Blood glucose concentration and risk of liver cancer: systematic review and meta-analysis of prospective studies

// Hedong Han 1, * , Tianyi Zhang 1, * , Zhichao Jin 1, * , Honglei Guo 2 , Xin Wei 3 , Yuzhou Liu 3 , Qi Chen 1 and Jia He 1 1 Department of Health Statistics, Second Military Medical University, Shanghai 200433, China 2 Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China 3 Mount Sinai St. Luke’s and West Medical Center, New York, NY 10025, USA * These authors contributed equally to this work Correspondence to: Jia He, email: hejia63@yeah.net Keywords: blood glucose, liver cancer, meta-analysis, prospective studies Received: November 16, 2016      Accepted: March 22, 2017      Published: April 04, 2017 ABSTRACT The question of whether elevated blood glucose is a risk factor for liver cancer has been intensively studied, yet with inconsistent results. To explore the relationship between blood glucose concentration and risk of liver cancer, we conduct a meta-analysis of prospective studies. Literature search was comprehensively performed using database of PubMed, EMBASE and the Cochrane Library through October 2016. Random-effect models were used to combine the effect estimations. Eight articles containing ten studies with a total of 1975 liver cancer cases were included. The pooled RRs demonstrated that elevated fasting blood glucose was associated with increased risk of liver cancer (combined RRs: 1.77; 95% CI: 1.46, 2.13) with mild heterogeneity (I 2 = 30.40%, P = 0.17). In sensitivity analysis, the pooled result remained significant (combined RRs: 1.33; 95% CI: 1.12, 1.59; I 2 = 33.90%, P = 0.16) when we restricted blood glucose categories in the range of nondiabetic subjects. We also detected a J-shaped non-linear dose-response relationship between blood glucose concentration and risk of liver cancer. There is evidence that elevated blood glucose increases risk of liver cancer across the range of prediabetes and diabetes. Considering the rapidly increasing prevalence of prediabetes and diabetes, controlling blood glucose may lower the risk of liver cancer.