Metabolic risk factors and primary liver cancer in a prospective study of 578,700 adults
Open accessAbstract
Initial studies have indicated diabetes and obesity to be risk factors for hepatocellular carcinoma; but the association between other metabolic risk factors and primary liver cancer (PLC) has not been investigated. The metabolic syndrome and cancer project (Me-Can) includes cohorts from Norway, Austria and Sweden with data on 578,700 subjects. We used Cox proportional hazard models to calculate relative risks (RRs) of PLC by body mass index (BMI), blood pressure and plasma levels of glucose, cholesterol and triglycerides as continuous standardized variables (z-score with mean = 0 and standard deviation (SD) = 1) and their standardized sum of metabolic syndrome (MetS) z-score. RRs were corrected for random error in measurements. During an average follow-up of 12.0 years (SD = 7.8), 266 PLCs were diagnosed among cohort members. RR of liver cancer per unit increment of z-score adjusted for age, smoking status and BMI and stratified by birth year, sex and sub-cohorts, was for BMI 1.39 (95% confidence interval (CI) 1.24-1.58), mid blood pressure 2.08 (0.95-4.73), blood glucose 2.13 (1.55-2.94) cholesterol 0.62 (0.51-0.76) and serum triglycerides 0.85 (0.65-1.10). The RR per one unit increment of the MetS z-score was 1.35 (1.12-1.61). BMI, glucose and a composite MetS score were positively and cholesterol negatively associated with risk of liver cancer.
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Obesity is associated with a significantly increased risk of HCC development and HCC-related mortality.
“Furthermore, obesity is associated with a signi fi cantly increased risk of HCC development and HCC-related mortality.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [46]
Metabolic syndrome itself and T2D have been reported to be associated with an increased risk of HCC in large cohort studies, but the increase in absolute HCC risk attributable to metabolic factors or genetic factors in individuals with non-cirrhotic MASLD is very small.
“Metabolic syndrome itself and T2D have also been reported to be associated with an increased risk of HCC in large cohort studies, 46,245 but the increase in absolute HCC risk attributable to metabolic factors ( e.g. T2D, obesity) or genetic factors in individuals with non-cirrhotic MASLD is very small.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [46]
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- Authors
- Borena, W., Strohmaier, S., Lukanova, A., Bjørge, T., Lindkvist, B., Hallmans, G., Edlinger, M., Stocks, T., Nagel, G., Manjer, J., Engeland, A., Selmer, R., Häggström, C., Tretli, S., Concin, H., Jonsson, H., Stattin, P., & Ulmer, H.
- Affiliations
- Innsbruck Medical University (AT)
- German Cancer Research Center (DE)
- Norwegian Institute of Public Health (NO)
- Sahlgrenska University Hospital (SE)
- Umeå University (SE)
- Universität Ulm (DE)
- Lund University (SE)
- University of Bergen (NO)
- Cancer Registry of Norway (NO)
- Corresponding author
- Ulmer, Hanno
- ORCID
- Venue
- International Journal of Cancer
- Publisher
- Wiley
- Published
- 2011-09-08
- Volume
- 131
- Issue
- 1
- Pages
- 193-200
- ISSN
- 0020-7136 (ISSN-L)
- 1097-0215
- OpenAlex
- W2001269645
- Cited by
- 177
- References
- 49
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 15 · 2023: 3 · 2022: 19 · 2021: 11 · 2020: 12 · 2019: 8 · 2018: 15 · 2017: 15 · 2016: 11 · 2015: 14 · 2014: 16 · 2013: 9 · 2012: 14
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Cancer (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Umeå Universitet
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- primary liver cancer, hepatocellular carcinoma, metabolic risk factors, metabolic syndrome, body mass index, obesity, blood pressure, blood glucose, cholesterol, triglycerides, cancer risk
- MeSH terms
- Adult, Aged, Austria, Blood Glucose, Blood Pressure, Cholesterol, Female, Follow-Up Studies, Humans, Lipids, Liver Neoplasms, Male, Middle Aged, Norway, Prospective Studies, Risk Factors, Sweden, Triglycerides, Cohort Studies, Body Mass Index, Proportional Hazards Models, Metabolic Syndrome
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