title: Dietary flavonoid, lignan and antioxidant capacity and risk of hepatocellular carcinoma in the European prospective investigation into cancer and nutrition study.
abstract: Limited epidemiological evidence suggests a protective role for plant foods rich in flavonoids and antioxidants in hepatocellular cancer (HCC) etiology. Our aim was to prospectively investigate the association between dietary intake of flavonoids, lignans and nonenzymatic antioxidant capacity (NEAC) and HCC risk. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 477,206 subjects (29.8% male) recruited from ten Western European countries, was analyzed. Flavonoid, lignan and NEAC intakes were calculated using a compilation of existing food composition databases linked to dietary information from validated dietary questionnaires. Dietary NEAC was based on ferric reducing antioxidant capacity (FRAP) and total radical-trapping antioxidant parameter (TRAP). Hepatitis B/C status was measured in a nested case-control subset. During a mean follow-up of 11-years, 191 incident HCC cases (66.5% men) were identified. Using Cox regression, multivariable adjusted models showed a borderline nonsignificant association of HCC with total flavonoid intake (highest versus lowest tertile, HR = 0.65, 95% CI: 0.40-1.04; p(trend) = 0.065), but not with lignans. Among flavonoid subclasses, flavanols were inversely associated with HCC risk (HR = 0.62, 95% CI: 0.39-0.99; p(trend) = 0.06). Dietary NEAC was inversely associated with HCC (FRAP: HR 0.50, 95% CI: 0.31-0.81; p(trend) = 0.001; TRAP: HR 0.49, 95% CI: 0.31-0.79; p(trend) = 0.002), but statistical significance was lost after exclusion of the first 2 years of follow-up. This study suggests that higher intake of dietary flavanols and antioxidants may be associated with a reduced HCC risk.
authors: Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors: Raul
authors: R
authors: Zamora-Ros
authors: Veronika
authors: V
authors: Fedirko
authors: Antonia
authors: A
authors: Trichopoulou
authors: Carlos A
authors: CA
authors: González
authors: Christina
authors: C
authors: Bamia
authors: Elisabeth
authors: E
authors: Trepo
authors: Ute
authors: U
authors: Nöthlings
authors: Talita
authors: T
authors: Duarte-Salles
authors: Mauro
authors: M
authors: Serafini
authors: Lea
authors: L
authors: Bredsdorff
authors: Kim
authors: K
authors: Overvad
authors: Anne
authors: A
authors: Tjønneland
authors: Jytte
authors: J
authors: Halkjaer
authors: Guy
authors: G
authors: Fagherazzi
authors: Florence
authors: F
authors: Perquier
authors: Marie-Christine
authors: MC
authors: Boutron-Ruault
authors: Verena
authors: V
authors: Katzke
authors: Annekatrin
authors: A
authors: Lukanova
authors: Anna
authors: A
authors: Floegel
authors: Heiner
authors: H
authors: Boeing
authors: Pagona
authors: P
authors: Lagiou
authors: Dimitrios
authors: D
authors: Trichopoulos
authors: Calogero
authors: C
authors: Saieva
authors: Claudia
authors: C
authors: Agnoli
authors: Amalia
authors: A
authors: Mattiello
authors: Rosario
authors: R
authors: Tumino
authors: Carlotta
authors: C
authors: Sacerdote
authors: H Bas
authors: HB
authors: Bueno-de-Mesquita
authors: Petra H M
authors: PH
authors: Peeters
authors: Elisabete
authors: E
authors: Weiderpass
authors: Dagrun
authors: D
authors: Engeset
authors: Guri
authors: G
authors: Skeie
authors: Marcial Vicente
authors: MV
authors: Argüelles
authors: Esther
authors: E
authors: Molina-Montes
authors: Miren
authors: M
authors: Dorronsoro
authors: María José
authors: MJ
authors: Tormo
authors: Eva
authors: E
authors: Ardanaz
authors: Ulrika
authors: U
authors: Ericson
authors: Emily
authors: E
authors: Sonestedt
authors: Malin
authors: M
authors: Sund
authors: Rikard
authors: R
authors: Landberg
authors: Kay-Tee
authors: KT
authors: Khaw
authors: Nicholas J
authors: NJ
authors: Wareham
authors: Francesca L
authors: FL
authors: Crowe
authors: Elio
authors: E
authors: Riboli
authors: Mazda
authors: M
authors: Jenab
mesh_terms: D000975:Antioxidants / Q000008:administration & dosage* / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage* / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D017705:Lignans / Q000008:administration & dosage* / Q000378:metabolism; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000975:Antioxidants; D005419:Flavonoids; D017705:Lignans
keywords: EPIC; antioxidant capacity; dietary intake; flavonoids; hepatocellular carcinoma; lignans