Anthropometric indicators of adiposity and risk of primary liver cancer: A systematic review and dose-response meta-analysis

Background and aims: Adiposity is associated with an increased risk of primary liver cancer (PLC). As the most commonly used indicator of adiposity, the body mass index (BMI) has been questioned for its limitations in reflecting visceral fat. This study aimed to investigate the role of different anthropometric indicators in identifying the risk of PLC by accounting for potential non-linear associations. Methods: Systematic searches were conducted in the PubMed, Embase, Cochrane Library, Sinomed, Web of Science, and CNKI databases. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were used to assess the pooled risk. The dose-response re-lationship was assessed using a restricted cubic spline model. Results: Sixty-nine studies involving more than 30 million participants were included in the final analysis. Regardless of the indicator used, adiposity was strongly associated with an increased risk of PLC. When comparing the HRs per 1-standard deviation increment across indicators of adiposity, the association was strongest for waist-to-height ratio (WHtR) (HR = 1.39), followed by waist-to-hip ratio (WHR) (HR = 1.22), BMI (HR = 1.13), waist cir-cumference (WC) (HR = 1.12), and hip circumference (HC) (HR = 1.12). A strong non-linear

Automated summary

This study investigated the association between different anthropometric indicators and the risk of primary liver cancer. Adiposity was found to be strongly associated with an increased risk of liver cancer, with waist-to-hip ratio and waist-to-height ratio showing the strongest association.