title: Obesity, diabetes, serum glucose, and risk of primary liver cancer by birth cohort, race/ethnicity, and sex: Multiphasic health checkup study.
abstract: Obesity and diabetes have been associated with liver cancer. However, recent US-based studies have suggested a lack of association between obesity and liver cancer among blacks and women.
  
  
  
  We conducted a nested case-control study within the Multiphasic Health Checkup (MHC) cohort of Kaiser Permanente Northern California (KPNC) members. Liver cancer was diagnosed using the KPNC Cancer Registry. Detailed self-administered questionnaires and a standardized examination that included measurement of height and weight and a 1-h glucose tolerance test were completed prior to diagnosis of liver cancer for cases (n=450) and matched controls (4489). Height and weight were utilized to calculate BMI (kg/m(2)) as a measure of adiposity: underweight (15-≤8.5kg/m(2)), normal weight (18.5-≤25kg/m(2)), overweight (25-≤30kg/m(2)), and obese (≥30kg/m(2)). Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the association between BMI, diabetes, and serum glucose with subsequent incidence of liver cancer, in models that were stratified by birth cohort, race/ethnicity, and sex.
  
  
  
  Compared to normal weight individuals, obese individuals had a 2.4-fold increased risk of liver cancer (OR=2.38, 95% CI: 1.68-3.36), and overweight individuals had a 32% increased risk (OR=1.32, 95% CI: 1.03-1.70). This association did not differ when stratified by birth cohort, race/ethnicity, or sex (pint>0.05). Among blacks and women, obesity was associated with at least a 2-fold increased risk of liver cancer (OR=2.29, 95% CI: 1.22-4.28 and OR=2.00, 95% CI: 1.14-3.52, respectively). More moderate increased odds ratios were noted for diabetes (OR=1.28, 95% CI: 0.65-2.54) and serum glucose ≥200mg/dL (OR=1.63, 95% CI: 0.48-5.55), although the results did not attain statistical significance.
  
  
  
  In summary, our finding of a positive association between obesity and liver cancer suggests that a higher BMI may increase the risk of liver cancer in the US, for both sexes and all race/ethnicities.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States. Electronic address: jessica.petrick@nih.gov.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Petrick
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Freedman
authors.affiliation: Information Management Services Inc., Silver Spring, MD, United States.
authors.forename: Jane
authors.initials: J
authors.lastname: Demuth
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States.
authors.forename: Baiyu
authors.initials: B
authors.lastname: Yang
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Engel
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D048909:Diabetes Complications; D005006:Ethnicity; D005260:Female; D005783:Gender Identity; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology*; D008297:Male; D009098:Multiphasic Screening; D009765:Obesity / Q000150:complications*; D044469:Racial Groups; D012307:Risk Factors; D011795:Surveys and Questionnaires