It remained to be clarified whether obesity and physical activity are associated with the risk of dying from hepatocellular carcinoma (HCC) in individuals with or without diabetes mellitus (DM).
We prospectively followed up 88,116 participants without DM and 3,509 participants with DM. The primary outcomes were deaths from HCC, endemic in Taiwan.
During a maximum of 10 years, there were 271 deaths from HCC. Obesity (BMI was ≥30 kg/m2) was associated with a higher adjusted risk of dying from HCC in total participants and participants without DM (adjusted hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.40 to 4.23). Nonetheless, obesity was not associated with deaths from HCC in participants with DM. On the other hand, inadequate physical activity were observed to be at elevated risk of dying from HCC in total participants (adjusted HR, 1.57; 95% CI, 1.19 to 2.06), participants with DM (adjusted HR, 2.28; 95% CI, 1.16 to 4.48), and participants without DM (adjusted HR, 1.45; 95% CI, 1.07 to 1.96). In subgroup sensitivity analysis for individuals without chronic hepatitis B or C infection, the associations remained similar. The positive association between obesity and HCC deaths in participants without DM persisted in women (adjusted HR, 2.44; 95% CI, 1.20 to 4.96) rather than men. Contrarily, the positive association between inadequate physical activity and risk of dying from HCC persisted in total male participants and male participants with DM (adjusted HR, 2.42; 95% CI, 1.02 to 5.78), but lost in male participants without DM and the female counterparts.
We pioneered to demonstrate the higher HCC mortality related to obesity in individuals without DM and inadequate physical activity regardless of DM. We suggest keeping not obese and physically active to associate with reduced subsequent HCC deaths even in adults without chronic viral hepatitis.