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Primary liver cancer is the third leading cause of cancer-related death worldwide. Most patients are diagnosed at late stages with poor prognosis; thus, identification of modifiable risk factors for primary prevention of liver cancer is urgently needed. The well-established risk factors of liver cancer include chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), heavy alcohol consumption, metabolic diseases such as obesity and diabetes, and aflatoxin exposure. However, a large proportion of cancer cases worldwide cannot be explained by current known risk factors. Dietary factors have been suspected as important, but dietary aetiology of liver cancer remains poorly understood. In this review, we summarised and evaluated the observational studies of diet including single nutrients, food and food groups, as well as dietary patterns with the risk of developing liver cancer. Although there are large knowledge gaps between diet and liver cancer risk, current epidemiological evidence supports an important role of diet in liver cancer development. For example, exposure to aflatoxin, heavy alcohol drinking and possibly dairy product (not including yogurt) intake increase, while intake of coffee, fish and tea, light-to-moderate alcohol drinking and several healthy dietary patterns (e.g. Alternative Healthy Eating Index) may decrease liver cancer risk. Future studies with large sample size and accurate diet measurement are warranted and need to consider issues such as the possible aetiological heterogeneity between liver cancer subtypes, the influence of chronic HBV or HCV infection, the high-risk populations (e.g. cirrhosis) and a potential interplay with host gut microbiota or genetic variations.

Epidemiological studies have reported inconsistent association between obesity and risk of bladder cancer, and the dose-response relationship between them has not been clearly defined. We carried out a meta-analysis to summarize available evidence from epidemiological studies on this point. Relevant articles were identified by searching the PubMed and Web of Science databases through September 30, 2014. We pooled the relative risks from individual studies using random-effect model, and the dose-response relationship was estimated by using restricted cubic spline model. Fifteen cohort studies with 38,072 bladder cancer cases among 14,201,500 participants were included. Compared to normal weight, the pooled relative risks and corresponding 95% confidence intervals of bladder cancer were 1.07(1.01-1.14) and 1.10(1.06-1.14) for preobese and obesity, with moderate (I² = 37.6%, P = 0.029) and low (I² = 15.5%, P = 0.241) heterogeneities between studies, respectively. In a dose-response meta-analysis, body mass index (BMI) was associated with bladder cancer risk in a linear fashion (P(non-linearity) = 0.467) and the risk increased by 4.2% for each 5 kg/m2 increase. No significant publication bias was found (P = 0.912 for Begg's test, P = 0.712 for Egger's test). Findings from this dose-response meta-analysis suggest obesity is associated with linear-increased risk of bladder cancer.

Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. The prevalence of T2DM is increasing rapidly in China. Understanding the contribution of modifiable lifestyle factors on T2DM risk is imperative to prevent the development of T2DM in China. We examined associations between lifestyle factors including physical activity, smoking and alcohol consumption with incidence of T2DM among middle-aged and elderly men in urban Shanghai. Information on socio-demographics, lifestyle habits, dietary habits, and disease history was collected via in-person interviews. Anthropometric measurements were taken. A total of 51 464 Chinese men aged 40-74 years free of T2DM, coronary heart disease (CHD), and stroke at baseline were included in the current study. Incident T2DM was identified through follow-up surveys conducted every 2-3 years. Cox proportional hazard analyses were conducted to evaluate associations between lifestyle risk factors and incidence of T2DM. We documented 1304 new cases of T2DM during 276 929 person-years of follow-up (average: 5.4 years). Physical activity was inversely associated with T2DM risk. Daily living, commuting, and total physical activity METs had inverse negative dose-response relationships with T2DM (P-trend = 0.0033, 0.0022, and <0.0001, respectively). Regular participation in exercise or sports reduced T2DM risk (HR = 0.86, 95%CI: 0.76-0.98). Moderate alcohol intake (1-3 drinks/day) was inversely related to T2DM risk (HR = 0.80, 95%CI: 0.67-0.94). Cigarette smoking, on the other hand, was associated with increased T2DM risk; HRs were 1.25 (95%CI: 1.00-1.56) for smoking more than 20 cigarettes per day and 1.28 (95%CI: 1.04-1.57) for smoking more than 40 pack-years. Physical activity and moderate alcohol intake are inversely associated with T2DM risk, whereas smoking was positively associated with T2DM risk among middle-age and elderly Chinese men. Preventive measures should be developed to focus on these modifiable lifestyle habits to reduce the upward trend of T2DM.

