Interaction and joint effect of ALT and chronic liver disease on liver cancer in type 2 diabetes patients
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Tsai-Chung Li1,2,*, Chia-Ing Li3,4,*, Chiu-Shong Liu3,4,5, Pao-Hsuan Lin1, Wen-Yuan Lin3,5, Chih-Hsueh Lin3,5, Sing-Yu Yang1, Jen-Huai Chiang6 and Cheng-Chieh Lin3,4,5
1Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
2Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
3School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
4Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
5Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
6Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
*These authors equally contributed as first author
Cheng-Chieh Lin, email: [email protected]
Keywords: alanine transaminase, cohort study, hepatocellular carcinoma, type 2 diabetes
Received: April 05, 2017 Accepted: September 20, 2017 Published: October 10, 2017
Background: This study examined whether serum alanine transaminase (ALT) and chronic liver diseases were interactively, jointly, or independently associated with hepatocellular carcinoma (HCC) risk in type 2 diabetic patients.
Materials and Methods: A retrospective cohort study was conducted in 46,369 Chinese type 2 diabetic patients, aged 30 and older, in National Diabetes Care Management Program in 2002-2004. These data were analyzed by multivariate Cox proportional hazards models.
Results: Mean follow-up period was 8.20 years. Multivariate-adjusted hazard ratios of HCC were 2.85 (95% confidence interval, CI: 2.45–3.31), 3.80 (3.04–4.76), and 3.89 (3.08–4.91) for patients with a level of ALT 40–80, 80–120, and >120 U/L, respectively, compared with patients with a level of ALT < 40 U/L after multivariable adjustment. Significant hazard ratios of HCC for patients with a level of ALT ≥ 40 U/L and alcoholic liver damage, nonalcoholic fatty liver disease, liver cirrhosis, hepatitis B virus and hepatitis C virus infection, or any one of these chronic liver diseases compared with patients with ALT level < 40 U/L and no counterpart comorbidity were observed. Significant effect modifications were observed between ALT level with liver cirrhosis and HBV.
Conclusions: Results suggest significant effect modification and joint associations of ALT ≥ 40 U/L and chronic liver diseases. Diabetes care should provide lifestyle or treatment interventions to manage ALT level, liver cirrhosis and hepatitis B virus infection for reducing burden of HCC.
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