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Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis.

ABSTRACT: OBJECTIVE:Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature. DESIGN:For the pooled analysis, we utilized the Liver Cancer Pooling Project, a consortium of 13 US-based, prospective cohort studies with data from 1,541,143 individuals (ICC cases n?=?414). In our systematic review, we identified 14 additional studies. We then conducted a meta-analysis, combining the results from LCPP with results from the 5 prospective studies identified through September 2017. RESULTS:In the LCPP, obesity and diabetes were associated with a 62% [Hazard Ratio (HR)?=?1.62, 95% Confidence Interval (CI): 1.24-2.12] and an 81% (HR?=?1.81, 95% CI: 1.33-2.46) increased ICC risk, respectively. In the meta-analysis of prospectively ascertained cohorts and nested case-control studies, obesity was associated with a 49% increased ICC risk [Relative Risk (RR)?=?1.49, 95% CI: 1.32-1.70; n?=?4 studies; I2?=?0%]. Diabetes was associated with a 53% increased ICC risk (RR?=?1.53, 95% CI: 1.31-1.78; n?=?6 studies). While we noted heterogeneity between studies (I2?=?67%) for diabetes, results were consistent in subgroup analyses. Results from hospital-based case-control studies (n?=?9) were mostly consistent, but these studies are potentially subject to reverse causation. CONCLUSIONS:These findings suggest that obesity and diabetes are associated with increased ICC risk, highlighting similar etiologies of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, additional prospective studies are needed to verify these associations.

SUBMITTER: Petrick JL

PROVIDER: S-EPMC6521884 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis.

Petrick Jessica L JL Thistle Jake E JE Zeleniuch-Jacquotte Anne A Zhang Xuehong X Wactawski-Wende Jean J Van Dyke Alison L AL Stampfer Meir J MJ Sinha Rashmi R Sesso Howard D HD Schairer Catherine C Rosenberg Lynn L Rohan Thomas E TE Robien Kim K Purdue Mark P MP Poynter Jenny N JN Palmer Julie R JR Newton Christina C CC Linet Martha S MS Liao Linda M LM Lee I-Min IM Koshiol Jill J Kitahara Cari M CM Hofmann Jonathan N JN Graubard Barry I BI Giovannucci Edward E Gaziano Michael J MJ Gapstur Susan M SM Freedman Neal D ND Chong Dawn Q DQ Chan Andrew T AT Buring Julie E JE Freeman Laura Beane E LBE Campbell Peter T PT McGlynn Katherine A KA

The American journal of gastroenterology 20180903 10

<h4>Objective</h4>Obesity and diabetes are associated with an increased liver cancer risk. However, most studies have examined all primary liver cancers or hepatocellular carcinoma, with few studies evaluating intrahepatic cholangiocarcinoma (ICC), the second most common type of liver cancer. Thus, we examined the association between obesity and diabetes and ICC risk in a pooled analysis and conducted a systematic review/meta-analysis of the literature.<h4>Design</h4>For the pooled analysis, we ...[more]

PMID: 30177781

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Project description:BackgroundPregestational excessive body mass index (BMI) is linked to an increased risk for gestational diabetes mellitus (GDM), but less is known on the effect of adolescent BMI on GDM occurrence. The study aimed to investigate possible associations of adolescent BMI and changes in BMI experienced before first pregnancy, with gestational diabetes risk.MethodsThis retrospective study was based on linkage of a military screening database of adolescent health status (Israel Defence Forces) including measured height and weight, with medical records (Maccabi Healthcare Services, MHS) of a state-mandated health provider. The latter covers about 25% of the Israeli population; about 90% of pregnant women undergo screening by the two-step Carpenter-Coustan method. Adolescent BMI was categorized according to Center of Disease Control and Prevention percentiles. Only first documented pregnanies were analyzed and GDM was the outcome.FindingsOf 190,905 nulliparous women, 10,265 (5.4%) developed GDM. Incidence proportions of GDM were 5.1%, 6.1%, 7.3%, and 8.9% among women with adolescent normal BMI, underweight, overweight, and obesity (p<0.001), respectively. In models that accounted for age at pregnancy, birth year, and sociodemographic variables, the adjusted odd ratios (aORs) for developing GDM were: 1.2 (95%CI, 1.1-1.3), 1.5 (1.4-1.6), and 1.9 (1.7-2.1) for adolescent underweight, overweight, and obesity (reference group, normal BMI). Adolescent BMI tracked with BMI notes in the pre-pregnancy period (r=63%). Resuming normal pre-pregnancy BMI from overweight or obesity in adolescence diminished GDM risk, but this diminished risk was not observed among those who returned to a normal per-pre-pregnancy BMI from being underweight in adolescence. Sustained overweight or obesity conferred an aOR for developing GDM of 2.5 (2.2-2.7); weight gain from adolescent underweight and normal BMI to pre-pregnancy excessive BMI conferred aORs of 3.1 (1.6-6.2) and 2.6 (2.2-2.7), respectively.InterpretationChange in BMI status from adolescence to pre-pregnancy may contribute to GDM risk. Identifying at-risk populations is important for early preventive interventions.FundingNone.

Dataset Information

Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis.

Publications

Body Mass Index, Diabetes and Intrahepatic Cholangiocarcinoma Risk: The Liver Cancer Pooling Project and Meta-analysis.

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