The Association Between Physical Activity, Sedentary Time, and Sleep with Risk of Hepatocellular Carcinoma in...

The majority of hepatocellular carcinoma (HCC) cases arise in patients with cirrhosis, with known major risk factors of hepatitis B (HBV) or C (HCV) infection, metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol-associated liver disease (ALD). However, the impact of additional risk factors that act independently or jointly on the pathogenesis of HCC in cirrhosis patients is unknown. The aim of this study was to determine whether sleep, sedentariness, or physical activity levels play a role in the progression of cirrhosis to HCC.

We systematically collected data on sleep, sedentary time, and physical activity from the ongoing prospective study, the Texas HCC Consortium Cohort, which recruited patients with cirrhosis from December 2016 and followed up until HCC development, death, or May 2024. Hazard ratios (HRs) were calculated using Fine-Gray competing risk regression models to evaluate the independent association between sleep, sedentary, and physical activity levels with the risk of HCC overall and in groups stratified by major HCC risk factors.

Of 3940 patients with cirrhosis (mean age = 59.9 years, 39.1% women), 9.3% of patients had active HCV, 34.6% had MASLD, 41.5% had MetALD, and 3.2% had ALD only. In total, 208 patients developed incident HCC (annual incidence rate, 2.37% [95% CI 2.07, 2.72%]). After adjustment for demographic and clinical factors, absent levels of light physical activity (HR = 0.92 [0.57-1.47]), excessive sitting time (HR = 0.91 [0.57-1.44]), and reduced sleep duration (HR = 0.92 [0.65-1.29]) were not associated with an increased risk of HCC development. There were no associations with increased risk of HCC development across all sub-groups examined.

In this study, the risk of HCC in patients with cirrhosis was not significantly affected by level of light physical activity, sedentariness, or sleep across all major etiologies of cirrhosis.