesity.

The population attributable fractions of these factors, however, have not been investigated in population-based studies in the United States.

Persons 68 years diagnosed with hepatocellular carcinoma between 1994 and 2007 were identified in the SEER-Medicare database.

Dr Tania Welzel and colleagues from Germany selected a 5% random sample of persons residing in SEER locations for comparison.

As anticipated, the risk of hepatocellular carcinoma was increased in relationship to each factor: hepatitis B and C viruses, alcohol-related disorders, rare metabolic disorders, and diabetes and/or obesity.

*Population attributable fractions of all factors combined was 65%*

American Journal of Gastroenterology

American Journal of Gastroenterology

The doctors found that the population attributable fractions of all factors combined was 65%.

The population attributable fractions were highest among Asians, and lowest among black persons.

Among individual factors, diabetes/obesity had the greatest population attributable fractions, followed by alcohol-related disorders, hepatitis B and C viruses and rare genetic disorders.

While diabetes/obesity had the greatest population attributable fractions among both males and females, alcohol-related disorders had the second greatest population attributable fractions among males and hepatitis C viruses the second greatest among females.

Diabetes/obesity had the greatest population attributable fractions among whites and Hispanics, while hepatitis C viruses had the greatest population attributable fractions among Asians and blacks.

The second greatest population attributable fractions was alcohol-related disorders in whites, Hispanics and blacks and hepatitis B virus in Asians.

Dr Welzel's team concludes, "The dominant risk factors for hepatocellular carcinoma in the United States among persons 68 years differ by sex and race/ethnicity."

"Overall, eliminating diabetes/obesity could reduce the incidence of hepatocellular carcinoma more than the elimination of any other factor."

*Am J Gastroenterol*2013: 108: 1314–1321

20 August 2013

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