Index-based dietary patterns and risk of incident hepatocellular carcinoma and mortality from chronic liver disease in a prospective study.
The role of diet in hepatocellular carcinoma (HCC) and its typical precursor, chronic liver disease (CLD), is poorly understood. Following dietary recommendations has been shown to reduce risk of many cancers, but whether such diets are associated with HCC and CLD is unknown. We prospectively evaluated the association of two dietary indices, the Healthy Eating Index-2010 (HEI-2010) and the alternate Mediterranean Diet Score (aMED), with HCC incidence and CLD mortality in a large U.S. prospective cohort. We calculated the HEI-2010 and aMED scores for 494,942 participants in the National Institutes of Health-AARP Diet and Health study, based on typical diet assessed using a food frequency questionnaire FFQ between 1995 and 1996. Hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of each index were estimated using Cox's proportional hazards regression, after adjusting for alcohol intake, smoking, body mass index, diabetes, and other covariates. A total of 509 HCC cases (1995-2006) and 1,053 CLD deaths (1995-2011) were documented during follow-up. Higher HEI-2010 scores, reflecting favorable adherence to dietary guidelines, were associated with lower risk of HCC (HR, 0.72, 95% CI: 0.53-0.97 for the highest quintile, compared to lowest; P trend = 0.03) and lower mortality resulting from CLD (HR, 0.57; 95% CI: 0.46-0.71; P trend < 0.0001). High aMED scores were also associated with lower risk of HCC (HR, 0.62; 95% CI: 0.47-0.84; P trend = 0.0002) and lower risk of CLD mortality (HR, 0.52; 95% CI: 0.42-0.65; P trend < 0.0001).


CONCLUSIONS
Adhering to dietary recommendations may reduce the risk of developing HCC and dying of CLD.
Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD; Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI.
Wen-Qing
WQ
Li
Yikyung
Y
Park
Katherine A
KA
McGlynn
Albert R
AR
Hollenbeck
Philip R
PR
Taylor
Alisa M
AM
Goldstein
Neal D
ND
Freedman
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality*; D002908:Chronic Disease; D038441:Diet, Mediterranean; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008107:Liver Diseases / Q000453:epidemiology / Q000401:mortality*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires