Mediterranean diet and hepatocellular carcinoma.
OBJECTIVE
Hepatocellular carcinoma (HCC) has a very poor prognosis and any effort to identify additional risk factors, besides those already established, would be important for the prevention of the disease. Data on the role of diet on HCC risk are still controversial.


METHODS
We have evaluated the association of adherence to the Mediterranean diet with HCC risk, as well as the interaction of this dietary pattern with chronic hepatitis infection, by combining two case-control studies undertaken in Italy and Greece, including overall 518 cases of HCC and 772 controls. Adherence to the traditional Mediterranean diet was assessed through the Mediterranean diet score (MDS), which ranges between 0 (lowest adherence) and 9 (highest adherence). Odds ratios (OR) for HCC were obtained through multiple logistic regression models, controlling for potentially confounding factors, including chronic infection with hepatitis B/C viruses.


RESULTS
Compared to MDS of 0-3, the ORs for HCC were 0.66 (95% confidence interval (CI), 0.41-1.04) for MDS equal to 4 and 0.51 (95% CI, 0.34-0.75) for MDS ⩾ 5, with a significant trend (p<0.001). The detrimental effect of poor adherence to Mediterranean diet on HCC risk was disproportionally high among those chronically infected with hepatitis B and/or C viruses, with a suggestion of super-additive interaction, albeit statistically non-significant.


CONCLUSIONS
Closer adherence to the Mediterranean diet appears to be protective against HCC. Our results also point to potential benefits from adhering to a Mediterranean dietary pattern for patients chronically infected with hepatitis viruses.
IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Dipartimento di Epidemiologia, Milan, Italy.
Federica
F
Turati
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Dimitrios
D
Trichopoulos
S.O.C. Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy.
Jerry
J
Polesel
IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Dipartimento di Epidemiologia, Milan, Italy; Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Francesca
F
Bravi
IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Dipartimento di Epidemiologia, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Marta
M
Rossi
S.O.C. Epidemiologia e Biostatistica, Centro di Riferimento Oncologico, IRCCS, Aviano (PN), Italy.
Renato
R
Talamini
International Agency for Research on Cancer, Lyon Cedex, France.
Silvia
S
Franceschi
Dipartimento di Epidemiologia, 'Fondazione G. Pascale', Istituto Nazionale Tumori, Naples, Italy.
Maurizio
M
Montella
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
Antonia
A
Trichopoulou
IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Dipartimento di Epidemiologia, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. Electronic address: carlo.lavecchia@marionegri.it.
Carlo
C
La Vecchia
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
Pagona
P
Lagiou
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged
BMI; CI; Case-control study; Dietary habits; HBV; HBsAg; HCC; HCV; Liver cancer; MDS; Mediterranean diet; OR; RERI; Risk factors; S; anti-HCV; antibodies against hepatitis C virus; body mass index; confidence interval; excess risk due to interaction; hepatitis B surface antigen; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; mediterranean diet score; odds ratio; synergy index