In the metabolic conditions group, impaired fasting glucose and/or diabetes mellitus was associated with 2.90- and 1.82-fold increased risks of HCC and ICC (P < 0.0001). Similarly, dyslipoproteinemia, hypertension, and obesity were each significantly (P < 0.0001) associated Dabrafenib nmr with increased risks, ranging from 1.35-1.93, of developing HCC and ICC. Combining the metabolic variables, metabolic syndrome was associated with a statistically significant 2.58- and 2.04-fold increased risk of HCC and ICC, respectively (95% CI = 2.4-2.76 [HCC] and 1.74-2.40 [ICC], P < 0.0001). To investigate whether the significant associations

between metabolic syndrome and risk of HCC and ICC were independent of other major liver cancer risk factors, we used a logistic regression model that adjusted for all demographic variables, as well as all risk factors that were significantly associated with HCC and ICC in the univariate analyses. As shown in Table 6, metabolic syndrome was associated with a significant 2.13-fold increased risk of HCC (95% CI = 1.96-2.31) and a significant 1.56-fold increased risk of ICC (95% CI = 1.32-1.83). Both associations were independent of all other major HCC or ICC risk factors. Several sensitivity analyses

were conducted. To minimize the possibility of diagnostic detection bias, the first analysis excluded conditions that were diagnosed in the year prior to cancer diagnosis. This limited the power to detect significant associations for some rare conditions (e.g., Wilson’s disease for HCC and choledochal Torin 1 datasheet cysts, infectious liver diseases and alcoholic liver disease for ICC). However, as in the main analysis, metabolic syndrome remained significantly associated with an increased Elongation factor 2 kinase and independent risk of both HCC and ICC (data not shown). To minimize the possibility of diagnostic misclassification, the analyses were also repeated, but restricted to histologically confirmed and well-differentiated or moderately differentiated tumors. In this analysis,

ORs remained similar to the main analysis; however, the power to detect statistically significant associations between HBV infection, alcoholic liver disease, biliary cirrhosis, and ICC risk were limited. In the adjusted analyses that excluded undifferentiated tumors, metabolic syndrome remained associated with a 2.07-fold increased risk of HCC and 1.80-fold increased risk of ICC (95% CI = 1.83-2.34, P < 0.0001 for HCC and 1.33-2.43, P < 0.0002 for ICC, respectively). This is the first large population-based study in the United States that investigated the association between metabolic syndrome and risk for both primary liver cancers: HCC and ICC. The results indicate that preexisting metabolic syndrome, as defined by the 2001 U.S. NCEP-ATP III criteria, confers a statistically significant 2.13- and 1.