Low skeletal muscle mass is associated with non-alcoholic fatty liver disease in Korean adults： the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND： Sarcopenia and non-alcoholic fatty liver dis- ease （NAFLD） share similar pathophysiological mechanisms, and the relationship between sarcopenia and NAFLD has been recently investigated. The study investigated whether low skel- etal muscle mass is differentially associated with NAFLD by gender in Korean adults. METHODS： We conducted a cross-sectional analysis of the data from the Fifth Korea National Health and Nutrition Examination Survey. The skeletal muscle index （SMI） was obtained by the appendicular skeletal muscle mass divided by the weight. NAFLD was defined as a fatty liver index （FLI） 〉60 in the absence of other chronic liver disease. RESULTS： Among the included subjects, 18.3% （SE： 1.4%） in men and 7.0% （SE： 0.7%） in women were classified as having FLI-defined NAFLD. Most of the risk factors for FLI-defined NAFLD showed a significant negative correlation with the SMI in both genders. Multiple logistic regression analysis showed that low SMI was associated with FLI-defined NAFLD, inde- pendent of other metabolic and lifestyle parameters in both genders [males： odds ratio （OR）=1.35; 95% confidence inter- val （CI）： 1.17-1.54; females： OR=1.36; 95% CI： 1.18-1.55]. The magnitude of the association between FLI-defined NAFLD and low SMI was higher in middle aged to elderly males （OR-1.50; 95% CI： 1.22-1.84） than in males less than 45 years of age （OR=1.25; 95% CI： 1.02-1.52） and in premenopausal females （OR=l.50; 95% CI： 1.12-2.03） than in postmenopausal females （OR-1.36; 95% CI： 1.20-1.54）.CONCLUSIONS： Low SMI is associated with the risk of FLI- defined NAFLD independent of other well-known metabolic risk factors in both genders. This association may differ ac- cording to age group or menopausal status. Further studies are warranted to confirm this relationship.

Predictive value of ^(18)F-fluorodeoxyglucose PET/CT for transarterial chemolipiodolization of hepatocellular carcinoma

AIM： To investigate the correlation of 18F-fluorodeoxy- glucose （18F-FDG） positron emission tomography （PET） with clinical features and the prediction of treatment response. METHODS： A total of 83 hepatocellular carcinoma （HCC） patients undergoing 18F-FDG PET before transar- terial chemolipiodolization with systemic chemo-infusion between October, 2006 and May, 2009 were retrospec-tively enrolled. The patients included 68 men and 15 women （mean age, 60 ~ 10.7 years）. The effect of 18F- FDG-monitored PET uptake on clinical features and on the evaluated treatment response was ascertained with modified Response Evaluation Criteria in Solid Tumors. The PET parameters of maximal standardized uptake value of the tumor （Tsuvmax）, the ratio of the tumor maximal standardized uptake value （SUV） to the liver maximal SUV （Tsuvmax/Lsuwax） and the ratio of tumor maximal SUV to the liver mean SUV （msuvmax/LSUVrnean） were tested as predictive factors. RESULTS： Among the 3 SUV parameters, the TSUV- =maxdLsuvmean ratio （cutoff value of 1.90） was significantly associated with tumor burden including tumor size, tu- mor number, α-fetoprotein levels and tumor stage （P 〈 0.001, P = 0.008, P = 0.011, P 〈 0.001, respectively）. The objective response rates in patients with a high SUV ratio （≥ 1.90） were significantly better than those with a low SUV ratio （〈 1.90） （P = 0.020）. The overall survival rates of patients exhibiting a low Tsuvmax/Lsu- Vmean ratio （〈 1.90） and those with a high SUV ratio （≥1.90） was 38.2 and 10.3 mo, respectively （P 〈 0.01）. However, the time to progression showed no significant difference between the groups （P = 0.15）. CONCLUSION： 18F-FDG PET can be an important predictor of HCC treatment. In particular, the Tsuvmax/ Lsuwean ratio （cutoff value of 1.90） can provide useful information in treatment prognosis for HCC patients treated with Iocoregional therapy.

Family history influences the early onset of hepatocellular carcinoma

AIM: To evaluate the relationship between a positive family history of primary liver cancer and hepatocellular carcinoma (HCC) development in Korean HCC patients. METHODS: We studied a total of 2242 patients diagnosed with HCC between January 1990 and July 2008, whose family history of primary liver cancer was clearly described in the medical records.positive family history of HCC and 2077 (92.6%) did not. The male to female ratio was 3.6:1, and the major causes of HCC were chronic hepatitis B virus (HBV) infection in 75.1%, chronic hepatitis C virus infection in 13.2% and alcohol in 3.1%. The median ages at diag- nosis in the positiveand negative-history groups were 52 years (range: 29-79 years) and 57 years (range: 18-89 years), respectively (P < 0.0001). Furthermore, among 1713 HCC patients with HBV infection, the number of patients under 45 years of age out of 136 patients with positive family history was 26 (19.1%), whereas those out of 1577 patients with negative family history was 197 (12.5%), suggesting that a positive family history may be associated with earlier development of HCC in the Korean population (P = 0.0028). CONCLUSION: More intensive surveillance maybe recommended to those with a positive family history of HCC for earlier diagnosis and proper management especially when HBV infection is present.

A Decade-old Change in the Screening Rate for Hepatocellular Carcinoma Among a Hepatitis B Virus-infected Population in Korea

Background： Evaluating a change in the screening rate for hepatocellular carcinoma （HCC） is critical for understanding screening implementation, and whether targeted population groups are receiving proper screening. This study examined recent nationwide changes in HCC screening use among hepatitis B virus （HBV）-infected populations after the introduction of the Korean National Cancer Screening Program and predictors of screening adherence. Methods： We analyzed 165 and 276 participants 〉40 years of age who were hepatitis B surface antigen-positive fiom 2001 （14,936 participants） to 2010-2011 （9159 participants） Korea National Health and Nutrition Examination Surveys, respectively. Demographic data, socioeconomic factors, and HCC screening use were collected by means of self-reported questionnaires. Results： The rate of HCC screening within the previous 2 years increased significantly from 17.5% in 2001 to 40.3% in 2010- 20I 1 （P〈 0.0001 ）. The rate of HCC screening use increased from 2001 to 2010-2011 in all study populations. Subjects who had a higher income staius and were aware of their infection were more likely to have undergone recent HCC screening. Conclusions： This study showed a substantial increase in HCC screening in high-risk HBV-infected subjects from 2001 to 2010-2011. However, the HCC screening participation rate remained suboptimal despite the introduction of the nationwide screening program. Efforts should be made to identiry high-risk individuals and increase attendance at HCC screening events among high-risk groups.