Incidence rates for liver cancer have increased 3-fold since the mid-1970s in the United States in parallel with increasing trends for obesity and type II diabetes mellitus. We conducted an analysis of baseline body mass index (BMI), waist circumference (WC), and type II diabetes mellitus with risk of liver cancer. The Liver Cancer Pooling Project maintains harmonized data from 1.57 million adults enrolled in 14 U.S.-based prospective studies. Cox regression estimated HRs and 95% confidence intervals (CI) adjusted for age, sex, study center, alcohol, smoking, race, and BMI (for WC and type II diabetes mellitus). Stratified analyses assessed whether the BMI-liver cancer associations differed by hepatitis sera-positivity in nested analyses for a subset of cases (n = 220) and controls (n = 547). After enrollment, 2,162 incident liver cancer diagnoses were identified. BMI, per 5 kg/m2, was associated with higher risks of liver cancer, more so for men (HR = 1.38; 95% CI, 1.30-1.46) than women (HR = 1.25; 95% CI, 1.17-1.35; Pinteraction = 0.02). WC, per 5 cm, was associated with higher risks of liver cancer, approximately equally by sex (overall, HR = 1.08; 95% CI, 1.04-1.13). Type II diabetes mellitus was associated with higher risk of liver cancer (HR = 2.61; 95% CI, 2.34-2.91). In stratified analyses, there was a null association between BMI and liver cancer risk for participants who were sera-positive for hepatitis. This study suggests that high BMI, high WC, and type II diabetes mellitus are associated with higher risks of liver cancer and that the association may differ by status of viral hepatitis infection.
Bibliographical noteFunding Information:
This research was supported, in part, by the Intramural Research Program of the NCI. The NIH-AARP Diet and Health study was supported by the Intramural Research Program of the NCI, NIH and represented by N. Freedman and A. Hollenbeck. The Agricultural Health Study was funded by the Intramural Program of the NIH, NCI (Z01 P010119) and the National Institute of Environmental Health Sciences (Z01 ES049030-11) and is represented by M. Alavanja and L. Freeman. The BCDDP Follow-up Study has been supported by the Intramural Research Program of the NCI, NIH and is represented by C. Schairer. The CPS-II Nutrition Cohort, including its creation, maintenance, and updating, is funded by the American Cancer Society (ACS) and is represented by P. Campbell, V. Stevens, and M. Gaudet. The Health Professionals Follow-up Study is supported by NIH/NCIP01 CA055075 and UM1 CA167552 and is represented by A. Chan, L. King, and D. Chong. The Iowa Women's Health Study is supported by a grant from the NCI (R01 CA39742) and is represented by K. Robien and J. Poynter. The Nurses' Health Study is supported by NIH/NCIUM1 CA186107, P01 CA87969, and R01CA49449 and is represented by A. Chan, L. King, and D. Chong. The NYU Women's Health Study is supported by grant nr. R01 CA 098661 and Center grant CA 016087 from the NCI and by Center grant ES 000260 from the National Institute of Environmental Health Sciences and is represented by A. Zeleniuch-Jacquotte. The Physicians' Health Study was supported by grants CA 97193, CA 34944, CA 40360, HL 26490, and HL 34595 from the NIH and is represented by H. Sesso and J. Gaziano. The USRT was supported by the Intramural Research Program of the NCI, NIH and is represented by M. Linet and A. Sigurdson. The WHS was supported by CA047988, HL043851, and HL080467 and is represented by J. Buring and I. Lee. The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is supported by contracts from the NCI and is represented by M. Purdue. The Black Women's Health Study is supported NCI grant R01 CA58420 and UM1 CA164974 and is represented by J. Palmer and L. Rosenberg. The WHI is supported by the NIH/NHLBI and is represented by M. Datta and J. Wactawski-Wende.
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