title: Abdominal obesity, weight gain during adulthood and risk of liver and biliary tract cancer in a European cohort.
abstract: General obesity has been positively associated with risk of liver and probably with biliary tract cancer, but little is known about abdominal obesity or weight gain during adulthood. We used multivariable Cox proportional hazard models to investigate associations between weight, body mass index, waist and hip circumference, waist-to-hip and waist-to-height ratio (WHtR), weight change during adulthood and risk of hepatocellular carcinoma (HCC), intrahepatic (IBDC) and extrahepatic bile duct system cancer [EBDSC including gallbladder cancer (GBC)] among 359,525 men and women in the European Prospective Investigation into Cancer and Nutrition study. Hepatitis B and C virus status was measured in a nested case-control subset. During a mean follow-up of 8.6 years, 177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC, occurred. All anthropometric measures were positively associated with risk of HCC and GBC. WHtR showed the strongest association with HCC [relative risk (RR) comparing extreme tertiles 3.51, 95% confidence interval (95% CI): 2.09-5.87; p(trend)  < 0.0001] and with GBC (RR: 1.56, 95% CI: 1.12-2.16 for an increment of one unit in WHtR). Weight gain during adulthood was also positively associated with HCC when comparing extreme tertiles (RR: 2.48, 95% CI: 1.49-4.13; <0.001). No statistically significant association was observed between obesity and risk of IBDC and EBDSC. Our results provide evidence of an association between obesity, particularly abdominal obesity, and risk of HCC and GBC. Our findings support public health recommendations to reduce the prevalence of obesity and weight gain in adulthood for HCC and GBC prevention in Western populations.
authors.affiliation: Section of Epidemiology, Institute of Experimental Medicine, Christian-Albrechts University of Kiel, Kiel, Germany. s.schlesinger@iem.uni-kiel.de
authors.forename: Sabrina
authors.initials: S
authors.lastname: Schlesinger
authors.forename: Krasimira
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authors.lastname: Aleksandrova
authors.forename: Tobias
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authors.lastname: Pischon
authors.forename: Veronika
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authors.forename: Anne
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authors.lastname: Tjønneland
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authors.lastname: Halkjær
authors.forename: Guy
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authors.lastname: Fagherazzi
authors.forename: Marie-Christine
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authors.lastname: Boutron-Ruault
authors.forename: Franck
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authors.lastname: Carbonnel
authors.forename: Rudolf
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authors.lastname: Kaaks
authors.forename: Annekatrin
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authors.lastname: Lukanova
authors.forename: Heiner
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authors.lastname: Boeing
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: H B
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Saskia
authors.initials: S
authors.lastname: van den Berg
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: Elisabete
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authors.lastname: Weiderpass
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Noémie
authors.initials: N
authors.lastname: Travier
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Björn
authors.initials: B
authors.lastname: Lindkvist
authors.forename: Sara
authors.initials: S
authors.lastname: Regner
authors.forename: Mårten
authors.initials: M
authors.lastname: Werner
authors.forename: Malin
authors.initials: M
authors.lastname: Sund
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nicholas
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authors.lastname: Wareham
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Travis
authors.forename: Teresa
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authors.lastname: Norat
authors.forename: Petra A
authors.initials: PA
authors.lastname: Wark
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Ute
authors.initials: U
authors.lastname: Nöthlings
mesh_terms: D001661:Biliary Tract Neoplasms / Q000453:epidemiology* / Q000209:etiology; D001823:Body Composition; D015992:Body Mass Index; D001835:Body Weight; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D056128:Obesity, Abdominal / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D049629:Waist-Hip Ratio; D015430:Weight Gain