Dietary Patterns and the Risk of Liver Cancer and Chronic Liver Disease Mortality

Accumulating evidence suggests that diet plays an important role in the development of liver disease. Compared with individual nutrients or foods, dietary patterns better represent overall eating behaviors, but their associations with liver cancer and chronic liver disease (CLD) remain poorly understood.

We evaluated whether greater adherence to healthy dietary patterns was associated with lower liver cancer risk and CLD mortality.

We analyzed data from 78,345 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Four dietary patterns [Alternative Healthy Eating Index-2010 (AHEI-2010), Healthy Eating Index-2020 (HEI-2020), alternate Mediterranean Diet (aMED), Dietary Approach to Stop Hypertension (DASH)] were calculated using dietary data collected via a validated food-frequency questionnaire. Liver cancer incidence and CLD death were ascertained by review of medical records or linkage to the National Death Index. Cox proportional hazards regression was performed to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

During a median follow-up of 22.1 y, 176 liver cancer cases and 128 CLD deaths were documented. For liver cancer, significant inverse associations were observed with HEI-2020 (HR Quartile 4 compared with Quartile 1 = 0.58, 95% CI: 0.37, 0.93, P-trend = 0.02) and DASH (HR Q4 compared with Q1 = 0.58, 95% CI: 0.35, 0.98, P-trend = 0.07). For CLD mortality, significant inverse associations were observed with AHEI-2010 (HR Q4 compared with Q1 = 0.50, 95% CI: 0.27, 0.92, P-trend = 0.02), HEI-2020 (HR Q4 compared with Q1 = 0.59, 95% CI: 0.33, 1.04, P-trend = 0.04), aMED (HR Q4 compared with Q1 = 0.48, 95% CI: 0.25, 0.90, P-trend = 0.02), and DASH (HR Q4 compared with Q1 = 0.49, 95% CI: 0.25, 0.95, P-trend = 0.02).

Maintaining an overall healthy diet may be associated with lower liver cancer risk and CLD mortality among postmenopausal women.