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Obesity Is Associated With Biliary Tract Cancer Mortality and Incidence: A Pooled Analysis of 21 Cohort Studies in the Asia Cohort Consortium Publisher Pubmed



Oze I1 ; Ito H2, 3 ; Koyanagi YN2 ; Abe SK4 ; Rahman MS4, 5 ; Islam MR4, 6 ; Saito E7 ; Gupta PC8 ; Sawada N9 ; Tamakoshi A10 ; Shu XO11 ; Sakata R12 ; Malekzadeh R13 ; Tsuji I14 Show All Authors
Authors
  1. Oze I1
  2. Ito H2, 3
  3. Koyanagi YN2
  4. Abe SK4
  5. Rahman MS4, 5
  6. Islam MR4, 6
  7. Saito E7
  8. Gupta PC8
  9. Sawada N9
  10. Tamakoshi A10
  11. Shu XO11
  12. Sakata R12
  13. Malekzadeh R13
  14. Tsuji I14
  15. Kim J15
  16. Nagata C16
  17. You SL17
  18. Park SK18
  19. Yuan JM19, 20
  20. Shin MH21
  21. Kweon SS22
  22. Pednekar MS8
  23. Tsugane S9, 23
  24. Kimura T10
  25. Gao YT24, 25
  26. Cai H11
  27. Pourshams A26
  28. Lu Y14
  29. Kanemura S14
  30. Wada K16
  31. Sugawara Y14
  32. Chen CJ27
  33. Chen Y28
  34. Shin A18, 29
  35. Wang R19
  36. Ahn YO18
  37. Shin MH21
  38. Ahsan H30
  39. Boffetta P31, 32
  40. Chia KS33
  41. Qiao YL34
  42. Rothman N35
  43. Zheng W11
  44. Inoue M4
  45. Kang D36
  46. Matsuo K1, 37

Source: International Journal of Cancer Published:2024


Abstract

Body fatness is considered a probable risk factor for biliary tract cancer (BTC), whereas cholelithiasis is an established factor. Nevertheless, although obesity is an established risk factor for cholelithiasis, previous studies of the association of body mass index (BMI) and BTC did not take the effect of cholelithiasis fully into account. To better understand the effect of BMI on BTC, we conducted a pooled analysis using population-based cohort studies in Asians. In total, 905 530 subjects from 21 cohort studies participating in the Asia Cohort Consortium were included. BMI was categorized into four groups: underweight (<18.5 kg/m2); normal (18.5-22.9 kg/m2); overweight (23-24.9 kg/m2); and obese (25+ kg/m2). The association between BMI and BTC incidence and mortality was assessed using hazard ratios (HR) and 95% confidence intervals (CIs) by Cox regression models with shared frailty. Mediation analysis was used to decompose the association into a direct and an indirect (mediated) effect. Compared to normal BMI, high BMI was associated with BTC mortality (HR 1.19 [CI 1.02-1.38] for males, HR 1.30 [1.14-1.49] for females). Cholelithiasis had significant interaction with BMI on BTC risk. BMI was associated with BTC risk directly and through cholelithiasis in females, whereas the association was unclear in males. When cholelithiasis was present, BMI was not associated with BTC death in either males or females. BMI was associated with BTC death among females without cholelithiasis. This study suggests BMI is associated with BTC mortality in Asians. Cholelithiasis appears to contribute to the association; and moreover, obesity appears to increase BTC risk without cholelithiasis. © 2023 UICC.
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