To evaluate associations of premature ovarian failure (POF) with mortality and morbidity in Asian populations. We identified 1,003 cases of POF among 36,402 postmenopausal women who participated in the Shanghai Women's Health Study, a population-based cohort study. Cox regression and logistic regression models were applied in data analysis. After adjustment for potential confounding factors, we found that POF increased the risk of total and cancer-specific mortality (HR (95%CIs): 1.29 (1.08-1.54) and 1.38 (1.05-1.81), respectively). POF was also associated with high prevalence of autoimmune disease (OR (95%CI): 1.56 (1.04-2.35)) but decreased incidence of breast cancer (OR (95%CI): 0.59 (0.38-0.91)). Similar results were observed when hormone replacement therapy users were excluded from the analysis. POF is associated with high waist-to-hip ratio. Our results suggest that women with POF experience increased mortality and that these women may benefit from heightened surveillance and appropriate interventions.

The relationship between consumption of cruciferous vegetables (CV) and risk of gastric cancer has been investigated by many studies, but remains controversial. We carried out a meta‐analysis to summarize available evidence from epidemiological studies on this point. Relevant published reports of CV intake and gastric cancer were identified using MEDLINE (PubMed), EMBASE, and Web of Science databases through to the end of September 2012. We pooled the relative risk from individual studies using a fixed‐ or random‐effects model and carried out heterogeneity and publication bias analyses. Sixteen case–control and six prospective studies were included in our analysis. When all studies were pooled, we yielded a significantly inverse association between CV (relative risk = 0.81; 95% confidence interval, 0.75–0.88) intake and gastric cancer risk, with little heterogeneity (Q = 27.27, P = 0.292, I2 = 12.0%). Specific analysis for cabbage intake yielded similar result. When separately analyzed, case–control studies of CV intake yielded significant results and the results of prospective studies showed borderline statistical significance. Moreover, significant results were consistent for high‐quality studies, for North American, European, and Asian studies, for studies on males, and for studies on non‐cardia gastric cancer. Findings from this meta‐analysis provide evidence that high intake of CV was inversely associated with the risk of gastric cancer and non‐cardia gastric cancer in humans. Further studies on other specific CV, food preparation methods, and stratified results by anatomic cancer site and histological type should be extended in the future.

Background Using the published survival statistics from cancer registration or population‐based studies, we aimed to describe the global pattern and trend of lung cancer survival. Methods By searching SinoMed, PubMed, Web of Science, EMBASE, and SEER, all survival analyses from cancer registration or population‐based studies of lung cancer were collected by the end of November 2022. The survival rates were extracted by sex, period, and country. The observed, relative, and net survival rates of lung cancer were applied to describe the pattern and time changes from the late 1990s to the early 21st century. Results Age‐standardized 5‐year relative/net survival rate of lung cancer was typically low, with 10%–20% for most regions. The highest age‐standardized relative/net survival rate was observed in Japan (32.9%, 2010–2014), and the lowest was in India (3.7%, 2010–2014). In most countries, the five‐year age‐standardized relative/net survival rates of lung cancer were higher in females and younger people. The patients with adenocarcinoma had a better prognosis than other groups. In China, the highest 5‐year overall relative/net survival rates were 27.90% and 31.62% in men and women in Jiangyin (2012–2013). Conclusion Over the past decades, the prognosis of lung cancer has gradually improved, but significant variations were also observed globally. Worldwide, a better prognosis of lung cancer can be observed in females and younger patients. It is essential to compare and evaluate the histological or stage‐specific survival rates of lung cancer between different regions in the future. This study collected globally published data on observed and relative survival rates of lung cancer from population‐based cancer registration. Over the past decades, the prognosis of lung cancer has gradually improved. However, region, period, sex, and age might affect the survival rate of lung cancer patients. The observed and relative survival rate of lung cancer patients varies greatly among different histological types and stages.

