Lifestyle and Hepatocellular Carcinoma What Is the Evidence and Prevention Recommendations

Abstract

The increasing burden of hepatocellular carcinoma (HCC) emphasizes the unmet need for primary prevention. Lifestyle measures appear to be important modifiable risk factors for HCC regardless of its etiology. Lifestyle patterns, as a whole and each component separately, are related to HCC risk. Dietary composition is important beyond obesity. Consumption of n-3 polyunsaturated fatty acids, as well as fish and poultry, are inversely associated with HCC, while red meat, saturated fat, and cholesterol are related to increased risk. Sugar consumption is associated with HCC risk, while fiber and vegetable intake is protective. Data from multiple studies clearly show a beneficial effect for physical activity in reducing the risk of HCC. However, the duration, mode and intensity of physical activity needed are yet to be determined. There is evidence that smoking can lead to liver fibrosis and liver cancer and has a synergistic effect with alcohol drinking. On the other hand, an excessive amount of alcohol by itself has been associated with increased risk of HCC directly (carcinogenic effect) or indirectly (liver fibrosis and cirrhosis progression. Large-scale intervention studies testing the effect of comprehensive lifestyle interventions on HCC prevention among diverse cohorts of liver disease patients are greatly warranted.

Contribution of PNPLA3 gene polymorphisms to hepatocellular carcinoma susceptibility in the Chinese Han population

“…This difference in gender distribution is thought to be closely related to hormone levels in men and their unhealthy lifestyles like overworking, staying up late and excessive drinking. Third, in terms of smoking status, studies have shown that smoking is a minor risk factor for HCC [ 30 , 31 ]. According to reports, smoking can increase the morbidity and mortality of HCC [ 32 ].…”

Obesity Management in the Primary Prevention of Hepatocellular Carcinoma

“…Such approaches limit the ability to parse out the combined impacts of obesity, smoking, and alcohol intake and increasing physical activity and plant-centered dietary patterns. Promisingly, changes in dietary patterns to increase plant-based foods can decrease the risk of liver cancer development by ~30–50%, although there is little information with regards to effects on HCC recurrence and mortality [ 82 ]. Detailed in the World Cancer Research Fund’s (WCRF) most recent report on diet, physical activity, and cancer, there is strong evidence that overweight or obesity, consumption of alcohol, and consuming foods contaminated with aflatoxins increases the incidence of liver cancer [ 83 ].…”

Hepatocellular carcinoma surveillance in non-alcoholic fatty liver disease patients

“…Up to 40% of HCC cases can develop in NAFLD patients without cirrhosis, and NAFLD represents the most common cause of HCC in those without cirrhosis, accounting for 26.3% of 605 HCC cases without cirrhosis compared to 13.4% of 4539 of HCC cases with cirrhosis [11][12][13] . In the NAFLD spectrum, HCC incidence in patients with uncomplicated steatosis is estimated to be approximately 0.8-6.2 per 100 person-years, but is poorly reported in NASH due to its invasive histological nature [14][15][16] . However, it is reasonable to approximate the incidence of HCC in NASH to the median prevalence of simple steatosis and cirrhosis [13] .…”