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Meta-Analysis
. 2021 Jan;27(1):157-174.
doi: 10.3350/cmh.2020.0176. Epub 2020 Nov 26.

Obesity and the risk of primary liver cancer: A systematic review and meta-analysis

Won Sohn  1 , Hyun Woong Lee  2 , Sangheun Lee  3 , Jin Hong Lim  4 , Min Woo Lee  5 , Chan Hyuk Park  6 , Seung Kew Yoon  7
Affiliations
Meta-Analysis

Obesity and the risk of primary liver cancer: A systematic review and meta-analysis

Won Sohn et al. Clin Mol Hepatol. 2021 Jan.

Abstract

Background/aims: In this systematic review and meta-analysis, we aimed to clarify the effect of obesity on the occurrence of and mortality from primary liver cancer.

Methods: This study was conducted using a systematic literature search of MEDLINE, EMBASE, and the Cochrane Library until November 2018 using the primary keywords "obesity," "overweight," "body mass index (BMI)," "body weight," "liver," "cancer," "hepatocellular carcinoma," "liver cancer," "risk," and "mortality." Studies assessing the relationship between BMI and occurrence of or mortality from primary liver cancer in prospective cohorts and those reporting hazard ratios (HRs) or data that allow HR estimation were included.

Results: A total of 28 prospective cohort studies with 8,135,906 subjects were included in the final analysis. These included 22 studies with 6,059,561 subjects for cancer occurrence and seven studies with 2,077,425 subjects for cancerrelated mortality. In the meta-analysis, an increase in BMI was associated with the occurrence of primary liver cancer (HR, 1.69; 95% confidence interval, 1.50-1.90, I2=56%). A BMI-dependent increase in the risk of occurrence of primary liver cancer was reported. HRs were 1.36 (95% CI, 1.02-1.81), 1.77 (95% CI, 1.56-2.01), and 3.08 (95% CI, 1.21-7.86) for BMI >25 kg/m2, >30 kg/m2, and >35 kg/m2, respectively. Furthermore, increased BMI resulted in enhanced liver cancer-related mortality (HR, 1.61; 95% CI, 1.14-2.27, I2=80%).

Conclusion: High BMI increases liver cancer mortality and occurrence of primary liver cancer. Obesity is an independent risk factor for the occurrence of and mortality from primary liver cancer.

Keywords: Carcinoma, Hepatocellular; Liver cancer; Mortality; Obesity; Risk.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Flow diagram of the studies included in the meta-analysis.
Figure 2.
Figure 2.
Forest plots of all the studies analyzing the occurrence (A) and cancer-related mortality (B) from primary liver cancer. SE, standard error; CI, confidence interval; BMI, body mass index.
Figure 3.
Figure 3.
Subgroup analysis according to ethnic group (Asian vs. non-Asian): the occurrence of (A, C) and cancer-related mortality (B, D) from primary liver cancer in Asian subjects (A, B) and non-Asian subjects (C, D). SE, standard error; CI, confidence interval; BMI, body mass index.
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