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Most BTC cases are diagnosed with metastatic disease which carries a 5\u2010year survival rate of &lt;5%. Physical activity, diet, and obesity might be associated with BTC risk, but studies have been limited particularly in African descendants. We addressed this knowledge gap by evaluating associations of BTC risk with obesity, physical activity, and dietary intakes in 723,326 adult participants in four cohort studies conducted in China, the United Kingdom, and the United States. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) in each cohort; results were combined using meta\u2010analysis. All cohorts had \u226511 median follow\u2010up years with 839 incident BTC cases combined. BTC risk was positively associated with body mass index (BMI) and waist\u2010to\u2010hip ratio (WHR) whereas physical activity, fruit intake, and fish intake were inversely associated. HR and (95% CI) comparing BMI &gt;35.0 to 18.5\u201324.9: 1.71 (1.26, 2.31), <jats:italic>p<\/jats:italic>\u2010trend &lt;.0001; comparing BMI\u2010adjusted WHR top to bottom quartile: 1.20 (0.94, 1.53), <jats:italic>p<\/jats:italic>\u2010trend\u2009=\u2009.05; comparing \u226515\u20130 metabolic equivalent task\u2010hours\/week 0.76 (0.61, 0.94), <jats:italic>p<\/jats:italic>\u2010trend\u2009= .009; comparing highest to lowest intake tertile for fruit and fish 0.79 (0.66, 0.95), <jats:italic>p<\/jats:italic>\u2010trend\u2009=\u2009.01; 0.82 (0.68, 0.98), <jats:italic>p<\/jats:italic>\u2010trend\u2009=\u2009.04, respectively. Associations were, in general, similar across ancestry groups. Our study provides strong evidence for important roles of obesity, diet, and physical activity in BTC etiology and stresses the need for lifestyle modification to combat the rising incidence of this fatal malignancy.<\/jats:p>","DOI":"10.1002\/ijc.35048","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T09:20:56Z","timestamp":1717752056000},"page":"1721-1730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Dietary intake, obesity, and physical activity in association with biliary tract cancer risk: Results from meta\u2010analyses of individual\u2010level data from prospective cohort studies of 723,326 adults"],"prefix":"10.1002","volume":"155","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9392-0644","authenticated-orcid":false,"given":"Valerie","family":"Gunchick","sequence":"first","affiliation":[{"name":"Vanderbilt Epidemiology Center, Division of Epidemiology, Department 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