Higher total physical activity, as well as vigorous physical activity, was found to be associated with a reduced risk of hepatocellular carcinoma (HCC), according to a study published in the Journal of Hepatology.

Researchers used the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, a multinational prospective study that analyzes the link between diet, lifestyle, and environmental factors with cancer risk and chronic diseases, to identify the relationship between physical activity and hepatobiliary cancer risk. From 1992 to 2000, men and women aged 25 to 70 years (n= 467,336) were recruited from 23 European centers; patient data on physical activity, education, smoking, alcohol consumption, coffee intake, anthropometric measurements, and medical history were collected at baseline. Of these patients, 275 were identified with HCC, 93 with intrahepatic bile duct cancers (IHBC), and 164 with nongallbladder extrahepatic bile duct cancers (NGBC).

The EPIC physical activity questionnaire was used to assess recreational, household, and occupational physical activity. Recreational activities such as cycling and physical exercises were calculated by the amount of time — in hours per week — spent performing these activities and summarized into 4 categories: inactive, moderately inactive, moderately active, and active. Occupational physical therapy was patient reported as either sedentary, standing, manual, or heavy manual work. Patients were also asked whether engaging in household or physical activity caused increased sweating or heart rate and, if so, how many hours per week they dedicated to vigorous physical activities.

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Patient mean age was 51.3 years; 70.2% were women. Follow-up occurred at 14.9 years or 6,508,182 person-years. Comparing active and inactive individuals resulted in an adjusted hazard ratio (HR) for HCC of 0.55. For HCC risk with >2 h/wk of vigorous activity vs no vigorous activity, the adjusted HR was 0.50. These outcomes were not modified by sex, age, waist circumference, body mass index (BMI), smoking, current alcohol consumption, or lifetime alcohol consumption. Total and vigorous physical activity were unrelated to IHBC or NGBC risk.

In the analysis of the associations with HCC that were mediated by waist circumference, BMI, and diabetes, waist circumference explained 40% and BMI explained 30% of the association of total physical activity and HCC. Of the total effect of vigorous physical activity on HCC mediated by waist circumference and BMI, the proportions were 17% and 12%, respectively. Diabetes did not mediate the associations.

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“Studies with more detailed and objectively measured physical activity assessed at multiple time points throughout the life course are warranted to confirm our findings and may help establish the optimal dose, type, intensity, and timing of physical activity that is needed to prevent HCC,” the authors concluded.


Baumeister SE, Schlesinger S, Aleksandrova K, et al. Association of physical activity and risk of hepatobiliary cancers: a multinational cohort study [published December 21, 2018]. J Hepatol. doi: 10.1016/j.jhep.2018.12.014