Association of Physical Activity, Including Amount and Maintenance, with the Risk of HCC among Patients with Type 2 Diabetes

Background & Aims We investigated the association of the amount and change of physical activity (PA) with the risk of HCC in patients with type 2 diabetes. Methods Patients with type 2 diabetes who had undergone health examinations in 2009 and 2011 were enrolled. In total, 1,439,152 patients were included in the analysis. The level of PA was classified as inactive (<500 metabolic equivalent task [MET]-min/week), moderately active (500-1500 MET-min/week), and active (≥1500 MET-min/week). Change in PA was categorized as persistently no active PA, newly active PA, active PA quitter, and persistently active PA according to change of active PA between 2009 and 2011. Results During a median of 5.2 years of follow-up, 22,686 patients developed HCC. Compared to the inactive group, the risk of HCC was significantly lower in the moderately active (adjusted hazard ratio [aHR]=0.96, 95% confidence interval [CI]=0.93–0.99), and in active group (aHR=0.95, 95% CI=0.91–0.99). The patients in the persistently active PA group had a significantly lower risk of HCC than those in the persistently no active PA group (aHR=0.91, 95% CI=0.84–0.98). Conclusions Physical activity showed a dose-response preventive effect against HCC in patients with diabetes. Impact and implications Our study investigated the impact of physical activity (PA) levels and changes on the risk of hepatocellular carcinoma (HCC) in patients with type 2 diabetes. PA was associated with a dose-response preventive effect against HCC. Patients in the persistently active PA group had a significantly lower risk of HCC than those in the persistently inactive PA group, while newly active patients and PA quitters had similar risks to the persistently inactive group. Our study highlighted the importance of maintaining regular PA as a preventive strategy against HCC.