High‐Quality Diets Are Associated With Reduced Risk of Hepatocellular Carcinoma and Chronic Liver Disease: The Multiethnic Cohort

Abstract

Hepatocellular carcinoma (HCC) and chronic liver disease (CLD) are major sources of morbidity and mortality globally. Both HCC incidence and CLD mortality are known to vary by race. There is limited research on the association between dietary measures and these outcomes in a diverse population. We prospectively investigated the associations between four diet quality index (DQI) scores (Healthy Eating Index‐2010, Alternative Healthy Eating Index‐2010, Alternate Mediterranean Diet [aMED], and Dietary Approaches to Stop Hypertension), HCC incidence, and CLD mortality in the Multiethnic Cohort. We analyzed data from 169,806 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites, aged 45 to 75 years. DQI scores were calculated by using a validated food frequency questionnaire administered at baseline. During an average 17 years of follow‐up, 603 incident cases of HCC and 753 CLD deaths were identified among study participants. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for each DQI were estimated using Cox regression. Higher aMED scores, reflecting favorable adherence to a healthful diet, were associated with a lower risk of HCC (quintile [Q]5 versus Q1 HR, 0.68; 95% CI, 0.51‐0.90; trend, P = 0.02). In racial/ethnic‐specific analyses, there was no significant heterogeneity across groups (interaction, P = 0.32); however, the association only remained statistically significant among Latinos (Q4 versus Q1 HR, 0.47; 95% CI, 0.29‐0.79; trend, P = 0.006). All DQI measures were inversely associated with CLD mortality, with no significant heterogeneity by race/ethnicity. Conclusion: Higher aMED scores were associated with a lower risk of HCC. A higher score of any DQI was associated with a lower risk of CLD mortality. These results suggest that better diet quality may reduce HCC incidence and CLD mortality.

Association between dietary patterns and prognosis of hepatocellular carcinoma in the Guangdong liver cancer cohort study

“…9 A second study suggested that closer adherence to a high-quality diet, assessed by the HEI-2010, aHEI-2010, aMED and DASH, was related to a reduction in CLD mortality. 12 Our study extends the study to HEI and HCC mortality. In contrast to the previous studies, we only observed a suggestive, nonsignificant, inverse association between HEI-2015 scores and HCC mortality.…”

“…The studies observed that adhering to healthy dietary patterns reduced the risk of developing HCC in diverse populations. [9][10][11][12][13][14][15] However, to date, few studies have investigated whether adherence to a healthy diet could improve the prognosis of HCC. Nevertheless, adherence to dietary recommendations has been reported to be associated with a lower risk of dying from chronic liver disease (CLD).…”

“…Nevertheless, adherence to dietary recommendations has been reported to be associated with a lower risk of dying from chronic liver disease (CLD). 9,12 In addition, accumulating evidence suggests that following healthy dietary patterns after diagnosis may improve overall survival in patients with multiple malignancies. 16,17 Therefore, we investigated the association of two dietary quality indices prospectively, i.e., the CHEI and the HEI-2015, reflecting adherence to the latest guidelines for Chinese and Americans, respectively, with the risk of all-cause and HCC-specific mortality among HCC survivors in the Guangdong Liver Cancer Cohort (GLCC) study.…”

The Association between Diet and Hepatocellular Carcinoma: A Systematic Review

“…Seventy-six studies were eligible for full text screening and 46 of these were excluded for the following reasons: abstract only ( n = 11), included only one nutrient ( n = 9), wrong article type or study design ( n = 4), too broad such as studying overall lifestyle habits rather than a focus on diet ( n = 16), looking at MAFLD not HCC ( n = 1) and looking at serum/biomarkers ( n = 5). There were 30 observational studies included in the systematic review [ 4 , 7 , 10 , 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

“…The data extracted from the included 30 articles are presented in Table 3 . All studies were observational and of these: seventeen were cohort, [ 20 , 21 , 22 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 38 , 41 , 42 , 43 , 44 , 45 ]; seven were case–control, [ 4 , 14 , 23 , 33 , 37 , 39 , 40 ] and six were cohort with nested case–control subset [ 7 , 10 , 24 , 25 , 26 , 36 ]. In total the 30 studies included 5,222,534 participants aged between 25–85 years across 22 countries including Asian, American and European populations.…”