Background: The objective was to evaluate the effects of personal characteristics on the validation of self-reported type 2 diabetes among Chinese adults in urban Shanghai. Methods: During 2015 through 2016, 4,322 participants were recruited in this validation study. We considered the criteria of diabetes verification to use the laboratory assays of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), or self-reported use of diabetic medication. Results: When taking diabetic medication or FPG ≥7.0 mmol/L was as identified diabetes, the measurements of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kappa value of self-reported diabetes were 72.0%, 99.2%, 95.1%, 93.9%, and 0.78, respectively. If an additional HbA1c test was used for 708 subjects (aged <65 years), slightly lower values of sensitivity, NPV, and Kappa were observed. More potential diabetes cases were found compared to only using FPG. Subjects who were female, older, or had a family history of diabetes had sensitivity over 75% and excellent Kappa over 0.8, while the sensitivity and Kappa of opposite groups had poorer values. Specificity, PPV, and NPV were similar among groups with different demographic or disease characteristics. The prevalence of type 2 diabetes was 19.3% in the study (14.1% diagnosed diabetes, 5.2% undiagnosed diabetes). About 26.2% of subjects were pre-diabetic. Additional HbA1c test indicated an increased prevalence of undiagnosed diabetes and pre-diabetes. Conclusions: Findings support self-reported diabetes is sufficiently valid to be used in large-scale, population-based epidemiologic studies. Participants with different characteristics may have different indicators in terms of validation, such as age, gender, and family history of diabetes in first-degree relatives.

The association between adiposity and increased liver cancer risk is well-recognized, yet underlying metabolic mechanisms require elucidation. This study aimed to identify metabolic mediators linking adiposity markers to liver cancer and assess their potential causality using two-sample Mendelian randomization (MR) analysis. We conducted a 1:1 matched nested case-control study within a population-based and prospective cohort study-the Shanghai Men's Health Study (SMHS). The SMHS was initiated in 2002-2006, including 61,469 Chinese men aged 40-74 years, and has been followed up for over 20 years. Targeted metabolomic profiling was performed on baseline plasma samples. Associations between seven anthropometric measurements (body mass index [BMI], waist circumference, waist-to-hip ratio, waist-to-height ratio, a body shape index, hip circumference, and adult weight gain), 186 circulating metabolites, and liver cancer risk were assessed. Linear and conditional logistic regression model adjusted for multiple confounders (including smoking, alcohol drinking, physical activity, chronic hepatitis and cirrhosis, diabetes, etc.) were used. Pathway analysis and network analysis were conducted to explore the biological functions of these metabolites. Parallel mediation analysis was employed to quantify the mediating effects through metabolites. Subsequently, MR analysis was performed to investigate potential causal relationships. This study incorporated 322 incident liver cancer cases and 322 cancer-free controls. Participants diagnosed with liver cancer had higher proportions of seropositive hepatitis B surface antigen (63.7%) compared to their matched controls (6.2%). We identified 27 intermediate metabolites associated with both adiposity markers and liver cancer risk, which formed an interconnected functional network. Pyroglutamic acid demonstrated the most robust consistency, being significantly associated with seven anthropometric measurements (β per doubling with BMI = 0.17; 95% confidence interval [CI]: [0.09, 0.24]) and liver cancer (odds ratio per doubling = 1.56; 95% CI: [1.13, 2.15]). Pathway analysis highlighted significant alterations in energy, lipid, and amino acid metabolism. Specifically, Phenylalanine, tyrosine, and tryptophan biosynthesis showed the highest impact, suggesting a key role for aromatic amino acid metabolism. Parallel mediation analysis demonstrated significant indirect effects via intermediate metabolites for six of the seven anthropometric measurements, with the proportion mediated by the identified metabolite clusters reaching 0.16 (95% CI: [0.05, 0.29]) for BMI. MR analysis provided evidence supporting potential causality for 23 of 108 initially observed associations. The strongest association was observed between WC and oxoglutaric acid (βIVW per standard deviation = 0.31; 95% CI: [0.17, 0.43]). Notably, while the observational analysis suggested a broad metabolic mediation of the adiposity marker-liver cancer association, the MR findings pinpointed a more specific and limited set of causal metabolic mediators. The main limitation of this study was the population mismatch between the observational (Chinese men) and the MR (European ancestry) analyses, which may limit the generalizability of the findings to other populations. Integrating prospective observational and genetic evidence, we identified specific metabolic mediators linking adiposity to liver cancer, particularly involving amino acid, lipid and energy metabolism. These findings enhanced molecular understanding of adiposity-driven hepatocarcinogenesis and provided potential metabolic targets for future primary prevention strategies.

