High prevalence of multinodular hepatocellular carcinoma in patients with cirrhosis attributable to multiple risk factors

ObjectivesTo investigate risk factor patterns and the simultaneous occurrence of multiple risk factors in the viral, metabolic and lifestyle domains among Asian Americans, who have had the highest mortality rates from hepatocellular carcinoma (HCC).SettingSacramento County, California, USA.ParticipantsEligible participants were county residents ages 18 and older who had not been screened for chronic hepatitis B virus (HBV) and were born in a CDC-defined endemic area or whose parent was born in that area. Of 1004 enrolled, 917 were foreign-born Chinese (130 women, 94 men), Hmong (133 women, 75 men), Korean (178 women, 90 men) or Vietnamese (136 women, 81 men) with complete risk factor data.Primary and secondary outcome measuresWe tested participants for HBV and chronic hepatitis C virus (HCV); measured haemoglobin A1c and waist circumference; and recorded self-reported history of diabetes, hypertension, alcohol use and smoking status. We identified risk factor patterns using cluster analysis and estimated gender-specific age-standardised prevalence rates.ResultsWe identified four patterns: (1) viral (chronic HBV or HCV); (2) lifestyle (current smoker or alcohol user, no viral); (3) metabolic (≥2 metabolic, no lifestyle or viral); and (4) lower risk (≤1 metabolic, no lifestyle or viral). Vietnamese men (16.3%, 95% CI 7.4% to 25.3%) and Hmong women (15.1%, 95% CI 7.8% to 22.5%) had the highest viral pattern prevalence. Hmong women had the highest metabolic (37.8%, 95% CI 29.8% to 45.9%), and Vietnamese men the highest lifestyle (70.4%, 95% CI 59.1% to 81.7%) pattern prevalence. In multiple domains, Hmong men and women were most likely to have viral+metabolic risk factors (men: 14.4%, 95% CI 6.0% to 22.7%; women: 11.9%, 95% CI 5.6% to 18.3%); Vietnamese men were most likely to have lifestyle+viral (10.7%, 95% CI 2.7% to 18.8%), and lifestyle+metabolic but not viral (46.4%, 95% CI 34.4% to 58.5%) risk factors.ConclusionsEfforts to reduce HCC must comprehensively address multiple risk factors.Trial registration numberNCT02596438.

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Longitudinal change of metabolite profile and its relation to multiple risk factors for the risk of developing hepatitis B‐related hepatocellular carcinoma

Molecular Carcinogenesis ◽

10.1002/mc.23255 ◽

2020 ◽

Vol 59 (11) ◽

pp. 1269-1279

Author(s):

Bo‐Yuan Huang ◽

Min‐Ru Tsai ◽

Jia‐Kai Hsu ◽

Ching‐Yu Lin ◽

Chih‐Lin Lin ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Hepatitis B ◽

Metabolite Profile ◽

Longitudinal Change ◽

Multiple Risk Factors ◽

Multiple Risk

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Managing Multiple Risk Factors

PsycEXTRA Dataset ◽

10.1037/e445602005-001 ◽

1998 ◽

Author(s):

Charlie M. Lolis ◽

Keyword(s):

Risk Factors ◽

Multiple Risk Factors ◽

Multiple Risk

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Data Watch: Racial/Ethnic Groups Reporting Multiple Risk Factors for Heart Disease, Stroke

Family Practice News ◽

10.1016/s0300-7073(05)71952-6 ◽

2005 ◽

Vol 35 (20) ◽

pp. 22

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ethnic Groups ◽

Multiple Risk Factors ◽

Multiple Risk ◽

Racial Ethnic

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The relative and interactive impact of multiple risk factors in schizophrenia spectrum disorders: a combined register-based and clinical twin study

Psychological Medicine ◽

10.1017/s0033291721002749 ◽

2021 ◽

pp. 1-11

Author(s):

C. Lemvigh ◽

R. Brouwer ◽

R. Hilker ◽

S. Anhøj ◽

L. Baandrup ◽

...

Keyword(s):

Risk Factors ◽

Environmental Factors ◽

Childhood Trauma ◽

Cannabis Use ◽

Paternal Age ◽

Interactive Effects ◽

Polygenic Risk Score ◽

Multiple Risk Factors ◽

Schizophrenia Spectrum ◽

Multiple Risk

Abstract Background Research has yielded evidence for genetic and environmental factors influencing the risk of schizophrenia. Numerous environmental factors have been identified; however, the individual effects are small. The additive and interactive effects of multiple risk factors are not well elucidated. Twin pairs discordant for schizophrenia offer a unique opportunity to identify factors that differ between patients and unaffected co-twins, who are perfectly matched for age, sex and genetic background. Methods Register data were combined with clinical data for 216 twins including monozygotic (MZ) and dizygotic (DZ) proband pairs (one or both twins having a schizophrenia spectrum diagnosis) and MZ/DZ healthy control (HC) pairs. Logistic regression models were applied to predict (1) illness vulnerability (being a proband v. HC pair) and (2) illness status (being the patient v. unaffected co-twin). Risk factors included: A polygenic risk score (PRS) for schizophrenia, birth complications, birth weight, Apgar scores, paternal age, maternal smoking, season of birth, parental socioeconomic status, urbanicity, childhood trauma, estimated premorbid intelligence and cannabis. Results The PRS [odds ratio (OR) 1.6 (1.1–2.3)], childhood trauma [OR 4.5 (2.3–8.8)], and regular cannabis use [OR 8.3 (2.1–32.7)] independently predicted illness vulnerability as did an interaction between childhood trauma and cannabis use [OR 0.17 (0.03–0.9)]. Only regular cannabis use predicted having a schizophrenia spectrum diagnosis between patients and unaffected co-twins [OR 3.3 (1.1–10.4)]. Conclusion The findings suggest that several risk factors contribute to increasing schizophrenia spectrum vulnerability. Moreover, cannabis, a potentially completely avoidable environmental risk factor, seems to play a substantial role in schizophrenia pathology.

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