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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Details of the CKB data are available upon reasonable request (http://www.ckbiobank.org/site/Data+Access).
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–32.
Chen W, Xia C, Zheng R, Zhou M, Lin C, Zeng H, et al. Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment. Lancet Glob Health. 2019;7:e257–e269.
Marrero JA, Fontana RJ, Fu S, Conjeevaram HS, Su GL, Lok AS. Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma. J Hepatol. 2005;42:218–24.
Vandenbulcke H, Moreno C, Colle I, Knebel JF, Francque S, Serste T, et al. Alcohol intake increases the risk of HCC in hepatitis C virus-related compensated cirrhosis: a prospective study. J Hepatol. 2016;65:543–51.
Yang Y, Zhang D, Feng N, Chen G, Liu J, Chen G, et al. Increased intake of vegetables, but not fruit, reduces risk for hepatocellular carcinoma: a meta-analysis. Gastroenterology. 2014;147:1031–42.
Ma Y, Yang W, Simon TG, Smith-Warner SA, Fung TT, Sui J, et al. Dietary patterns and risk of hepatocellular carcinoma among U.S. men and women. Hepatology. 2019;70:577–86.
Baumeister SE, Schlesinger S, Aleksandrova K, Jochem C, Jenab M, Gunter MJ, et al. Association between physical activity and risk of hepatobiliary cancers: a multinational cohort study. J Hepatol. 2019;70:885–92.
Berzigotti A, Saran U, Dufour JF. Physical activity and liver diseases. Hepatology. 2016;63:1026–40.
Pang Y, Kartsonaki C, Guo Y, Chen Y, Yang L, Bian Z, et al. Central adiposity in relation to risk of liver cancer in Chinese adults: A prospective study of 0.5 million people. Int J cancer. 2019;145:1245–53.
Assi N, Gunter MJ, Thomas DC, Leitzmann M, Stepien M, Chajès V, et al. Metabolic signature of healthy lifestyle and its relation with risk of hepatocellular carcinoma in a large European cohort. Am J Clin Nutr. 2018;108:117–26.
Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–55.
Chen Z, Chen J, Collins R, Guo Y, Peto R, Wu F, et al. China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up. Int J Epidemiol. 2011;40:1652–66.
Millwood IY, Li L, Smith M, Guo Y, Yang L, Bian Z, et al. Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates. Int J Epidemiol. 2013;42:816–27.
Lv J, Qi L, Yu C, Yang L, Guo Y, Chen Y, et al. Consumption of spicy foods and total and cause specific mortality: population based cohort study. BMJ. 2015;351:h3942.
Yu C, Shi Z, Lv J, Du H, Qi L, Guo Y, et al. Major dietary patterns in relation to general and central obesity among Chinese adults. Nutrients. 2015;7:5834–49.
Du H, Li L, Bennett D, Guo Y, Key TJ, Bian Z, et al. Fresh fruit consumption and major cardiovascular disease in China. N. Engl J Med. 2016;374:1332–43.
Saran U, Humar B, Kolly P, Dufour JF. Hepatocellular carcinoma and lifestyles. J Hepatol. 2016;64:203–14.
International, W. C. R. F. Diet, nutrition, physical activity and liver cancer (2018).
Obesity. preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep. Ser 894. 2000;i-xii:1–253.
Bragg F, Li L, Smith M, Guo Y, Chen Y, Millwood I, et al. Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank. Diabet Med. 2014;31:540–51.
Koh WP, Robien K, Wang R, Govindarajan S, Yuan JM, Yu MC. Smoking as an independent risk factor for hepatocellular carcinoma: the Singapore Chinese Health Study. Br J Cancer. 2011;105:1430–5.
Mandair DS, Rossi RE, Pericleous M, Whyand T, Caplin M. The impact of diet and nutrition in the prevention and progression of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol. 2014;8:369–82.
Behrens G, Matthews CE, Moore SC, Freedman ND, McGlynn KA, Everhart JE, et al. The association between frequency of vigorous physical activity and hepatobiliary cancers in the NIH-AARP Diet and Health Study. Eur J Epidemiol. 2013;28:55–66.
Liu J, Liang W, Jing W, Liu M. Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019;97:230–8.
Matsumoto A, Tanaka E, Rokuhara A, Kiyosawa K, Kumada H, Omata M, et al. Efficacy of lamivudine for preventing hepatocellular carcinoma in chronic hepatitis B: A multicenter retrospective study of 2795 patients. Hepatol Res. 2005;32:173–84.
Pang Y, Kartsonaki C, Turnbull I, Guo Y, Chen Y, Clarke R, et al. Adiposity in relation to risks of fatty liver, cirrhosis and liver cancer: a prospective study of 0.5 million Chinese adults. Sci Rep. 2019;9:785.
Yu MW, Hsieh HH, Pan WH, Yang CS, CJ CH. Vegetable consumption, serum retinol level, and risk of hepatocellular carcinoma. Cancer Res. 1995;55:1301–5.
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).
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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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). https://doi.org/10.1038/s41416-021-01645-x