Food Environments and Hepatocellular Carcinoma Incidence.

Mimi Ton,Peter James,Michael J Widener,Trang Vopham

doi:10.3390/ijerph18115740

Abstract

Research into the potential impact of the food environment on liver cancer incidence has been limited, though there is evidence showing that specific foods and nutrients may be potential risk or preventive factors. Data on hepatocellular carcinoma (HCC) cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries. The county-level food environment was assessed using the Modified Retail Food Environment Index (mRFEI), a continuous score that measures the number of healthy and less healthy food retailers within counties. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between mRFEI scores and HCC risk, adjusting for individual- and county-level factors. The county-level food environment was not associated with HCC risk after adjustment for individual-level age at diagnosis, sex, race/ethnicity, year, and SEER registry and county-level measures for health conditions, lifestyle factors, and socioeconomic status (adjusted IRR: 0.99, 95% CI: 0.96, 1.01). The county-level food environment, measured using mRFEI scores, was not associated with HCC risk.

Highlights

Hepatocellular carcinoma (HCC) comprises 85–90% of primary liver cancer cases [1,2].HCC incidence and mortality have generally increased over time [1]
We evaluated potential confounding by ambient PM2.5 and ultraviolet radiation (UV) exposure, which have been shown to have positive and inverse associations with HCC risk, respectively [27,28]
HCC cases lived in counties where an average of 8.4% of the population consumed alcohol, 29.0% smoked cigarettes, 28.4% were obese, and 12.2% had diabetes

Summary

Introduction

HCC incidence and mortality have generally increased over time [1]. Some research suggests that dietary factors may be associated with HCC risk. There is evidence suggesting that a lower vegetable intake [5], low selenium levels [6] and a higher intake of red meat and saturated fats [7,8] are associated with an increased risk of HCC, while inverse associations have been observed for the higher intake of plant-based fats and protein [9,10], whole grains and fiber [11], tree nuts [12], milk and yogurt, white meats, eggs, fruit, and tofu [13,14,15]. There is evidence of dietary patterns impacting HCC development, where improved diet quality (measured by the Alternative Healthy Eating Index or AHEI) may reduce the risk of HCC [16]

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