Table 1.
Characteristics of included studies
| First author, Year of publication | Time period; Follow-up | Patients/participants | Deaths; method of outcome assessment | Mean or median BMI; % obese (BMI >30 kg/m2); timing and method of BMI assessment | Association between BMI and mortality (HR, 95% CI) | Covariates adjusted for |
|---|---|---|---|---|---|---|
| Calle, 20035 | 1982–1998, 16y | 900,053 (all cancer-free at inception); unclear what proportion developed HCC), | 620; record linkage with national death index, and personal inquiries by volunteers | NA; NA; BMI assessed based on usual premorbid height and weight (self reported) | Reference: 18.5–24.9kg/m2 Men: 25–29.9 vs. ref: 1.13 (0.94–1.34) 30–34.9 vs. ref: 1.90 (1.46–2.47) 35–39.9 vs. ref: 4.52 (2.94–6.94) Women: 25–29.9 vs. ref: 1.02 (0.80–1.31) 30–34.9 vs. ref: 1.40 (0.97–2.00) 35–39.9 vs. ref: 1.68 (0.93–3.05) |
1,2,3,6,7,9,13,15,16,17,18,24 |
| Parr, 201023 | 1961–1999; 4y | 424,519 (all cancer-free at inception); unclear what proportion developed HCC) | 774; record linkage with registry (ICD coding) | NR; NR; BMI assessed based on usual premorbid height and weight (self reported) | Reference 18.5–24.9 kg/m2 12–18.4 vs. ref: 1.13 (0.78–1.68) 25–29.9 vs. ref: 1.06 (0.87–1.30) 30–60 vs. ref: 1.10 (0.63–1.91) Trend for 5 units rise in BMI >18.5 kg/m2: 1.11 (0.94–1.31) |
1,2,3,7,11,20 |
| Gray, 201122 | 1962–1966; maximum 82 y | 19,593 (all cancer-free at inception); unclear what proportion developed HCC | 69; record linkage with Alumni office and state health department | 24.4; NR; premorbid BMI assessed at inception (measured) | Reference <22.8 kg/m2 22.8 – < 24.3 vs. ref: 1.15 (0.55–2.41) 24.3–<25.8 vs. ref: 0.96 (0.42–2.18) >25.8 vs. ref: 0.91 (0.35–2.40) |
1, 2, 3, 18 |
| Meyer, 201520 | 1997–1993; mean 18.9 years | 35,703 (all cancer-free at inception); unclear what proportion developed HCC | 81; record linkage with Swiss National Cohort | 24.3; 7.9%; premorbid BMI assessed at inception (measured and self reported in different cohorts) | Reference < 25 kg/m2 25–29.9 vs. ref: 1.28 (0.77–2.12) > 30 vs. ref: 2.21 (1.18–4.15) |
1,2,7,9, 11, 17, 18, 20,21, |
| Batty, 20056 | 1967–1970; median 28.1 years | 17, 102 (all cancer-free at inception); unclear what proportion developed HCC) | 51; record linkage with National Health Service Central Registry (NHSCR) | NR;4.2%; premorbid BMI assessed at inception (measured) | Reference 18.5–25 kg/m2 25–29.9 vs. ref: 0.99 (0.53 – 1.88) > 30 vs. ref: 3.76 (1.36 – 10.40) |
1,2,3,4, 5, 8, 10,17,18, 19, 23, 25 |
| Hart, 201021 | 1965–1976 across 3 subgroup studies; median 26 years | 26,738 (all cancer-free at inception); unclear what proportion developed HCC) | 69; record linkage with NHS | NR;8% men and 14% women; premorbid BMI assessed at inception (measured and self reported in different cohorts) | Reference 18.5–25 kg/m2 Men 25–29.9 vs. ref: 1.01 (0.54 – 1.91) > 30 vs. ref: 3.05 (1.33 – 7.00) Women 25–29.9 vs. ref: 1.06 (0.40 – 2.80) > 30 vs. ref: 1.11 (0.24–5.27) |
1,3,4,5,8,20,25, 26,27,28 |
| Li, 201340 | 1988–1990; median 19 years | 72,473 (all cancer-free at inception); unclear what proportion developed HCC) | 527; review of death certificates | 22.7 in men and 23.0 in women ; NR; premorbid BMI assessed at inception (self-reported) | Reference 21.0–22.9 kg/m2 Men <18.5 vs. ref: 1.42 (0.93 – 2.15) 18.5–20.9 vs. ref: 1.09 (0.81– 1.48) 23.0–24.9 vs. ref: 1.04 (0.76 – 1.42) > 25 vs. ref: 1.15 (0.83 – 1.60) Women <18.5 vs. ref: 0.74 (0.35 – 1.60) 18.5–20.9 vs. ref: 1.08 (0.69– 1.68) 23.0–24.9 vs. ref: 1.16 (0.75 – 1.79) > 25 vs. ref: 1.42 (0.95 – 2.13) |
1,3,4,7,8,11,18,29,30,31,32 |
| Park, 200619 | 1996–2002; median 1.9 years | 14,578 (all had cancer at inception, of which 2,815 had HCC) | 2,171; record linkage with National Statistical Office | NR; 1%; premorbid BMI assessed at inception (measured) | Reference: BMI<23kg/m2 23–24.9 vs. ref: 0.83 (0.75–0.93) ≥25 vs. ref: 1.03 (0.92–1.14) |
1,2,4,5,6,7,10,15,18,19,21 |
| Tseng, 201241 | 1995–1998; 12 years | 88,694 (all cancer-free at inception); unclear what proportion developed HCC) | 1,345; record linkage with national registry | NR; NR; NR | Reference: 18.5–22.9 kg/m2 <18.5 vs. ref: 1.15 (0.84–1.58) 23–24.9 vs. ref: 0.86 (0.76–0.97) ≥25 vs. ref: 0.77 (0.66–0.89) |
1,2,3,4,33 |
NR-not reported, HCC-hepatocellular cancer, BMI-body mass index, HR-hazard ratio, CI-confidence interval 1-Age, 2-Sex, 3-Smoking, 4-Diabetes mellitus/fasting glucose, 5-Hypertension/blood pressure/antihypertensive medication, 6-Race/ethnicity, 7-Alcohol intake, 8-Socioeconomic status/housing status/occupation, 9-Education, 10-Hyperlipidemia/hypercholesterolemia/cholesterol levels, 11-Region/Nation, 12-Reproductive history, 13-Hormone replacement therapy use, 14-Time since menopause, 15-Fat/vegetable consumption, 16-Aspirin use, 17-Marital status, 18-Physical activity/Exercise, 19-Comorbidities, 20-Particular study (in pooled studies), 21-Healthy diet, 22-Family history of malignancy, 23-Skin fold thickness, 24-Study year, 25-Pulmonary function tests, 26-MI/Angina, 27-Bronchitis, 28-Height, 29-Consumption of coffee/fish, 30-History of liver disease, 31-History of disease of gall bladder, 32-History of transfusion, 33-History of insulin use, 34-History of cirrhosis, 35-History of chronic Hepatitis B, 36-History of Hepatitis C