title: Dietary fat, fat subtypes and hepatocellular carcinoma in a large European cohort.
abstract: The role of amount and type of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) is poorly understood, despite suggestive biological plausibility. The associations of total fat, fat subtypes and fat sources with HCC incidence were investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which includes 191 incident HCC cases diagnosed between 1992 and 2010. Diet was assessed by country-specific, validated dietary questionnaires. A single 24-hr diet recall from a cohort subsample was used for measurement error calibration. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazard models. Hepatitis B and C viruses (HBV/HCV) status and biomarkers of liver function were assessed separately in a nested case-control subset with available blood samples (HCC = 122). In multivariable calibrated models, there was a statistically significant inverse association between total fat intake and risk of HCC (per 10 g/day, HR = 0.80, 95% CI: 0.65-0.99), which was mainly driven by monounsaturated fats (per 5 g/day, HR = 0.71, 95% CI: 0.55-0.92) rather than polyunsaturated fats (per 5 g/day, HR = 0.92, 95% CI: 0.68-1.25). There was no association between saturated fats (HR = 1.08, 95% CI: 0.88-1.34) and HCC risk. The ratio of polyunsaturated/monounsaturated fats to saturated fats was not significantly associated with HCC risk (per 0.2 point, HR = 0.86, 95% CI: 0.73-1.01). Restriction of analyses to HBV/HCV free participants or adjustment for liver function did not substantially alter the findings. In this large prospective European cohort, higher consumption of monounsaturated fats is associated with lower HCC risk.
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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authors.affiliation: Department of Epidemiology, Rollins School of Public Health, , Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Veronika
authors.initials: V
authors.lastname: Fedirko
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Magdalena
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authors.lastname: Stepien
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Krasimira
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authors.lastname: Aleksandrova
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Department of Epidemiology, Harvard School of Public Health, Boston, MA.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Anne Sofie Dam
authors.initials: AS
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authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Hansen
authors.affiliation: Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
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authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
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authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France.|Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France.|Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France.|Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: His
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
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authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Verena
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authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Tilman
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authors.affiliation: Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.|Hellenic Health Foundation, Athens, Greece.
authors.forename: Antonia
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authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Hellenic Health Foundation, Athens, Greece.
authors.forename: Elissavet
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authors.affiliation: Hellenic Health Foundation, Athens, Greece.
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authors.forename: Giovanna
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authors.forename: Salvatore
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authors.affiliation: Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
authors.forename: Sabina
authors.initials: S
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authors.affiliation: Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza Hospital-CPO Piedmont, Turin, Italy.|Department of Epidemiology, Local Health Unit To3, Turin, Italy.
authors.forename: Fulvio
authors.initials: F
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authors.affiliation: Cancer Registy and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, ASP, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
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authors.affiliation: Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H B As
authors.initials: HB
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authors.affiliation: Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.|Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Petra H
authors.initials: PH
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authors.affiliation: Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway.
authors.forename: Guri
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authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway.|Cancer Registry of Norway, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Group of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
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authors.affiliation: Navarre Public Health Institute, Pamplona, Spain.|CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.
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authors.forename: Catalina
authors.initials: C
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authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.|Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Maria-Dolores
authors.initials: MD
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authors.affiliation: Public Health Direction and Biodonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain.
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authors.forename: J Ramón
authors.initials: JR
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authors.forename: Ingegerd
authors.initials: I
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authors.affiliation: Department of Clinical Sciences, Division of Internal Medicine, Lund University, Sweden.
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authors.affiliation: Department of Clinical Sciences, Division of Internal Medicine, Lund University, Sweden.|Department of Gastroenterology and Nutrition, Skåne University Hospital, Malmö, Sweden.
authors.forename: Klas
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authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
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authors.affiliation: School of Clinical Medicine, Clinical Gerontology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Kay-Tee
authors.initials: KT
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authors.initials: RC
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authors.affiliation: MRC Epidemiology Unit, Cambridge, United Kingdom.
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authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Heinz
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authors.forename: Isabelle
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
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mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology*; D016022:Case-Control Studies; D004032:Diet / Q000009:adverse effects; D004041:Dietary Fats / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004041:Dietary Fats
keywords: European populations; cohort study; dietary fats; hepatocellular carcinoma