The impact of pre-existing diabetes mellitus (DM) on hepatocellular carcinoma (HCC) occurrence and prognosis is complex and unclear. The aim of this meta-analysis is to evaluate the association between pre-existing diabetes mellitus and hepatocellular carcinoma occurrence and prognosis. We searched PubMed, Embase and the Cochrane Library from their inception to January, 2011 for prospective epidemiological studies assessing the effect of pre-existing diabetes mellitus on hepatocellular carcinoma occurrence, mortality outcomes, cancer recurrence, and treatment-related complications. Study-specific risk estimates were combined by using fixed effect or random effect models. The database search generated a total of 28 prospective studies that met the inclusion criteria. Among these studies, 14 reported the risk of HCC incidence and 6 studies reported risk of HCC specific mortality. Six studies provided a total of 8 results for all-cause mortality in HCC patients. Four studies documented HCC recurrence risks and 2 studies reported risks for hepatic decomposition occurrence in HCC patients. Meta-analysis indicated that pre-existing diabetes mellitus (DM) was significantly associated with increased risk of HCC incidence [meta-relative risk (RR) = 1.87, 95% confidence interval (CI): 1.15-2.27] and HCC-specific mortality (meta-RR = 1.88, 95%CI: 1.39-2.55) compared with their non-DM counterparts. HCC patients with pre-existing DM had a 38% increased (95% CI: 1.13-1.48) risk of death from all-causes and 91% increased (95%CI: 1.41-2.57) risk of hepatic decomposition occurrence compared to those without DM. In DM patients, the meta-RR for HCC recurrence-free survival was 1.93(95%CI: 1.12-3.33) compared with non-diabetic patients. The findings from the current meta-analysis suggest that DM may be both associated with elevated risks of both HCC incidence and mortality. Furthermore, HCC patients with pre-existing diabetes have a poorer prognosis relative to their non-diabetic counterparts.

Depression is one of the most prevalent mental disorders worldwide. Little information is available regarding association of depressive symptoms (DS) with cancer and chronic diseases among middle-aged and elderly Chinese in a population-based setting. In this study we evaluated the prevalence and examined correlates of DS in two population-based cohort studies. Included in the analyses were 103,595 people with a mean age of 61.8 years at the DS assessment. The prevalence of DS was 2.4% in men and 5.6% in women. We found elderly participants, those with lower BMI, or chronic diseases were more likely to experience DS. Having a history of stroke (odds ratio (OR) = 2.2 in men and 1.8 in women), cancer (OR = 3.3 in men and 1.9 in women), or Parkinson’s disease (OR = 3.1 in men and 2.7 in women) was associated with high DS. In women, high income and high education levels were inversely related to DS. Being a single woman, long-term or heavy female smoker was associated with high prevalence of DS. High BMI was correlated with low prevalence of depression in men. Our data suggests a low prevalence of DS among middle-aged and elderly people in Shanghai, China. Age, education, income, marital status, smoking, BMI, and certain health conditions were associated with DS.