Dietary Patterns and Risk of Hepatocellular Carcinoma Among ... : Hepatology (original) (raw)

Original Articles: HEPATOBILIARY MALIGNANCIES

Ma, Yanan1,2,†; Yang, Wanshui3,†; Simon, Tracey G.4,5,6; Smith‐Warner, Stephanie A.7,8; Fung, Teresa T.7; Sui, Jing2,9; Chong, Dawn10; VoPham, Trang2,7,8; Meyerhardt, Jeffrey A.11; Wen, Deliang1; Giovannucci, Edward L.2,7,8; Chan, Andrew T.2,5,6,‡; Zhang, Xuehong*,2,‡

1School of Public HealthChina Medical UniversityShenyangChina

2Channing Division of Network Medicine, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA

3Department of Nutrition, School of Public HealthAnhui Medical UniversityHefeiChina

4Liver Center, Division of Gastroenterology, Department of MedicineMassachusetts General HospitalBostonMA

5Division of Gastroenterology, Department of MedicineMassachusetts General HospitalBostonMA

6Clinical and Translational Epidemiology Unit (CTEU)Massachusetts General HospitalBostonMA

7Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA

8Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA

9Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of public HealthSoutheast UniversityNanjingChina

10National Cancer Centre SingaporeSingapore

11Department of Medical OncologyDana‐Farber Cancer Institute and Harvard Medical SchoolBostonMA

*Address Correspondence and Reprint Request To:
Xuehong Zhang, M.D., Sc.D.
Brigham and Women’s Hospital and Harvard
Medical School
181 Longwood Avenue
Room 453
Boston, MA 02115
E‐mail: [email protected]
Tel: +1‐617‐525‐0342

†These authors contributed equally as first co‐authors.

‡These authors contributed equally as senior co‐authors.

Abstract

Although adherence to healthy dietary guidelines has been associated with a reduced risk of several health outcomes, including cardiovascular diseases, type 2 diabetes, and some cancers, little is known about the role of dietary patterns in the development of hepatocellular carcinoma (HCC). We prospectively assessed the associations of three key commonly used a priori dietary patterns—the Alternative Healthy Eating Index‐2010 (AHEI‐2010), Alternate Mediterranean Diet (AMED), and Dietary Approaches to Stop Hypertension (DASH)—with risk of incident HCC in the Health Professionals Follow‐Up Study (HPFS) and the Nurses’ Health Study (NHS), two large prospective cohort studies. Diet was assessed almost every 4 years using validated food frequency questionnaires (FFQs). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. During up to 32 years of follow‐up, 160 incident HCC cases were identified. After adjustment for most HCC risk factors, participants in the highest tertile of Alternative Healthy Eating Index‐2010 (AHEI‐2010) had a multivariable HR of 0.61 (95% CI, 0.39‐0.95; _P_trend = 0.03), compared with those in the lowest tertile. There was a suggestive, but nonsignificant, inverse association for Alternate Mediterranean Diet (AMED; HR = 0.75; 95% CI, 0.49‐1.15; _P_trend = 0.18) and a null association for Dietary Approaches to Stop Hypertension (DASH; HR = 0.90; 95% CI, 0.59‐1.36; _P_trend = 0.61) in relation to the risk of HCC development. Conclusion: Our findings suggest that better adherence to the AHEI‐2010 may decrease the risk of developing HCC among U.S. adults. Future studies are needed to replicate our results, examine these associations in other populations, and elucidate the underlying mechanisms.