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. 2025 Jan 22;20(1):e0316175.
doi: 10.1371/journal.pone.0316175. eCollection 2025.

Impact of high body mass index on hepatocellular carcinoma risk in chronic liver disease: A population-based prospective cohort study

Moonho Kim  1 , Baek Gyu Jun  2 , Hwang Sik Shin  3 , Jee-Jeon Yi  4 , Sang Gyune Kim  5 , Sang-Wook Yi  6
Affiliations

Impact of high body mass index on hepatocellular carcinoma risk in chronic liver disease: A population-based prospective cohort study

Moonho Kim et al. PLoS One. .

Abstract

Background and aims: We investigated associations between body mass index (BMI) and hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) C (HCV) virus infection, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), and liver cirrhosis (LC).

Methods: We followed 350,608 Korean patients with liver disease who underwent routine health examinations from 2003-2006 until December 2018 via national hospital discharge records. Multivariable adjusted hazard ratios (HRs) per 5-kg/m2 BMI increase (BMI ≥25 kg/m2) for HCC risk were calculated using Cox models. HCC developed in 17,752 patients.

Results: The HRs (95% CI) were 1.17 (1.06-1.28), 1.08 (0.87-1.34), 1.34 (1.14-1.58), 1.51 (1.17-1.94), and 1.11 (1.00-1.23) for HBV, HCV, ALD, NAFLD, and LC, respectively. The HRs for HBV were 1.45 (1.23-1.70) and 1.06 (0.95-1.19) in women and men, respectively; the corresponding HRs for LC were 1.27 (1.07-1.50) and 1.02 (0.90-1.16), respectively. In patients <65 years old with HBV, HCV, and NAFLD, the HRs were 1.17 (1.07-1.29), 1.33 (1.03-1.73), and 1.20 (0.87-1.64), respectively; the corresponding HRs were 1.05 (0.70-1.59), 0.74 (0.50-1.10), and 2.40 (1.62-3.54), respectively, in patients ≥65 years old. A BMI of 27.5-29.9 kg/m2 showed significantly higher HCC risks in patients with HBV, ALD, NAFLD, and LC.

Conclusions: Higher BMIs were associated with increased HCC risks in patients with HBV, ALD, NAFLD, and LC. Overweight status increased HCC risk. Women with HBV and LC had stronger BMI-HCC associations than men. The effect of high BMI was stronger in older patients with NAFLD and younger patients with viral hepatitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of the study cohort.
Fig 2
Fig 2. Hepatocellular carcinoma risk according to liver disease, for each 5-kg/m2 BMI increase in patients with BMI ≥25 kg/m2.
HBV, hepatitis B virus; HCV, hepatitis C virus; ALD, alcoholic liver disease; NAFLD, nonalcoholic fatty liver disease; LC, liver cirrhosis; BMI, body mass index.
Fig 3
Fig 3. Cox regression analysis of hepatocellular carcinoma risk according to liver disease, for each 5-kg/m2 BMI increase in patients with BMI ≥25 kg/m2.
HBV, hepatitis B virus; HCV, hepatitis C virus; ALD, alcoholic liver disease; NAFLD, nonalcoholic fatty liver disease; LC, liver cirrhosis; BMI, body mass index.
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