High-quality diet may reduce HCC risk

15 Jan 2021 byRoshini Claire Anthony
High-quality diet may reduce HCC risk

Adhering to a healthy diet may reduce the risk of hepatocellular carcinoma (HCC), a Singapore study showed.

“[H]igher scores of four diet-quality indices (DQIs) …, [which reflected] higher quality dietary patterns, were associated with a 15 to 33 percent lower risk of developing HCC,” said the researchers.

“These findings support the notion that adherence to a healthier diet may lower the risk of HCC, suggesting that dietary modification may be an effective approach for primary prevention of HCC,” they said.

Data of 63,257 Chinese individuals aged 45–74 years enrolled in the prospective Singapore Chinese Health Study (SCHS) were used to identify the effect of DQI scores on HCC risk. Participant dietary intake was ascertained using food frequency questionnaires and 24-hour dietary recall interviews. DQI scores were created from the Alternative Health Eating Index-2010 (AHEI-2010), Alternate Mediterranean Diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Healthy Diet Indicator (HDI), with higher scores denoting better adherence to dietary guidelines.

After a mean 17.6-year follow up of 61,321 participants, 561 cases of incident HCC were identified from the Singapore Cancer Registry (median age 60 years, 72.2 percent male, mean BMI 24.0 kg/m2). Median age at diagnosis was 71 years.

Compared with the control (non-HCC) group, individuals who developed HCC were older, more likely to be men, had a higher BMI and history of type 2 diabetes (T2D), had a higher red meat and lower vegetable intake, and were heavy drinkers or smokers.

Participants in the highest quartile of all DQIs had lower intake of red meat, and higher intake of vegetables, fruits, and fibre.

The risk of HCC was lower among individuals in the highest (Q4) vs the lowest quartiles (Q1) for AHEI 2010 (Q4 [51.5–75.9] vs Q1 [17.0–42.1]; hazard ratio [HR], 0.69, 95 percent confidence interval [CI], 0.53–0.89; ptrend=0.02), aMED (Q4 [6.0–8.0] vs Q1 [0–2.0]; HR, 0.70, 95 percent CI, 0.52–0.95; ptrend=0.06), and DASH (Q4 [28.0–39.0] vs Q1 [8.0–21.0]; HR, 0.67, 95 percent CI, 0.51–0.87; ptrend=0.004), though less apparent with HDI (Q4 [55.1–70.0] vs Q1 [14.2–45.2]; HR, 0.85, 95 percent CI, 0.66–1.09; ptrend=0.04). [Int J Cancer 2020;doi:10.1002/ijc.33367]

A case-control analysis was conducted among 28,346 participants who provided blood samples at baseline. Each of the 220 incident HCC cases diagnosed before December 31, 2015, was matched with 2–3 participants without HCC. There was no inverse association between higher AHEI-2010, DASH, and HDI scores and HCC risk. However, in a subset of hepatitis B surface antigen (HBsAg)-negative individuals, participants in the highest aMED quartile had reduced HCC risk vs the lowest quartile (HR, 0.46, 95 percent CI, 0.23–0.94; ptrend=0.10).

The researchers also observed a lower HCC risk with higher intake of legumes and long-chain n-3 polyunsaturated fatty acids (PUFAs) and an increased HCC risk with the meat-dim sum pattern in the SCHS and total PUFA intake.

According to the researchers, the variation in associations between the different DQIs and HCC risk may be attributable to differences in food group composition and nutrient content.

Diet quality contributes to the development obesity and T2D, which in turn contribute to the development of non-alcoholic fatty liver disease, an underlying condition for HCC, they said.

“Our findings support adherence to a high-quality diet with a focus on different healthy plant-based foods, including vegetables, fruits, and nuts/legumes, and lower consumption of sodium and higher intake of PUFAs for lowering the risk of HCC incidence,” said the researchers.