Journal
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
Volume 30, Issue 4, Pages 789-796Publisher
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1055-9965.EPI-20-1329
Keywords
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Funding
- NIH [K07 CA188126, R21CA238651, K24 DK098311]
- American Cancer Society Research Scholar Grant [RSG NEC130476]
- [UM1 CA186107]
- [P01 CA87969]
- [U01 167552]
- [R00 CA207736]
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The study suggests that inflammation and insulin resistance/hyperinsulinemia may increase the risk of developing hepatocellular carcinoma (HCC) associated with diet and lifestyle. Additionally, diabetes and obesity may partly mediate the association of these patterns with HCC risk.
Background: We prospectively examined the extent to which greater inflammatory and insulinemic potential of diet and lifestyle are associated with the risk of developing hepatocellular carcinoma (HCC) in two nationwide cohorts. Methods: Five kinds of pattern scores, including the empirical dietary inflammatory pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH) and insulin resistance (EDIR), empirical lifestyle pattern score for hyperinsulinemia (ELIH) and insulin resistance (ELIR) were calculated. Multivariable hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. Results: After an average follow-up of 25.6 years among 119,316 participants, 142 incident HCC cases were documented. Higher adherence to EDIP (HR by comparing extreme tertiles: 2.03; 95% CI, 1.31-3.16; P-trend = 0.001), EDIH (HR, 1.61; 95% CI, 1.06-2.43; P-trend = 0.02), and EDIR (HR, 1.62; 95% CI: 1.08-2.42; P-trend = 0.02) was associated with increased risk of HCC. Likewise, participants with higher scores of ELIH (HR, 1.89; 95% CI, 1.25-2.87; P-trend = 0.001) and ELIR (HR, 2.05; 95% CI, 1.34-3.14, P-trend = 0.0004) had higher risk of developing HCC. Additional adjustment for diabetes mellitus and/or body mass index attenuated the magnitude of the associations, indicating that diabetes and/or adiposity may partly mediate the association of these patterns with HCC risk. Conclusions: Our findings suggest that inflammation and insulin resistance/hyperinsulinemia are potential mechanisms linking dietary or lifestyle factors and HCC development. Impact: Inflammation and insulin resistance/hyperinsulinemia may partly mediate the association of diet and other lifestyles with HCC development, and interventions to reduce the adverse effect of pro-inflammatory and hyperinsulinemic diet and lifestyle may reduce HCC risk.
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