Obesity, diabetes, serum glucose, and risk of primary liver cancer by birth cohort, race/ethnicity, and sex: Multiphasic health checkup study.
Obesity, diabetes, serum glucose, and risk of primary liver cancer by birth cohort, race/ethnicity, and sex: Multiphasic health checkup study.
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DOI：
10.1016/j.canep.2016.04.009
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发表时间：
2016-06
影响因子：
2.6
通讯作者：
McGlynn KA
中科院分区：
文献类型：
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作者：
Petrick JL;Freedman ND;Demuth J;Yang B;Van Den Eeden SK;Engel LS;McGlynn KA
肥胖和糖尿病与肝癌有关。然而，最近的美国研究表明，黑人和女性的肥胖与肝癌之间缺乏联系。我们在北方加州Kaiser Permanente（KPNC）成员的多相健康检查（MHC）队列中进行了巢式病例对照研究。使用KPNC癌症登记处诊断肝癌。在确诊肝癌之前，对病例组（n=450）和匹配对照组（4，489）进行了详细的自我管理问卷调查和标准化检查，包括身高和体重测量以及1小时葡萄糖耐量试验。使用身高和体重计算BMI（kg/m2）作为肥胖的指标：体重不足（15-<18.5 kg/m2）、正常体重（18.5-<25 kg/m2）、超重（25-<30 kg/m2）和肥胖（≥30 kg/m2）。在按出生队列、种族/民族和性别分层的模型中，使用条件logistic回归估计BMI、糖尿病和血糖与随后肝癌发病率之间关联的比值比（OR）和95%置信区间（CI）。与正常体重个体相比，肥胖个体患肝癌的风险增加2.4倍（OR=2.38，95%CI：1.68-3.36），超重个体患肝癌的风险增加32%（OR=1.32，95%CI：1.03-1.70）。当按出生队列、种族/民族或性别分层时，这种关联没有差异（pint>0.05）。在黑人和女性中，肥胖与肝癌风险增加至少2倍相关（OR=2.29，95%CI：1.22-4.28和OR=2.00，95%CI：1.14-3.52）。糖尿病（OR=1.28，95% CI：0.65-2.54）和血糖≥200 mg/dL（OR=1.63，95% CI：0.48-5.55）的比值比增加更为中度，但结果未达到统计学显著性。总之，我们发现肥胖与肝癌之间存在正相关性，这表明在美国，无论男女还是所有种族/民族，较高的BMI都可能增加肝癌的风险。
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-hour glucose tolerance test were completed prior to diagnosis of liver cancer for cases (n=450) and matched controls (4,489). Height and weight were utilized to calculate BMI (kg/m2) as a measure of adiposity: underweight (15–<18.5 kg/m2), normal weight (18.5–<25 kg/m2), overweight (25–<30 kg/m2), and obese (≥30 kg/m2). 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 ≥200 mg/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.