Sex-specific differences exist in the association between adiposity and primary liver cancer death, with positive linear associations in women (especially premenopausal) and U-shaped associations in men, and combined CUN-BAE and BMI models best predicted liver cancer death in both sexes.
Key Findings
Results
Women showed positive linear associations between 11 anthropometric indices and primary liver cancer death, with highest-quartile individuals showing 46-82% elevated death risk compared with lowest-quartile counterparts.
11 indices showed positive linear associations in women: five traditional and six emerging anthropometric indices
Highest-quartile women had 46-82% elevated PLC death risk compared with lowest-quartile counterparts
Associations were especially pronounced in premenopausal women
300 women died from PLC over a median follow-up of 22.0 years in a cohort of 72,691 women
Results
Men displayed U-shaped associations between 10 anthropometric indices and primary liver cancer death, indicating death risk was minimized at moderate adiposity levels.
10 indices showed U-shaped (nonlinear) associations with PLC death in men
The U-shaped pattern indicates both low and high adiposity were associated with elevated risk, with lowest risk at moderate adiposity levels
485 men died from PLC over a median follow-up of 16.1 years in a cohort of 59,892 men
The nonlinear pattern in men warrants mechanistic investigation for potential hormonal or metabolic mediators
Results
The combined model incorporating the Clínica Universitaria de Navarra Body Adiposity Estimator (CUN-BAE) and BMI best predicted primary liver cancer death in both sexes.
CUN-BAE is classified as an emerging anthropometric index in this study
The combined CUN-BAE + BMI model outperformed models using individual indices alone for PLC death prediction
This predictive superiority was observed in both women and men
Findings highlight the utility of combined models to identify high-risk individuals
Methods
This study examined 16 anthropometric indices—six traditional and 10 emerging—for sex-specific associations with primary liver cancer death across two prospective Chinese cohorts.
Total study population: 72,691 women and 59,892 men across two prospective cohort studies in China
Cox proportional hazards regression models with restricted cubic spline functions were applied to evaluate associations
Median follow-up was 22.0 years for women and 16.1 years for men
This is described as 'the first comprehensive investigation into the sex-specific associations between 16 anthropometric indices (traditional/emerging) and liver cancer death in two Chinese cohorts'
Results
Premenopausal women showed particularly strong associations between adiposity indices and primary liver cancer death risk.
Among women, premenopausal status was associated with especially elevated PLC death risk at higher adiposity levels
The positive linear pattern in women was described as especially pronounced in premenopausal women
This finding suggests menopausal status may be an important effect modifier of the adiposity-PLC relationship in women
Five traditional and six emerging indices were among the 11 showing positive linear associations in women
Results
Sex-specific differences in the adiposity–liver cancer death relationship were observed across both traditional and emerging anthropometric indices.
Women showed positive linear associations for 11 of 16 indices examined
Men showed U-shaped associations for 10 of 16 indices examined
The divergent patterns (linear vs. U-shaped) were consistent across both traditional and emerging index categories
Findings highlight 'the need for sex-specific adiposity management' according to the authors
What This Means
This research suggests that body fat and body size measurements are linked to death from primary liver cancer differently in men and women. Among over 130,000 Chinese adults followed for up to 22 years, women with higher levels of adiposity (body fatness) across a wide range of measurements—including traditional ones like BMI and newer ones like body shape indices—had a 46 to 82% higher risk of dying from liver cancer compared to women with the lowest adiposity. This risk was especially pronounced in women who had not yet gone through menopause, suggesting that hormonal factors may play a role. In contrast, men showed a more complex U-shaped pattern, where both very low and very high adiposity were associated with increased liver cancer death risk, while men at moderate adiposity levels had the lowest risk.
The study also found that combining two measures—the CUN-BAE (a newer body fat estimator) with traditional BMI—provided the best ability to predict who would die from liver cancer in both men and women. This suggests that using multiple complementary measurements, rather than relying on any single index, may help identify people at higher risk. Notably, this is described as the first study to comprehensively compare 16 different body size and fat measurements (6 traditional, 10 newer/emerging) for their sex-specific links to liver cancer death in Chinese populations.
This research suggests that strategies to manage body weight and adiposity for liver cancer prevention may need to be tailored differently for men and women. The nonlinear (U-shaped) pattern found in men is particularly noteworthy and points to a need for further research into the biological mechanisms—such as hormonal or metabolic pathways—that might explain why both underweight and overweight men face elevated liver cancer mortality risk. Policymakers and healthcare professionals may want to consider sex-specific approaches when designing public health interventions targeting liver cancer risk.
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Yang D, Li H, Shen Q, Wang J, Fang J, Tan Y, et al.. (2026). Large cohort studies assessing sex-specific associations between anthropometric indices and liver cancer death.. JHEP reports : innovation in hepatology. https://doi.org/10.1016/j.jhepr.2026.101812