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Epidemiology

Impact of overweight and obesity on the risk of hepatocellular carcinoma: a prospective cohort study in 14.3 million Koreans

British Journal of Cancer volume 127, pages 109–115 (2022)Cite this article

Subjects

Abstract

Background

Whether obesity and being overweight, defined by body mass index (BMI), increase hepatocellular carcinoma (HCC) has been less apparent in Asian populations.

Methods

Overall, 14,265,822 Korean adults who underwent routine health examinations during 2003–2006 were followed up for HCC. Multivariable-adjusted hazard ratios (HRs) associated with BMI were calculated.

Results

During 13.7 years (mean) of follow-up, 47,308 individuals developed HCC. HRs of HCC associated with BMIs of 25.0–26.4, 26.5–27.9, 28.0–29.4, 29.5–30.9 and ≥31 kg/m² compared to those for 23.5–24.9 kg/m² were 1.05, 1.20, 1.39, 1.59 and 2.13, respectively. For BMI < 25 kg/m², linear associations were not apparent. For BMI ≥ 25 kg/m2, the HR per 5 kg/m2 increase in BMI was 1.60 (total), 1.60 (men), and 1.59 (women). The corresponding HRs were 1.56, 1.61 and 1.60 for individuals aged <45, 45–64 and ≥65 years, respectively. Further adjustment for alanine transaminase (ALT) levels substantially reduced the HRs for high BMI, especially in men and younger adults.

Conclusions

Overweight and obesity clearly increase HCC risk in Koreans. ALT levels are a mediator of the impact of obesity, but it may not accurately predict high BMI-induced liver damage that can potentially progress to HCC, especially in women and older adults.

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Fig. 1: Age- and sex-adjusted HRs across 11 categories of BMI for HCC incidence.
Fig. 2: HRs across seven categories of BMI for HCC incidence according to age.
Fig. 3: HRs across BMI categories for HCC incidence after further adjustment for mediators (sensitivity analysis).

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Data availability

The data underlying the results presented in the study are available from the National Health Insurance Service (https://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do).

Code availability

All data analyses were performed using SAS, version 9.4 (SAS Institute, Inc., Cary, NC). The code used to perform the analysis is available on request to the authors.

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Funding

This research was supported by Medical Research Promotion Program through the Gangneung Asan Hospital funded by the Asan Foundation (2021IB005).

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Author notes

  1. These authors contributed equally: Baek Gyu Jun, Moonho Kim.

Authors and Affiliations

  1. Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, 01757, Republic of Korea

    Baek Gyu Jun

  2. Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Gangwon-do, 25440, Republic of Korea

    Moonho Kim

  3. Department of Family Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, 31151, Republic of Korea

    Hwang Sik Shin

  4. Institute for Occupational and Environmental Health, Catholic Kwandong University, Gangneung, 25601, Republic of Korea

    Jee-Jeon Yi

  5. Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, 25601, Republic of Korea

    Sang-Wook Yi

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Contributions

BGJ and SWY conceived the study concept and design. SWY acquired the data and performed statistical analyses. BGJ, MK and SWY wrote the first draft. HSS and JJY searched literature. BGJ, MK, SWY, HSS and JJY analysed and interpreted the data. All authors contributed to the critical revision of the manuscript. All authors have read and approved the final submitted version of the manuscript. SWY is the guarantor of this study, and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Sang-Wook Yi.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was performed in accordance with the Declaration of Helsinki. This study was approved by the Institutional Review Board of Catholic Kwandong University. Informed consent was waived because the anonymized data were used that was provided by NHIS according to strong confidentiality protocol.

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Jun, B.G., Kim, M., Shin, H.S. et al. Impact of overweight and obesity on the risk of hepatocellular carcinoma: a prospective cohort study in 14.3 million Koreans. Br J Cancer 127, 109–115 (2022). https://doi.org/10.1038/s41416-022-01771-0

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