Abdominal and gluteofemoral size and risk of liver cancer: The liver cancer pooling project

Andrea A. Florio, Peter T. Campbell, Xuehong Zhang, Anne Zeleniuch-Jacquotte, Jean Wactawski-Wende, Stephanie A. Smith-Warner, Rashmi Sinha, Tracey G. Simon, Howard D. Sesso, Catherine Schairer, Lynn Rosenberg, Thomas E. Rohan, Kim Robien, Andrew G. Renehan, Mark P. Purdue, Jenny N. Poynter, Julie R. Palmer, Christina C. Newton, Yunxia Lu, Martha S. LinetLinda M. Liao, I. Min Lee, Jill Koshiol, Cari M. Kitahara, Victoria A. Kirsh, Jonathan N. Hofmann, Barry I. Graubard, Edward Giovannucci, John M. Gaziano, Susan M. Gapstur, Neal D. Freedman, Jane Demuth, Dawn Q. Chong, Andrew T. Chan, Julie E. Buring, Patrick T. Bradshaw, Laura E. Beane Freeman, Katherine A. McGlynn, Jessica L. Petrick

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Obesity is known to be associated with primary liver cancer (PLC), but the separate effects of excess abdominal and gluteofemoral size are unclear. Thus, we examined the association between waist and hip circumference with risk of PLC overall and by histologic type—hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). The Liver Cancer Pooling Project is a consortium of prospective cohort studies that include data from 1,167,244 individuals (PLC n = 2,208, HCC n = 1,154, ICC n = 335). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using proportional hazards regression. Waist circumference, per 5 cm increase, was associated with an 11% increased PLC risk (HR = 1.11, 95%CI: 1.09–1.14), including when adjusted for hip circumference (HR = 1.12, 95%CI: 1.08–1.17) and also when restricted to individuals in a normal body mass index (BMI) range (18.5 to <25 kg/m2; HR = 1.14, 95%CI: 1.07–1.21). Hip circumference, per 5 cm increase, was associated with a 9% increased PLC risk (HR = 1.09, 95%CI: 1.06–1.12), but no association remained after adjustment for waist circumference (HR = 0.99, 95%CI: 0.94–1.03). HCC and ICC results were similar. These findings suggest that excess abdominal size is associated with an increased risk of liver cancer, even among individuals considered to have a normal BMI. However, excess gluteofemoral size alone confers no increased risk. Our findings extend prior analyses, which found an association between excess adiposity and risk of liver cancer, by disentangling the separate effects of excess abdominal and gluteofemoral size through utilization of both waist and hip circumference measurements.

Original languageEnglish (US)
Pages (from-to)675-685
Number of pages11
JournalInternational Journal of Cancer
Volume147
Issue number3
DOIs
StatePublished - Aug 1 2020

Bibliographical note

Funding Information:
For the Black Women's Health Study, pathology data were obtained from several of the following state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA), and results reported do not necessarily represent their views. For the Nurses’ Health Study and the Health Professionals Follow‐up Study, we would like to thank the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. For NIH‐AARP, the acknowledgment can be found at the following website: https://dietandhealth.cancer.gov/acknowledgement.html . For the Women's Health Initiative, the full list of investigators that have contributed can be found on the following website: https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pdf . This study was supported by NIH Intramural Research Program, National Cancer Institute (J.L.P., A.A.F., L.E.B.‐F., J.N.H., C.M.K., N.D.F., B.I.G., J.K., L.M.L., M.S.L., M.P.P., C.S., R.S., K.A. M.). National Institutes of Health grants CA047988 (I.L., J.E.B.), HL043851 (I.L., J.E.B.), HL080467 (I.L., J.E.B.), HL099355 (I.L., J.E.B.), K07 CA188126 (X.Z.), DK098311 (A.T.C.), CA186107 (A.T.C.), CA87969 (A.T.C.), CA167552 (A.T.C.), R01 CA39742 (K.R., J.P.), UM1 CA182934 (A.Z.‐J.), P30 CA016087 (A.Z.‐J.), P30 ES000260 (A.Z.‐J.), U01 CA164974 (L.R., J.R.P.), and R01 CA058420 (L.R., J.R.P.). American Cancer Society Research Scholar Grant RSG NEC‐130476 (X.Z.). The WHI program (J.W.‐W., T.E.R.) is funded by the National Institutes of Health contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C and HHSN268201600004C. The HPFS and NHS programs (X.Z.) were supported by the National Cancer Institute, National Institutes of Health grant numbers UM1CA186107, P50CA127003, P01CA87969 and UM1CA167552.

Funding Information:
For the Black Women's Health Study, pathology data were obtained from several of the following state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA), and results reported do not necessarily represent their views. For the Nurses? Health Study and the Health Professionals Follow-up Study, we would like to thank the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data. For NIH-AARP, the acknowledgment can be found at the following website: https://dietandhealth.cancer.gov/acknowledgement.html. For the Women's Health Initiative, the full list of investigators that have contributed can be found on the following website: https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pdf. This study was supported by NIH Intramural Research Program, National Cancer Institute (J.L.P., A.A.F., L.E.B.-F., J.N.H., C.M.K., N.D.F., B.I.G., J.K., L.M.L., M.S.L., M.P.P., C.S., R.S., K.A. M.). National Institutes of Health grants CA047988 (I.L., J.E.B.), HL043851 (I.L., J.E.B.), HL080467 (I.L., J.E.B.), HL099355 (I.L., J.E.B.), K07 CA188126 (X.Z.), DK098311 (A.T.C.), CA186107 (A.T.C.), CA87969 (A.T.C.), CA167552 (A.T.C.), R01 CA39742 (K.R., J.P.), UM1 CA182934 (A.Z.-J.), P30 CA016087 (A.Z.-J.), P30 ES000260 (A.Z.-J.), U01 CA164974 (L.R., J.R.P.), and R01 CA058420 (L.R., J.R.P.). American Cancer Society Research Scholar Grant RSG NEC-130476 (X.Z.). The WHI program (J.W.-W., T.E.R.) is funded by the National Institutes of Health contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C and HHSN268201600004C. The HPFS and NHS programs (X.Z.) were supported by the National Cancer Institute, National Institutes of Health grant numbers UM1CA186107, P50CA127003, P01CA87969 and UM1CA167552.

Publisher Copyright:
© 2019 UICC

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • abdominal obesity
  • epidemiology
  • gluteofemoral obesity
  • hepatocellular carcinoma
  • intrahepatic cholangiocarcinoma

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