Division of Gastroenterology and Division of Epidemiology, University of California at San Diego, 9500 Gilman Drive, MC 0063, La Jolla, CA 92093, USA.
Am J Epidemiol. 2013 Feb 15;177(4):333-42. doi: 10.1093/aje/kws252. Epub 2013 Jan 24.
Obesity and alcohol interact to increase the risk of death from liver failure in men. In the present study, we aimed to examine whether obesity and alcohol were multiplicative or additive in increasing the risk of hepatocellular carcinoma (HCC) in both men and women. We conducted a prospective, population-based study of 23,712 Taiwanese residents (50.3% men) from 7 townships who underwent an evaluation for liver disease and were followed for 11.6 years for incident HCC. The mean age was 47 (standard deviation, 10) years and the mean body mass index (weight (kg)/height (m)(2)) was 24 (standard deviation, 3). Overall, 305 cases of HCC were identified over 275,126 person-years of follow-up. Age, male sex, alcohol drinking, cigarette smoking, elevated alanine aminotransferase, serum hepatitis B surface antigen, anti-hepatitis C virus positivity, and diabetes mellitus were each statistically significant predictors of incident HCC in univariate analyses (P < 0.05). Alcohol use and obesity (body mass index ≥30) showed a synergistic association with the risk of incident HCC in both unadjusted analyses (hazard ratio = 7.19, 95% confidence interval: 3.69, 14.00; P < 0.01) and multivariable-adjusted analyses (age, sex, smoking, serum alanine aminotransferase, serum hepatitis B surface antigen, anti-hepatitis C virus antibody, and diabetes mellitus) (hazard ratio = 3.82, 95% confidence interval: 1.94, 7.52; P < 0.01). Relative excess risks due to interaction, attributable proportion, and synergy index were 4.83, 0.67, and 4.53, respectively, suggesting a multiplicative interaction between alcohol use and obesity. Obesity and alcohol synergistically increase the risk of incident HCC.
肥胖和饮酒会增加男性因肝衰竭而死亡的风险。本研究旨在探讨肥胖和饮酒是否会对男性和女性的肝细胞癌（HCC）风险产生相加或相乘作用。我们进行了一项前瞻性、基于人群的研究，纳入了来自 7 个乡镇的 23712 名台湾居民（50.3%为男性），这些人接受了肝脏疾病评估，并随访了 11.6 年以发现 HCC 新发病例。平均年龄为 47（标准差为 10）岁，平均体重指数（体重（kg）/身高（m）（2））为 24（标准差为 3）。总的来说，在 275126 人年的随访中，共发现 305 例 HCC 病例。在单因素分析中，年龄、男性、饮酒、吸烟、丙氨酸氨基转移酶升高、乙型肝炎表面抗原阳性、抗丙型肝炎病毒阳性和糖尿病均为 HCC 新发病例的统计学显著预测因素（P < 0.05）。饮酒和肥胖（体重指数≥30）在未经调整的分析（危险比=7.19，95%置信区间：3.69，14.00；P < 0.01）和多变量调整分析（年龄、性别、吸烟、血清丙氨酸氨基转移酶、乙型肝炎表面抗原、抗丙型肝炎病毒抗体和糖尿病）中均与 HCC 新发病例风险呈协同关联（危险比=3.82，95%置信区间：1.94，7.52；P < 0.01）。交互作用所致的相对超额风险、归因比例和协同指数分别为 4.83、0.67 和 4.53，提示饮酒和肥胖之间存在相乘性交互作用。肥胖和饮酒协同增加 HCC 的发病风险。
