Tuo Jia-Yi, Shen Qiu-Ming, Li Zhuo-Ying, Yang Dan-Ni, Zou Yi-Xin, Tan Yu-Ting, Li Hong-Lan, Xiang Yong-Bing
State Key Laboratory of Systems Medicine for Cancer & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
State Key Laboratory of Systems Medicine for Cancer & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
Clin Nutr ESPEN. 2025 Jun;67:599-611. doi: 10.1016/j.clnesp.2025.03.173. Epub 2025 Apr 3.
Although dietary factors have been extensively investigated as potential risk factors for liver cancer, the evidence is inconclusive. Our study systematically assessed the associations between ten dietary guidelines compliance scores and liver cancer risk among adult people, and found out the dietary patterns for liver cancer prevention.
Participants of 59,844 men and 72,680 women, aged 40-74 years and living in urban Shanghai, were included in two prospective cohort studies conducted between 2002-2006 and 1996-2000, respectively. Dietary intakes were assessed during baseline in-person interviews using validated food-frequency questionnaires, and dietary guideline compliance scores were calculated by adjusting for total energy intake and adapting existing dietary recommendations. Hazards ratios (HRs) with 95 % confidence intervals (CIs) were evaluated by both tertile categories and per standard deviation (SD) increment using Cox proportional hazard regression models to assess the associations between ten dietary guideline compliance scores and liver cancer risk.
In the two cohorts, 431 male and 256 female incident liver cancer cases were identified during a mean follow-up of 11.90 and 17.44 years, respectively. There were no statistically significant associations between these ten dietary guidelines and male liver cancer risk (P > 0.05). In contrast, only the modified reversed Empirical Dietary Inflammation Pattern (rEDIP) tended to be associated with the low risk of female liver cancer (HR = 0.67, 95 % CI: 0.48-0.92, P = 0.016, HR per SD = 0.94, 95 % CI: 0.85-1.03). The inverse associations appeared stronger between rEDIP and liver cancer risk at younger ages (<55 years) in women (HR per SD = 0.91, 95 % CI: 0.84-0.99) compared to the older women (≥55 years). There were suggestive but non-significant inverse associations between the modified Diabetes Risk Reduction Diet (mDRRD) (men: HR per SD = 0.92, 95 % CI: 0.84-1.02; women: HR per SD = 0.97, 95 % CI: 0.84-1.02) and the modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) (men: HR per SD = 0.93, 95 % CI: 0.84-1.02; women: HR per SD = 0.91, 95 % CI: 0.80-1.03) and liver cancer incidence. The associations of mDRRD (HR per SD = 0.82, 95 % CI: 0.75-0.98) and mWCRF/AICR (HR per SD = 0.83, 95 % CI: 0.74-0.99) on liver cancer risk were significant in men who ever smoked.
Our findings confirm that greater adherence to some healthy dietary patterns (i.e. rEDIP, mDRRD and mWCRF/AICR) is inversely associated with liver cancer risk, especially in certain populations. Future studies are required to confirm these findings and elucidate potential mechanisms.
尽管饮食因素作为肝癌潜在危险因素已得到广泛研究，但证据尚无定论。我们的研究系统评估了成人中十种饮食指南依从性得分与肝癌风险之间的关联，并找出预防肝癌的饮食模式。
59844名男性和72680名女性参与者，年龄在40 - 74岁，居住在上海市区，分别纳入了两项前瞻性队列研究，研究分别于2002 - 2006年和1996 - 2000年进行。在基线面对面访谈期间，使用经过验证的食物频率问卷评估饮食摄入量，并通过调整总能量摄入并采用现有饮食建议来计算饮食指南依从性得分。使用Cox比例风险回归模型，通过三分位数分类和每标准差（SD）增量评估十种饮食指南依从性得分与肝癌风险之间的关联，得出风险比（HRs）及95%置信区间（CIs）。
在这两个队列中，分别在平均11.90年和17.44年的随访期间，确定了431例男性和256例女性肝癌新发病例。这十种饮食指南与男性肝癌风险之间无统计学显著关联（P > 0.05）。相比之下，仅改良的反向经验性饮食炎症模式（rEDIP）往往与女性肝癌低风险相关（HR = 0.67，95% CI：0.48 - 0.92，P = 0.016，每SD的HR = 0.94，95% CI：0.85 - 1.03）。与年龄较大的女性（≥55岁）相比，rEDIP与年龄较小（<55岁）女性的肝癌风险之间的负相关似乎更强（每SD的HR = 0.91，95% CI：0.84 - 0.99）。改良的糖尿病风险降低饮食（mDRRD）（男性：每SD的HR = 0.92，95% CI：0.84 - 1.02；女性：每SD的HR = 0.97，95% CI：0.84 - 1.02）和改良的世界癌症研究基金会/美国癌症研究协会（mWCRF/AICR）（男性：每SD的HR = 0.93, 95% CI：0.84 - 1.02；女性：每SD的HR = 0.91, 95% CI：0.80 - 1.03）与肝癌发病率之间存在提示性但不显著的负相关。mDRRD（每SD的HR = 0.82，95% CI：0.75 - 0.98）和mWCRF/AICR（每SD的HR = 0.83，95% CI：0.74 - 0.99）对肝癌风险的关联在曾经吸烟的男性中显著。
我们的研究结果证实，更多地遵循某些健康饮食模式（即rEDIP、mDRRD和mWCRF/AICR）与肝癌风险呈负相关，尤其是在特定人群中。未来需要进一步研究来证实这些发现并阐明潜在机制。
