Elevated Serum Insulin is an Independent Risk Factor for Hepatocellular Carcinoma: A Case Control Study from Nepal

Aim: To investigate associations of fasting insulin and glucose levels in serum with hepatocellular carcinomarisk. Materials and
Methods: This hospital based study was carried out using data retrieved from the registermaintained in the Department of Biochemistry of the Nepalese Army Institute of Health Sciences, between1st December, 2011 and 31st June, 2013. The variables collected were age, fasting plasma glucose, fastingplasma insulin and ALT. Quantitative determination of human insulin concentrations was accomplished bychemiluminescence enzyme immunoassay.
Results: Of the total 220 subjects enrolled in our present study, 20cases were of HCC and 200 were healthy controls. The maximum number of cases of hepatocellular carcinomain category cutpoints of fasting insulin levels fell in the range of >6.10 μU/ml. The highest insulin levels (>6.10μU/ml) were seen to be associated with an 2.36 fold risk of HCC when compared with fasting insulin levels of(<2.75 μU/ml). Furthermore, the insulin levels (2.75-4.10 μU/ml) of category cutpoints also conferred a 1.57fold risk for HCC when compared with lowest fasting insulin levels of (<2.75 μU/ml).
Conclusions: The effectof an insulin level in increasing HCC risk appeared consistent, influencing incidence, risk of recurrence, overallsurvival, and treatment-related complications in HCC patients.