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Adherence to Healthy Lifestyle and Liver cancer in Chinese: a prospective cohort study of 0.5 million people



Little prospective evidence exists about whether a combination of healthy lifestyle factors is related to a considerable reduction of liver cancer risk.


Based on the prospective China Kadoorie Biobank (CKB) cohort with a total of 492,640 Chinese adults, we examined the associations of five lifestyle factors with risk of liver cancer. Low-risk lifestyle factors were defined as non-smoking, non-drinking, median or higher level of physical activity, a healthy diet, and waist-to-hip ratio (WHR) < 0.90 for men and <0.85 for women.


During a median of 10.12 years of follow-up, 2529 liver cancer events were observed. There was a significant decrease in liver cancer risk with the increasing of the healthy lifestyle index scores (P < 0.001). Participants with a favourable lifestyle (4 or 5 healthy lifestyle factors) had a 43% reduced liver cancer risk compared with those with an unfavourable lifestyle (0 or 1 healthy lifestyle factor) (HR, 0.57 [95% CI, 0.47–0.68]). The cumulative protective effect of a healthy lifestyle on liver cancer appeared to be more dramatic for patients with hepatitis B surface antigen (HBsAg) positive, the individuals at high risk of liver cancer.


Individuals adhering to a favourable lifestyle was associated with a considerable absolute risk reduction of liver cancer.

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Fig. 1: The risk of liver cancer across lifestyle categories.

Data availability

Details of the CKB data are available upon reasonable request (


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The most acknowledgement is to the participants in the study and the members of the survey teams in each of the 10 regional centres, as well as to the project development and management teams based at Beijing, Oxford and the 10 regional centres.


This study was supported by National Natural Science Foundation of China (81903382, 91846303), Natural Science Foundation of Jiangsu Province (BK20190652), grants from by the National Key R&D Program of China (2016YFC0900500, 2016YFC0900501, 2016YFC0900504), China Postdoctoral Science Foundation (General Program, 2019M651900). The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z), and Chinese Ministry of Science and Technology (2011BAI09B01).

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Authors and Affiliations



ZH, LL and HS contributed to the study design and supervised the whole project. CS, Chengxiao Yu contributed to the data interpretation, data analysis, and writing of the manuscript. CS and JL contributed to the study design, data collection, and data interpretation of the present analysis. MZ, Canqing Yu, YG, LY, YC, ZC, TJ, HM and GJ contributed to the study design and sample collection. All of the authors reviewed or revised the manuscript.

Corresponding authors

Correspondence to Zhibin Hu or Liming Li.

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Ethics approval and consent to participate

Studies based on CKB was performed in accordance with the Declaration of Helsinki. This study was approved by the ethical review committee of the Chinese Center for Disease Control and Prevention (Beijing, China) and the Oxford Tropical Research Ethics Committee, University of Oxford (UK). Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Song, C., Lv, J., Yu, C. et al. Adherence to Healthy Lifestyle and Liver cancer in Chinese: a prospective cohort study of 0.5 million people. Br J Cancer 126, 815–821 (2022).

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