{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:09:51Z","timestamp":1790762991515,"version":"4.1.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T00:00:00Z","timestamp":1571616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T00:00:00Z","timestamp":1571616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>Diabetes increases the risk of liver disease progression and cirrhosis development in patients with nonalcoholic steatohepatitis (NASH). The association between diabetes and the risk of hepatocellular carcinoma (HCC) in NASH patients with cirrhosis is not well quantified. All patients with the diagnosis of NASH cirrhosis seen at Mayo Clinic Rochester between January 2006 and December 2015 were identified. All adult liver transplant registrants with NASH between 2004 and 2017 were identified using the United Network for Organ Sharing (UNOS)\/Organ Procurement and Transplantation registry for external validation. Cox proportional hazard analysis was performed to investigate the association between diabetes and HCC risk. Among 354 Mayo Clinic patients with NASH cirrhosis, 253 (71%) had diabetes and 145 (41%) were male. Mean age at cirrhosis evaluation was 62. During a median follow\u2010up of 47\u00a0months, 30 patients developed HCC. Diabetes was associated with an increased risk of developing HCC in univariate (hazard ratio [HR]\u00a0=\u00a03.6; 95% confidence interval [CI]\u00a0=\u00a01.1\u201011.9; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.04) and multivariable analysis (HR\u00a0=\u00a04.2; 95% CI\u00a0=\u00a01.2\u201014.2; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.02). In addition, age (per decade, HR\u00a0=\u00a01.8; 95% CI\u00a0=\u00a01.2\u20102.6; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01) and low serum albumin (HR\u00a0=\u00a02.1; 95% CI\u00a0=\u00a01.5\u20102.9; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01) were significantly associated with an increased risk of developing HCC in multivariable analysis. Other metabolic risk factors, including body mass index, hyperlipidemia, and hypertension, were not associated with HCC risk. Among UNOS NASH registrants (N\u00a0=\u00a06,630), 58% had diabetes. Diabetes was associated with an increased risk of developing HCC in univariate (HR\u00a0=\u00a01.4; 95% CI\u00a0=\u00a01.1\u20101.8; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01) and multivariable (HR\u00a0=\u00a01.3; 95% CI\u00a0=\u00a01.0\u20101.7; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.03) analysis. <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Diabetes is associated with an increased risk of HCC in patients with NASH cirrhosis.<\/jats:p>","DOI":"10.1002\/hep.30858","type":"journal-article","created":{"date-parts":[[2019,7,16]],"date-time":"2019-07-16T04:28:18Z","timestamp":1563251298000},"page":"907-916","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":181,"title":["Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease"],"prefix":"10.1097","volume":"71","author":[{"given":"Ju Dong","family":"Yang","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic College of Medicine and Science,Rochester,MN"},{"name":"Division of Digestive and Liver Diseases, Department of Internal Medicine,Cedars\u2010Sinai Medical Center,Los Angeles,CA"},{"name":"Comprehensive Transplant Center,Cedars Sinai Medical Center,Los Angeles,CA"},{"name":"Samuel Oschin Comprehensive Cancer Institute,Cedars Sinai Medical Center,Los Angeles,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fowsiyo","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic College of Medicine and Science,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin C.","family":"Mara","sequence":"additional","affiliation":[{"name":"Department of Health Science Research,Mayo Clinic College of Medicine and Science,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benyam D.","family":"Addissie","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Geisinger Medical Center,Danville,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8393-8410","authenticated-orcid":false,"given":"Alina M.","family":"Allen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic College of Medicine and Science,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Gores","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo Clinic College of Medicine and Science,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis R.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Mayo 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