超重和肥胖对肝细胞癌风险的影响：一项对 1430 万韩国人的前瞻性队列研究。
Impact of overweight and obesity on the risk of hepatocellular carcinoma: a prospective cohort study in 14.3 million Koreans.
机构信息
Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, 01757, Republic of Korea.
Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung-si, Gangwon-do, 25440, Republic of Korea.
出版信息
Br J Cancer. 2022 Jul;127(1):109-115. doi: 10.1038/s41416-022-01771-0. Epub 2022 Mar 5.
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/m, the HR per 5 kg/m 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.
背景
身体质量指数（BMI）定义的肥胖和超重是否会增加肝细胞癌（HCC），在亚洲人群中表现得并不明显。
方法
共有 14265822 名韩国成年人在 2003-2006 年期间接受了常规健康检查，对他们进行了 HCC 的随访。计算了与 BMI 相关的多变量调整后的风险比（HR）。
结果
在 13.7 年（平均）的随访期间，47308 人发生 HCC。与 BMI 为 23.5-24.9kg/m²相比，BMI 为 25.0-26.4kg/m²、26.5-27.9kg/m²、28.0-29.4kg/m²、29.5-30.9kg/m²和≥31kg/m²的个体发生 HCC 的 HR 分别为 1.05、1.20、1.39、1.59 和 2.13。对于 BMI<25kg/m²，线性关联不明显。对于 BMI≥25kg/m²，BMI 每增加 5kg/m²，HR 为 1.60（总人群）、1.60（男性）和 1.59（女性）。对于年龄<45 岁、45-64 岁和≥65 岁的个体，相应的 HR 分别为 1.56、1.61 和 1.60。进一步调整丙氨酸氨基转移酶（ALT）水平后，高 BMI 的 HR 明显降低，尤其是在男性和年轻成年人中。
结论
超重和肥胖明显增加了韩国人 HCC 的风险。ALT 水平是肥胖影响的中介，但它可能无法准确预测可能进展为 HCC 的高 BMI 引起的肝损伤，尤其是在女性和老年人群中。
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