Physical activity compared to adiposity and risk of liver-related mortality: Results from two prospective, nationwide cohorts

JOURNAL OF HEPATOLOGY

卷:72

Article

Simon, Tracey G.^1,2,3  Kim, Mi Na^3,4  Luo, Xiao^2,5  Yang, Wanshui^2,6  Ma, Yanan^2,6  Chong, Dawn Q.⁷  Fuchs, Charles S.⁸  Meyerhardt, Jeffrey A.^2,9  Corey, Kathleen E.^1,2,3  Chung, Raymond T.^1,2  Stampfer, Meir^2,6,10,11  Zhang, Xuehong²  Giovannucci, Edward L.^2,6,10,11  Chan, Andrew T.^{1,2,3,6,12,13} 

[1] Massachusetts Gen Hosp, Dept Med, Div Gastroenterol, Boston, MA 02114 USA

[2] Harvard Med Sch, Boston, MA 02115 USA

[3] Massachusetts Gen Hosp, Clin & Translat Epidemiol Unit CTEU, Boston, MA 02114 USA

[4] CHA Univ, Div Gastroenterol, Dept Internal Med, CHA Bundang Med Ctr,Sch Med, Seongnam, South Korea

[5] China Med Univ, Sch Publ Hlth, Shenyang, Liaoning, Peoples R China

[6] Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA

[7] Natl Canc Ctr Singapore, Singapore, Singapore

[8] Yale Univ, Canc Ctr, New Haven, CT USA

[9] Dana Farber Canc Ctr, Boston, MA USA

[10] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[11] Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA USA

[12] Broad Inst, Boston, MA USA

[13] Harvard TH Chan Sch Publ Hlth, Dept Immunol & Infect Dis, Boston, MA USA

关键词: Cirrhosis;    Lifestyle;    Modifiable risk factor;    Prevention;   

DOI  :  10.1016/j.jhep.2019.12.022

来源: Elsevier

【 摘 要 】

Background & Aims: Obesity in adulthood has been associated with increased risk of liver-related mortality. Whether higher levels of physical activity counteract the excess risk conferred by obesity remains unknown. We simultaneously evaluated the long-term impact of physical activity and adiposity on liver-related mortality, within 2 nationwide populations. Methods: We conducted a prospective cohort study of 77,238 women and 48,026 men, with detailed, validated assessments of weekly physical activity (metabolic equivalent task [MET]hours]), adiposity (body mass index [BMI], waist circumference), and diet, alcohol use and clinical comorbidities, biennially from 1986 through 2012. Using Cox proportional hazards regression models, we calculated multivariable-adjusted hazard ratios (aHRs) and 95% CIs for liver-related mortality, including death from hepatocellular carcinoma (HCC) and other complications of cirrhosis. Results: Over 1,856,226 person-years, we recorded 295 liver-related deaths (108 HCC; 187 cirrhosis). Risk of liver-related mortality increased monotonically with higher BMI during adulthood (ptrend<0.0001) and with weight gain during early adulthood (ptrend<0.0001). The risk of liver-related mortality also declined progressively, with increasing physical activity (ptrend = 0.0003); the aHRs across increasing physical activity quintiles were: 1.0, 0.70 (95% CI 0.51-0.96), 0.59 (95% CI 0.42-0.84), 0.52 (95% CI 0.36-0.74) and 0.46 (95% CI 0.31-0.66). Compared to lean-active adults (BMI <25; >= 18 MET-hours/week), the aHRs for obese-active, lean-sedentary, and obese-sedentary adults were: 1.04 (95% CI 0.73-1.37), 2.08 (95% CI 1.21-3.33) and 3.40 (95% CI 2.06-5.56), respectively. Findings were similar for HCC-specific and cirrhosis-specific mortality. Overall, engaging in average-pace walking for >3 hours/week could have prevented 25% of liver-related deaths (95% CI 0.12-0.38). Conclusions: In 2 prospective, nationwide cohorts, both excess adiposity and reduced physical activity were significant predictors of liver-related mortality. Achieving higher physical activity levels counteracted the excess liver-related risks associated with obesity. Lay summary: This is the first large, prospective cohort study to simultaneously evaluate the impact of obesity and physical activity on the long-term risk of liver-related mortality in 2 nationwide populations of American men and women. The study demonstrated that obesity predicted significantly increased risk of liver-related mortality, while physical activity predicted significantly lower risk of liver-related mortality. Importantly, the excess risk of liver-related mortality observed with obesity was no longer statistically significant among adults who engaged in the equivalent of average-pace walking for 3 hours or more, per week. (C) 2020 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.

【 授权许可】

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