Highlights
- •BMI, WC, WHR, WHtR, and HC were, respectively, positively associated with risk of PLC.
- •Elevated WC, independent of BMI, was associated with an increased risk of PLC.
- •The incidence of PLC was higher in central adiposity than that in general adiposity.
- •WC might be a more promising predictive indicator for PLC beyond BMI.
Abstract
Background and aims
Adiposity is associated with an increased risk of primary liver cancer (PLC). As the
most commonly used indicator of adiposity, the body mass index (BMI) has been questioned
for its limitations in reflecting visceral fat. This study aimed to investigate the
role of different anthropometric indicators in identifying the risk of PLC by accounting
for potential non-linear associations.
Methods
Systematic searches were conducted in the PubMed, Embase, Cochrane Library, Sinomed,
Web of Science, and CNKI databases. Hazard ratios (HRs) and the corresponding 95%
confidence intervals (CIs) were used to assess the pooled risk. The dose-response
relationship was assessed using a restricted cubic spline model.
Results
Sixty-nine studies involving more than 30 million participants were included in the
final analysis. Regardless of the indicator used, adiposity was strongly associated
with an increased risk of PLC. When comparing the HRs per 1-standard deviation increment
across indicators of adiposity, the association was strongest for waist-to-height
ratio (WHtR) (HR = 1.39), followed by waist-to-hip ratio (WHR) (HR = 1.22), BMI (HR = 1.13), waist circumference (WC) (HR = 1.12), and hip circumference (HC) (HR = 1.12). A strong non-linear association was observed between each anthropometric
parameter and the risk of PLC, regardless of whether the original or decentralised
value was used. The positive association between WC and PLC risk remained substantial
after adjusting for BMI. The incidence of PLC was higher with central adiposity (52.89
per 100,000 person-years, 95% CI = 50.33–55.44) than general adiposity (39.01 per
100,000 person-years, 95% CI = 37.26–40.75).
Conclusion
Central adiposity seems to contribute more to the development of PLC than general
adiposity. A larger WC, independent of BMI, was strongly associated with the risk
of PLC and might be a more promising predictive indicator than BMI.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: March 07, 2023
Accepted:
March 1,
2023
Received in revised form:
January 29,
2023
Received:
December 17,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
