Originally published as JCO Early Release 10.1200/JCO.2008.16.1075 on October 27 2008

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Body-Mass Index and Progression of Hepatitis B: A Population-Based Cohort Study in Men

Ming-Whei Yu, Wei-Liang Shih, Chih-Lin Lin, Chun-Jen Liu, Jhih-Wei Jian, Keh-Sung Tsai, Chien-Jen Chen

From the Graduate Institute of Epidemiology, College of Public Health, National Taiwan University; Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital; Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine; and the Department of Laboratory Medicine, National Taiwan University Hospital and Genomics Research Center, Academia Sinica, Taipei, Taiwan

Corresponding author: Ming-Whei Yu, PhD, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Room 522, No.17, Xuzhou Rd, Zhongzheng District, Taipei City 10055, Taiwan; e-mail: yumw{at}ntu.edu.tw

Purpose To determine prospectively whether body-mass index (BMI) is associated with liver-related morbidity and mortality among male hepatitis B virus (HBV) carriers.

Patients and Methods We performed a prospective study of 2,903 male HBV surface antigen–positive government employees who were free of cancer at enrollment between 1989 and 1992. Main outcome measures included ultrasonography, biochemical tests, incident hepatocellular carcinoma (HCC), and liver-related death.

Results During mean follow-up of 14.7 years, 134 developed HCC and 92 died as a result of liver-related causes. In Cox proportional hazards models adjusting for age, number of visits, diabetes, and use of alcohol and tobacco, the hazard ratios for incident HCC were 1.48 (95% CI, 1.04 to 2.12) in overweight men (BMI between 25.0 and 29.9 kg/m²) and 1.96 (95% CI, 0.72 to 5.38) in obese men (BMI 30.0 kg/m²), compared with normal-weight men (BMI between 18.5 and 24.9 kg/m²). Liver-related mortality had adjusted hazard ratios of 1.74 (95% CI, 1.15 to 2.65) in overweight men and 1.50 (95% CI, 0.36 to 6.19) in obese men. Excess BMI was also associated with the occurrence of fatty liver and cirrhosis detected by ultrasonography, as well as elevated ALT and -glutamyltransferase (GGT) activity during follow-up. The association of BMI with GGT was stronger than with ALT, and elevated GGT activity and cirrhosis were the strongest predictors for incident HCC and liver-related death.

Conclusion This longitudinal cohort study indicates that excess body weight is involved in the transition from healthy HBV carrier state to HCC and liver-related death among men.

published online ahead of print at www.jco.org on October 27, 2008.

Supported by Grants No. NSC94-3112-B-002-017, NSC95-3112-B-002-001, and NSC95-2314-B-002-244-MY3 from the National Science Council, Taiwan.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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