Primary hepatocellular carcinoma and metabolic syndrome: An update

Table 1 Incidence and mortality rates of hepatocellular carcinoma according to race/ethnicity and gender, reported in Surveillance Epidemiology and End Results database 2006-2010

Race/Ethnicity	Incidence rate per100000		Mortality rate per100000
	Male	Female	Male	Female
All races	11.9	4.0	8.3	3.4
Non-Hispanic White	10.4	3.5	7.6	3.2
African American	15.1	4.5	11.8	4.1
Hispanics	18.3	6.9	12.3	5.4
Asian/Pacific Islander	21.4	8.2	14.4	6.0
American Indian/Alaska Native	20.6	7.7	13.2	6.1

Table 2 Changes in incidence rate of hepatocellular carcinoma from 2001 to 2006

Incidence rate/100000	2001	2006
Overall	2.7	3.2
Male	4.5	5.4
Female	1.2	1.4

Table 3 Criteria used to define the metabolic syndrome

Diagnostic criterion	WHO (1999)	ATP (2005)	IDF (2006)
Abdominal obesity	BMI - Waist/hip ratio > 0.9 (men) or > 0.85 (women) or BMI ≥ 30 kg/m2	Central - Waist ≥ 102 cm (men) or ≥ 88 cm (women)	Central - Waist ≥ 102 cm (men) or ≥ 88 cm (women)
Hypertension	≥ 140/90 mmHg	≥ 130/85 mmHg or drug treatment for hypertension	≥ 130/85 mmHg or drug treatment for hypertension
Fasting glucose	IPG/HOMA	≥ 5.6 mol/L	≥ 6.1 mol/L
Hypertriglyceridemia	≥ 1.7 mmol/L (150 mg/dL) or drug treatment for elevated triglycerides	≥ 1.7 mmol/L (150 mg/dL) or drug treatment for elevated triglycerides	≥ 1.7 mmol/L (150 mg/dL) or drug treatment for elevated triglycerides
Low HDL cholesterol	Not used	< 1.0 mmol/L (40 mg/dL) (men); < 1.3 mmol/L (50 mg/dL) (women) or drug treatment for low HDL	< 1.0 mmol/L (40 mg/dL) (men); < 1.3 mmol/L (50 mg/dL) (women) or drug treatment for low HDL
Micro albuminuria	Used	Not used	Not used

ATP: Adult Treatment Panel; BMI: Body mass index; HDL: High-density lipoprotein; IDF: International Diabetes Federation; IPG/HOMA: Impaired plasma glucose/homeostatic model assessment; WHO: World Health Organization.

Table 4 Association of different components of metabolic syndrome and the development of hepatocellular carcinoma

Author	Type of Study	Risk Parameter	Obesity	DM	Hyperlipidemia	HTN
Larsson et al[35]	Meta analysis	RR	1.85
Calle et al[37]	Prospective	RR	4.52 (Male)
			1.68 (Female)
Welzel et al[40]	Retrospective	OR	1.93	2.9	1.35	2.2
Borena et al[25]	Prospective	RR	1.39	2.13	0.85	2.08
Turati et al[48]	Retrospective	OR	1.97	4.33
Davila et al[42]	Retrospective	OR		2.87
Lagiou et al[43]	Prospective	RR		4.5 (Male)
				1.86 (Female)
El-Serag et al[46]	Prospective	RR		2
Tomimaru et al[55]	Prospective	RR		82.2 (with cirrhosis)

RR: Relative risk; OR: Odd ratio; DM: Diabetes mellitus; HTN: Hypertension.