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Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study.
Liver Int 2017; 37(2):251-258LI

Abstract

BACKGROUND & AIM

Diabetes mellitus has been linked to cirrhosis-related mortality in Western populations, but less is known about this relationship in Asian populations. We studied the impact of diabetes on the risk of cirrhosis mortality in a population-based cohort among Chinese in Singapore.

METHODS

We used data collected and analysed from the Singapore Chinese Health Study, a prospective community-based cohort of 63 275 subjects aged 45-74 years during enrolment between 1993 and 1998. Information on diet, lifestyle and medical history was collected via structured questionnaire. Mortality cases from cirrhosis in the cohort were identified via linkage with nationwide death registry up to 31 December 2014. Cox proportional regression models were used to estimate the associations with adjustment for risk factors of cirrhosis.

RESULTS

After a mean follow-up of 16.9 years, there were 133 deaths from cirrhosis. Diabetes was associated with an increased risk of cirrhosis mortality (hazard ratio [HR]: 2.80; 95% confidence interval [CI]: 2.04-3.83), and for both viral (HR: 2.20; 95% CI: 1.18-4.11) and non-viral hepatitis-related cirrhosis mortality (HR: 3.06; 95% CI: 2.13-4.41). The association between diabetes and non-viral hepatitis-related cirrhosis mortality was stronger among participants of body mass index (BMI) less than 23 kg/m2 (HR: 7.11; 95% CI: 3.42-14.79) compared to heavier individuals (HR: 2.28; 95% CI: 1.20-4.35) (Pinteraction =0.02).

CONCLUSION

Diabetes is a risk factor for cirrhosis mortality, especially for non-viral hepatitis-related cirrhosis in population with BMI considered low or normal in Asia.

Authors+Show Affiliations

Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore. Duke-NUS Medical School, Singapore, Singapore.Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Key Laboratory of Environment and Health, Ministry of Education, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore. Duke-NUS Medical School, Singapore, Singapore.Division of Cancer Control and Population Science, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.Duke-NUS Medical School, Singapore, Singapore. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

27566448

Citation

Goh, George Boon-Bee, et al. "Association Between Diabetes Mellitus and Cirrhosis Mortality: the Singapore Chinese Health Study." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 37, no. 2, 2017, pp. 251-258.
Goh GB, Pan A, Chow WC, et al. Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study. Liver Int. 2017;37(2):251-258.
Goh, G. B., Pan, A., Chow, W. C., Yuan, J. M., & Koh, W. P. (2017). Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study. Liver International : Official Journal of the International Association for the Study of the Liver, 37(2), pp. 251-258. doi:10.1111/liv.13241.
Goh GB, et al. Association Between Diabetes Mellitus and Cirrhosis Mortality: the Singapore Chinese Health Study. Liver Int. 2017;37(2):251-258. PubMed PMID: 27566448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between diabetes mellitus and cirrhosis mortality: the Singapore Chinese Health Study. AU - Goh,George Boon-Bee, AU - Pan,An, AU - Chow,Wan-Cheng, AU - Yuan,Jian-Min, AU - Koh,Woon-Puay, Y1 - 2016/09/16/ PY - 2016/07/08/received PY - 2016/08/19/accepted PY - 2016/8/28/pubmed PY - 2017/12/6/medline PY - 2016/8/28/entrez KW - Singapore KW - body mass index KW - cirrhosis mortality KW - diabetes mellitus SP - 251 EP - 258 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int. VL - 37 IS - 2 N2 - BACKGROUND & AIM: Diabetes mellitus has been linked to cirrhosis-related mortality in Western populations, but less is known about this relationship in Asian populations. We studied the impact of diabetes on the risk of cirrhosis mortality in a population-based cohort among Chinese in Singapore. METHODS: We used data collected and analysed from the Singapore Chinese Health Study, a prospective community-based cohort of 63 275 subjects aged 45-74 years during enrolment between 1993 and 1998. Information on diet, lifestyle and medical history was collected via structured questionnaire. Mortality cases from cirrhosis in the cohort were identified via linkage with nationwide death registry up to 31 December 2014. Cox proportional regression models were used to estimate the associations with adjustment for risk factors of cirrhosis. RESULTS: After a mean follow-up of 16.9 years, there were 133 deaths from cirrhosis. Diabetes was associated with an increased risk of cirrhosis mortality (hazard ratio [HR]: 2.80; 95% confidence interval [CI]: 2.04-3.83), and for both viral (HR: 2.20; 95% CI: 1.18-4.11) and non-viral hepatitis-related cirrhosis mortality (HR: 3.06; 95% CI: 2.13-4.41). The association between diabetes and non-viral hepatitis-related cirrhosis mortality was stronger among participants of body mass index (BMI) less than 23 kg/m2 (HR: 7.11; 95% CI: 3.42-14.79) compared to heavier individuals (HR: 2.28; 95% CI: 1.20-4.35) (Pinteraction =0.02). CONCLUSION: Diabetes is a risk factor for cirrhosis mortality, especially for non-viral hepatitis-related cirrhosis in population with BMI considered low or normal in Asia. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/27566448/Association_between_diabetes_mellitus_and_cirrhosis_mortality:_the_Singapore_Chinese_Health_Study_ L2 - https://doi.org/10.1111/liv.13241 DB - PRIME DP - Unbound Medicine ER -