Type 2 diabetes increases the risk of a person getting a severe liver disease, including cancer, regardless of their body mass index (BMI) reading, research on Swedish men shows.
The study, “High BMI in late adolescence predicts future severe liver disease and hepatocellular carcinoma: a national, population-based cohort study in 1.2 million men,” appeared in the journal Gut.
There has been a global increase in the number of people who are overweight or obese. In fact, around 1 billion people are expected to be obese by 2030. Meanwhile, the prevalence of non-alcoholic liver disease, which can lead to end-stage liver disease, has increased to an estimated 25 percent of the world population.
A high BMI score is associated with an increased risk of severe liver disease and hepatocellular carcinoma, the most common type of liver cancer, in adults, previous research has indicated. The association holds true even when factors such as alcohol consumption, smoking, and use of narcotics are taken into account.
Conversely, a high BMI score increases the risk of a person developing Type 2 diabetes mellitus, or T2DM. That, in turn, enhances the risk of them developing severe liver disease.
The research that generated those findings involved adolescent men who were drafted into the military in 1969 and 1970, however. That was a time when overweight and obesity were relatively uncommon.
It was unclear whether the risk of developing a liver disease differed across BMI categories, and if T2DM played a role in this.
Hannes Hagström, MD, PhD, and colleagues at the Center for Digestive Diseases at the Karolinska Institutet in Sweden used data on more than 1.2 million male conscripts as a starting point for new research. The men were drafted between 1969 and 1996. The researchers’ population-based design enabled them to analyze around 97 percent of Swedish men.
The team also studied new events of severe liver disease and T2DM during a follow-up period that lasted until Dec. 21, 2012. And they looked at the incidence of hepatocellular carcinoma (HCC), or liver cancer, across BMI categories.
During the follow-up period, they identified 5,281 cases of severe liver disease. They excluded from their analysis men with alcoholic liver disease diagnosed during follow-up.
The liver disease cases included 251 HCC patients. Overweight and obese adolescent men were associated with severe liver disease in later life, including HCC.
Importantly, development of T2DM further increased the risk of severe liver disease across all BMI categories. Obese men with T2DM were more than three times likelier to develop liver problems than non-diabetic, non-obese men, the researchers found.
The findings suggest that the global increase in people who are overweight and obese could lead to an increase in the incidence of severe liver disease, including HCC.
Researchers said the fact that this was an observational study precluded them from making conclusions about cause and effect. Moreover, changes in BMI during the follow-up period could not be measured.
Nevertheless, the results “could have implications for public health decision making, strengthening the need of targeted intervention against overweight and obesity at an early age,” the researchers wrote.
They added that “screening of men with type 2 diabetes mellitus for presence of manifest liver disease using non-invasive, inexpensive scoring systems could be a way forward.”