Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany; Institute for Community Medicine, University Medicine Greifswald, Germany. Electronic address: firstname.lastname@example.org.
Junior Research Group Systematic Reviews, Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany.
Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
Department of Public Health, Section for Epidemiology, Aarhus University, Denmark.
Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France; Institut Gustave Roussy, Villejuif, France.
Institut Gustave Roussy, Villejuif, France; Department of Gastroenterology, Bicêtre University Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin Bicêtre, France.
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
Hellenic Health Foundation, Athens, Greece; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece.
Hellenic Health Foundation, Athens, Greece; Dept. of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy.
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for cancer research, prevention and clinical network (ISPRO) Florence, Italy.
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
Cancer Registry and Histopathology Department, "Civic - M.P. Arezzo" Hospital, ASP Ragusa, Italy.
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milano, Italy.
Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Institute for Risk Assessment Sciences, Utrecht University, The Netherlands; Julius Centre for Public Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.
Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Spain.
Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
Department of Surgical and Perioperative Sciences, Umeå University, Sweden.
Department of Public Health and Clinical Medicine, Umeå University, Sweden.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland.
BACKGROUND & AIMS:
Evidence on the association between physical activity and risk of hepatobiliary cancers is inconclusive. We examined this association in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC).
We identified 275 hepatocellular carcinoma (HCC) cases, 93 intrahepatic bile duct cancers (IHBC), and 164 non-gallbladder extrahepatic bile duct cancers (NGBC) among 467,336 EPIC participants (median follow-up 14.9 years). We estimated cause-specific hazard ratios (HRs) for total physical activity and vigorous physical activity, performed mediation analysis, and secondary analyses to assess robustness to confounding (e.g., due to hepatitis virus infection).
In the EPIC cohort, the multivariable-adjusted HR of HCC was 0.55 (95% confidence intervals (CI) 0.38-0.80) comparing active and inactive individuals. Regarding vigorous physical activity, for those reporting >2 hours/week compared to those with no vigorous activity, the HR for HCC was 0.50 (0.33-0.76). Estimates were similar in sensitivity analyses for confounding. Total and vigorous physical activity were unrelated to IHBC and NGBC. In mediation analysis, waist circumference explained about 40% and body mass index 30% of the overall association of total physical activity and HCC.
Findings suggest an inverse association between physical activity and risk of HCC, which is potentially mediated by obesity.
In a pan-European study of 467,336 men and women, we found that physical activity is associated with a reduced risk of developing liver cancers over the next decade. This risk was independent of other liver cancer risk factors, and did not vary by age, gender, smoking status, body weight, and alcohol consumption.