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Epidemiology

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

British Journal of Cancer volume 126, pages 815–821 (2022)Cite this article

Subjects

Abstract

Background

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

Methods

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.

Results

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.

Conclusions

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.

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Data availability

Details of the CKB data are available upon reasonable request (http://www.ckbiobank.org/site/Data+Access).

References

  1. 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.

    Article  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  CAS  Google Scholar 

  5. 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.

    Article  CAS  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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.

    Article  CAS  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. Berzigotti A, Saran U, Dufour JF. Physical activity and liver diseases. Hepatology. 2016;63:1026–40.

    Article  CAS  Google Scholar 

  10. 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.

    Article  CAS  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–55.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  CAS  Google Scholar 

  18. Saran U, Humar B, Kolly P, Dufour JF. Hepatocellular carcinoma and lifestyles. J Hepatol. 2016;64:203–14.

    Article  Google Scholar 

  19. International, W. C. R. F. Diet, nutrition, physical activity and liver cancer (2018).

  20. Obesity. preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep. Ser 894. 2000;i-xii:1–253.

    Google Scholar 

  21. 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.

    Article  CAS  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Liu J, Liang W, Jing W, Liu M. Countdown to 2030: eliminating hepatitis B disease, China. Bull World Health Organ. 2019;97:230–8.

    Article  Google Scholar 

  26. 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.

    Article  CAS  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. 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.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Funding

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).

Author information

Author notes

  1. These authors contributed equally: Ci Song, Jun Lv, Chengxiao Yu.

Authors and Affiliations

  1. Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China

    Ci Song, Chengxiao Yu, Meng Zhu, Tao Jiang, Hongxia Ma, Guangfu Jin, Hongbing Shen & Zhibin Hu

  2. Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China

    Ci Song, Chengxiao Yu, Meng Zhu, Tao Jiang, Hongxia Ma, Guangfu Jin, Hongbing Shen & Zhibin Hu

  3. Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China

    Jun Lv, Canqing Yu & Liming Li

  4. Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China

    Jun Lv, Canqing Yu & Liming Li

  5. The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, China

    Chengxiao Yu

  6. Chinese Academy of Medical Sciences, Beijing, 100730, China

    Yu Guo

  7. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Ling Yang, Yiping Chen & Zhengming Chen

Authors
  1. Ci Song
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Contributions

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.

Ethics declarations

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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Not applicable.

Competing interests

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). https://doi.org/10.1038/s41416-021-01645-x

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