Pooled Analysis of the Associations between Body Mass Index, Total Cholesterol, and Liver Cancer-related Mortality in Japan

Document Type : Research Articles


1 Department of Public Health, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.

2 Research Unit of Advanced Interdisciplinary Care Science, Osaka City University Graduate School of Human Life Science, Osaka, Japan.

3 Department of Medical Statistics, Toho University Faculty of Medicine, Tokyo, Japan.

4 Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

5 Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan.

6 Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

7 Graduate School of Medicine, Tohoku University, Miyagi, Japan.

8 Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan.

9 Department of Public Health, Shiga University of Medical Science, Shiga, Japan.

10 Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.

11 Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.


Objective: We employed a large-scale pooled analysis to investigate the association of liver cancer-related
mortality with being overweight/obese and total cholesterol (TC) levels, since limited and inconsistent data on these
associations exist in Japan. Methods: A total of 59,332 participants (23,853 men and 35,479 women) from 12 cohorts
without a history of cancer who were followed for a median of 14.3 years were analyzed. A sex-specific stratified
Cox proportional hazards model adjusted for age and other potential confounders was used to calculate hazard ratios
(HRs) and 95% confidence intervals (CI) for liver cancer-related mortality. Results: A total of 447 participants
(266 men and 181 women) died of liver cancer within the follow-up period. Individuals classified as having a high
BMI (≥25.0 kg/m2) and low TC levels (mortality (HR 7.05, 95% CI 4.41–11.26 in men; HR 8.07, 95% CI 4.76–13.67 in women) when compared with those
in the intermediate BMI (18.5–24.9 kg/m2) and TC (160–219 mg/dL) categories. These associations remained after
limiting the follow-up duration to >5 years. Conclusion: Being overweight/obese, combined with low TC levels, was
strongly associated with liver cancer-related mortality in the EPOCH-JAPAN.


Main Subjects