@article{3106063,
    title = "Association between physical activity and risk of hepatobiliary cancers: A multinational cohort study",
    author = "Baumeister, S.E. and Schlesinger, S. and Aleksandrova, K. and Jochem, C. and Jenab, M. and Gunter, M.J. and Overvad, K. and Tjønneland, A. and Boutron-Ruault, M.-C. and Carbonnel, F. and Fournier, A. and Kühn, T. and Kaaks, R. and Pischon, T. and Boeing, H. and Trichopoulou, A. and Bamia, C. and La Vecchia, C. and Masala, G. and Panico, S. and Fasanelli, F. and Tumino, R. and Grioni, S. and Bueno de Mesquita, B. and Vermeulen, R. and May, A.M. and Borch, K.B. and Oyeyemi, S.O. and Ardanaz, E. and Rodríguez-Barranco, M. and Dolores Chirlaque López, M. and Felez-Nobrega, M. and Sonestedt, E. and Ohlsson, B. and Hemmingsson, O. and Werner, M. and Perez-Cornago, A. and Ferrari, P. and Stepien, M. and Freisling, H. and Tsilidis, K.K. and Ward, H. and Riboli, E. and Weiderpass, E. and Leitzmann, M.F.",
    journal = "WORLD JOURNAL OF HEPATOLOGY",
    year = "2019",
    volume = "70",
    number = "5",
    pages = "885-892",
    publisher = "Elsevier B.V.",
    doi = "10.1016/j.jhep.2018.12.014",
    keywords = "adult;  aged;  Article;  bile duct carcinoma;  body mass;  cancer risk;  cohort analysis;  confounding variable;  European;  female;  follow up;  hazard ratio;  hepatobiliary system cancer;  human;  liver cell carcinoma;  major clinical study;  male;  physical activity;  priority journal;  sensitivity analysis;  waist circumference;  bile duct cancer;  complication;  exercise;  liver cell carcinoma;  liver tumor;  middle aged;  obesity;  pathophysiology;  prospective study;  risk, Adult;  Aged;  Bile Duct Neoplasms;  Carcinoma, Hepatocellular;  Exercise;  Female;  Humans;  Liver Neoplasms;  Male;  Middle Aged;  Obesity;  Prospective Studies;  Risk",
    abstract = "Background & Aims: To date, evidence on the association between physical activity and risk of hepatobiliary cancers has been inconclusive. We examined this association in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC). Methods: We identified 275 hepatocellular carcinoma (HCC) cases, 93 intrahepatic bile duct cancers (IHBCs), and 164 non-gallbladder extrahepatic bile duct cancers (NGBCs) among 467,336 EPIC participants (median follow-up 14.9 years). We estimated cause-specific hazard ratios (HRs) for total physical activity and vigorous physical activity and performed mediation analysis and secondary analyses to assess robustness to confounding (e.g. due to hepatitis virus infection). Results: In the EPIC cohort, the multivariable-adjusted HR of HCC was 0.55 (95% CI 0.38–0.80) comparing active and inactive individuals. Regarding vigorous physical activity, for those reporting >2 hours/week compared to those with no vigorous activity, the HR for HCC was 0.50 (95% CI 0.33–0.76). Estimates were similar in sensitivity analyses for confounding. Total and vigorous physical activity were unrelated to IHBC and NGBC. In mediation analysis, waist circumference explained about 40% and body mass index 30% of the overall association of total physical activity and HCC. Conclusions: These findings suggest an inverse association between physical activity and risk of HCC, which is potentially mediated by obesity. Lay summary: In a pan-European study of 467,336 men and women, we found that physical activity is associated with a reduced risk of developing liver cancers over the next decade. This risk was independent of other liver cancer risk factors, and did not vary by age, gender, smoking status, body weight, and alcohol consumption. © 2019 European Association for the Study of the Liver"
}