The association between alcohol consumption and the risk of hepatocellular carcinoma according to glycemic status in Korea: A nationwide population-based study

BackgroundAlcohol and diabetes are known risk factors for hepatocellular carcinoma (HCC); however, it is unclear whether the association between alcohol consumption and HCC risk differs by fasting serum glucose level and diabetes. We investigated the dose-response relationship between alcohol consumption and the risk of HCC according to glycemic status. Methods and findingsThis population-based observational cohort study included patients who underwent general health checkups in 2009 using the Korean National Health Insurance Service Database. The primary outcome was HCC incidence, and Cox proportional hazard regression analysis was performed to estimate the relationship between alcohol consumption and HCC risk according to glycemic status. A total of 34,321 patients newly diagnosed with HCC were observed in the median follow-up period of 8.3 years. In the multivariable model, we adjusted for age, sex, smoking, regular exercise, income, hypertension, dyslipidemia, and body mass index. Mild-to-moderate alcohol consumption increased the risk of HCC in all glycemic statuses (normoglycemia: hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02 to 1.10; prediabetes: HR, 1.19; 95% CI, 1.14 to 1.24; and diabetes: HR, 2.02; 95% CI, 1.93 to 2.11) compared to normoglycemic nondrinking. Heavy alcohol consumption also increased the risk of HCC in all glycemic statuses (normoglycemia: HR, 1.39; 95% CI, 1.32 to 1.46; prediabetes: HR, 1.67; 95% CI, 1.58 to 1.77; and diabetes: HR, 3.29; 95% CI, 3.11 to 3.49) compared to normoglycemic nondrinking. Since alcohol consumption information in this study was based on a self-administered questionnaire, there may be a possibility of underestimation. Although we excluded patients with a history of viral hepatitis using diagnosis codes, we could not obtain information on hepatitis B or hepatitis C serum markers. ConclusionsBoth mild-to-moderate and heavy alcohol consumption was associated with an increased risk of HCC in all glycemic statuses. The increased risk of HCC according to alcohol consumption was the highest in the diabetes group, suggesting that more intensive alcohol abstinence is required for patients with diabetes. Author summary Why was this study done? Alcohol and diabetes are known risk factors for hepatocellular carcinoma (HCC).It is unclear whether the association between alcohol consumption and HCC risk differs by fasting serum glucose level and diabetes. What did the researchers do and find? We analyzed the health checkup data of the Korean population aged 20 years or older in 2009 provided by the Korean National Health Insurance Service.Multivariable Cox proportional hazards regression models were used to evaluate the association of alcohol consumption with the risk of HCC, with a median follow-up duration of 8.3 years.In this study, the risk of HCC increased linearly with alcohol consumption in a dose-dependent manner according to glycemic status with synergistic effects between prediabetes/diabetes and alcohol.Any amount or frequency of alcohol consumption increased the risk of HCC in patients with diabetes or prediabetes status. What do these findings mean? The increased risk of HCC according to alcohol consumption was the highest in the diabetes group, suggesting that more intensive alcohol abstinence is required for patients with diabetes.The interpretation of these results is limited due to potential underestimation of alcohol consumption as the information on alcohol consumption obtained in this study was based on a self-administered questionnaire.