Abstract

Studies using metabolomic data have identified metabolites from several compound classes that are associated with disease-related lifestyle factors. In this study, we identified metabolic signatures reflecting lifestyle patterns and related them to the risk of hepatocellular carcinoma (HCC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Within a nested case-control study of 147 incident HCC cases and 147 matched controls, partial least squares (PLS) analysis related 7 modified healthy lifestyle index (HLI) variables (diet, BMI, physical activity, lifetime alcohol, smoking, diabetes, and hepatitis) to 132 targeted serum-measured metabolites and a liver function score. The association between the resulting PLS scores and HCC risk was examined in multivariable conditional logistic regression models, where ORs and 95% CIs were computed. The lifestyle component's PLS score was negatively associated with lifetime alcohol, BMI, smoking, and diabetes, and positively associated with physical activity. Its metabolic counterpart was positively related to the metabolites sphingomyelin (SM) (OH) C14:1, C16:1, and C22:2, and negatively related to glutamate, hexoses, and the diacyl-phosphatidylcholine PC aaC32:1. The lifestyle and metabolomics components were inversely associated with HCC risk, with the ORs for a 1-SD increase in scores equal to 0.53 (95% CI: 0.38, 0.74) and 0.28 (0.18, 0.43), and the associated AUCs equal to 0.64 (0.57, 0.70) and 0.74 (0.69, 0.80), respectively. This study identified a metabolic signature reflecting a healthy lifestyle pattern which was inversely associated with HCC risk. The metabolic profile displayed a stronger association with HCC than did the modified HLI derived from questionnaire data. Measuring a specific panel of metabolites may identify strata of the population at higher risk for HCC and can add substantial discrimination compared with questionnaire data. This trial was registered at clinicaltrials.gov as NCT03356535.

Highlights

  • Hepatocellular carcinoma (HCC) is the predominant form of liver cancer and is the second most frequent cause of cancer death worldwide [1]

  • In most of the European Prospective Investigation into Cancer and Nutrition (EPIC) centers, participants were recruited from the general population with the following exceptions: for France, women were enrolled from a health insurance scheme for school and university employees; in Utrecht (Netherlands) and in Florence (Italy), participants came from breast cancer screening programs; some centers in Italy and National Research Council (Italy) (Turin and Ragusa) and Spain recruited blood donors; and the Oxford subcohort (United Kingdom) included mostly health-conscious individuals recruited throughout the United Kingdom

  • The metabolic signature was associated with a significant 72% reduction in hepatocellular carcinoma (HCC) risk, which was statistically significantly different from the 51% risk reduction associated with a lifestyle profile based on questionnaire data

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Summary

Introduction

Hepatocellular carcinoma (HCC) is the predominant form of liver cancer and is the second most frequent cause of cancer death worldwide [1]. Objective: In this study, we identified metabolic signatures reflecting lifestyle patterns and related them to the risk of hepatocellular carcinoma (HCC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Design: Within a nested case-control study of 147 incident HCC cases and 147 matched controls, partial least squares (PLS) analysis related 7 modified healthy lifestyle index (HLI) variables (diet, BMI, physical activity, lifetime alcohol, smoking, diabetes, and hepatitis) to 132 targeted serum-measured metabolites and a liver function score. Measuring a specific panel of metabolites may identify strata of the population at higher risk for HCC and can add substantial discrimination compared with questionnaire data. This trial was registered at clinicaltrials.gov as NCT03356535.

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