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. 2023 Jun 28;29(24):3843-3854.
doi: 10.3748/wjg.v29.i24.3843.

Effect of lifestyle modification on hepatocellular carcinoma incidence and mortality among patients with chronic hepatitis B

Yewan Park  1   2 , Danbee Kang  3   4 , Dong Hyun Sinn  2   5 , Hyunsoo Kim  6 , Yun Soo Hong  7 , Juhee Cho  3   6   7 , Geum-Youn Gwak  5
Affiliations

Effect of lifestyle modification on hepatocellular carcinoma incidence and mortality among patients with chronic hepatitis B

Yewan Park et al. World J Gastroenterol. .

Abstract

Background: Research exploring the influence of healthier lifestyle modification (LSM) on the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) is limited.

Aim: To emulate a target trial to determine the effect of LSM on HCC incidence and mortality among patients with CHB by large-scale population-based observational data.

Methods: Among the patients with CHB enrolled in the Korean National Health Insurance Service between January 1, 2009, and December 31, 2017, those aged ≥ 20 years who drank alcohol, smoked cigarettes, and were sedentary were analyzed. Exposure included at least one LSM, including alcohol abstinence, smoking cessation, and regular exercise. The primary outcome was HCC development, and the secondary outcome was liver-related mortality. We used 2:1 propensity score matching to account for covariates.

Results: With 48766 patients in the LSM group and 103560 in the control group, the adjusted hazard ratio (HR) for incident HCC and liver-related mortality was 0.92 [95% confidence interval (CI): 0.87-0.96] and 0.92 (95%CI: 0.86-0.99) in the LSM group, respectively, compared with the control group. Among the LSM group, the adjusted HR (95%CI) for incident HCC was 0.84 (0.76-0.94), 0.87 (0.81-0.94), and 1.08 (1.00-1.16) for alcohol abstinence, smoking cessation, and regular exercise, respectively. The adjusted HR (95%CI) for liver-related mortality was 0.92 (0.80-1.06), 0.81 (0.72-0.91), and 1.15 (1.04-1.27) for alcohol abstinence, smoking cessation, and regular exercise, respectively.

Conclusion: LSM lowered the risk of HCC and mortality in patients with CHB. Thus, active LSM, particularly alcohol abstinence and smoking cessation, should be encouraged in patients with CHB.

Keywords: Cancer; Chronic hepatitis B; Hepatocellular carcinoma; Lifestyle modification; Mortality.

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Conflict of interest statement

Conflict-of-interest statement: All authors have nothing to disclose.

Figures

Figure 1
Figure 1
Flow chart of study participants. HBV: Hepatitis B virus; HIV: Human immunodeficiency virus; HCV: Hepatitis C virus.
Figure 2
Figure 2
Covariate balance check. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CCT: γ-glutamyl transferase; BMI: Body mass index.
See this image and copyright information in PMC

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