Index-based dietary patterns and risk of incident hepatocellular carcinoma and mortality from chronic liver disease in a prospective study

Authors

  • Wen-Qing Li,

    Corresponding author
    1. Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
    2. Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI
    • Address reprint requests to: Wen-Qing Li, Ph.D., Department of Dermatology, Warren Alpert Medical School, Brown University, 339 Eddy Street, Providence, RI 02906. E-mail: wen-qing_li@brown.edu; fax: 401-444-7105.

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  • Yikyung Park,

    1. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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  • Katherine A. McGlynn,

    1. Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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  • Albert R. Hollenbeck,

    1. AARP (retired), Washington, DC
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  • Philip R. Taylor,

    1. Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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  • Alisa M. Goldstein,

    1. Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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  • Neal D. Freedman

    1. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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  • Potential conflict of interest: Dr. Albert R. Hollenbeck is a retired employee of AARP and serves as advisor in the National Science Foundation Fellowship Review Panel (between December 2013 and January 2014), Love/Avon Army of Women Scientific Advisory Panel (volunteer), and Board of Directors, Society of Psychologists in Management (elected volunteer). The other authors indicated no potential conflicts of interest.

  • This research was supported by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD.

Abstract

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. (Hepatology 2014;60:588–597)

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