Jung HN, Heo JH, Roh E, Kim BJ, Lee M, Kim JK, Kim JH, Han B, Han KD, Kang JG, Lee SJ, Ihm SH. Risk of hepatocellular carcinoma according to body mass index and waist circumference in nonalcoholic fatty liver disease. World J Gastrointest Oncol 2025; 17(6): 107364 [DOI: 10.4251/wjgo.v17.i6.107364]
Corresponding Author of This Article
Jun Goo Kang, Department of Internal Medicine, Hallym University College of Medicine, No. 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Chuncheon-si 24252, Gangwon-do, South Korea. kjg0804@empas.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jun 15, 2025; 17(6): 107364 Published online Jun 15, 2025. doi: 10.4251/wjgo.v17.i6.107364
Risk of hepatocellular carcinoma according to body mass index and waist circumference in nonalcoholic fatty liver disease
Han Na Jung, Ji Hye Heo, Eun Roh, Bum Jun Kim, Minwoo Lee, Jwa-Kyung Kim, Joo-Hee Kim, Boram Han, Kyung-Do Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm
Han Na Jung, Ji Hye Heo, Eun Roh, Bum Jun Kim, Jwa-Kyung Kim, Joo-Hee Kim, Boram Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon-si 24252, Gangwon-do, South Korea
Minwoo Lee, Department of Neurology, Hallym University College of Medicine, Chuncheon-si 24252, Gangwon-do, South Korea
Kyung-Do Han, Department of Statistics and Actuarial Science, College of Natural Sciences, Soongsil University, Seoul 06978, South Korea
Co-corresponding authors: Kyung-Do Han and Jun Goo Kang.
Author contributions: Jung HN interpreted the data and was a major contributor to writing the manuscript; Heo JH, Roh E, Kim BJ, Lee M, Kim JK, Kim JH, Han B, Lee SJ, and Ihm SH reviewed the research and edited the manuscript; Han KD gathered resources and curated and analyzed the data; Kang JG conceptualized and managed the project and supervised the research; Han KD and Kang JG contributed equally to this article and are the co-corresponding authors of this manuscript; and all authors approved the final submitted draft.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Hallym University Sacred Heart Hospital, approval No. HALLYM 2024-04-026.
Informed consent statement: Owing to strict confidentiality measures that ensure anonymity in the NHIS database, the need for written informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and/or analyzed during the current study are available in the National Health Insurance Sharing Service repository, https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Goo Kang, Department of Internal Medicine, Hallym University College of Medicine, No. 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Chuncheon-si 24252, Gangwon-do, South Korea. kjg0804@empas.com
Received: March 21, 2025 Revised: April 3, 2025 Accepted: April 17, 2025 Published online: June 15, 2025 Processing time: 84 Days and 6.7 Hours
Abstract
BACKGROUND
The association between adiposity parameters and incident hepatocellular carcinoma (HCC) in individuals with nonalcoholic fatty liver disease (NAFLD) is yet to be evaluated.
AIM
To investigate the risk of HCC according to body mass index (BMI) and waist circumference (WC) in people with NAFLD.
METHODS
This population-based cohort study included Korean National Health Insurance Service examination participants with NAFLD (n = 1110773). NAFLD was defined as a fatty liver index of ≥ 30. The risk of HCC was determined by Cox proportional hazards regression according to BMI and WC after adjusting for age, sex, health behaviors, income, comorbidities, and WC or BMI.
RESULTS
HCC was diagnosed in 4773 (0.43%) participants during a median follow-up of 10.3 years. A U-shaped association between BMI or WC and HCC was observed, with the highest risk observed in the lowest BMI and WC groups. Compared to normal BMI, the adjusted hazard ratio (aHR) of the underweight BMI group was 2.02 [95% confidence interval (CI): 1.25-3.28]. The lowest risk was found in groups with overweight BMI (aHR = 0.67, 95%CI: 0.60-0.73; reference: normal BMI) and WC: 85-89.9/80-84.9 cm for men/women (aHR = 0.55, 95%CI: 0.49-0.63; reference: < 80/< 75 cm). Subgroup analyses of age, sex, health behaviors, and fatty liver index showed consistent results.
CONCLUSION
The development of HCC shows a U-shaped relationship with BMI and WC in people with NAFLD, with the highest risk in underweight individuals.
Core Tip: While the risk of hepatocellular carcinoma (HCC) increases with body mass index and waist circumference (WC) in the general population, the risk in nonalcoholic fatty liver disease (NAFLD) is unknown. This population-based study of people with NAFLD demonstrated a U-shaped association of body mass index and WC with HCC, with the highest risk in the underweight and lowest WC groups. These findings suggest that surveillance for incident HCC is necessary in populations with NAFLD, irrespective of obesity, with particular attention to individuals with low adiposity.
