Abstract
Globally, liver cancer is the sixth most common cause of cancer mortality, with hepatocellular carcinoma (HCC) being the most common type of primary liver cancer. Emerging evidence states that diet is recognised as a potential lifestyle-related risk factor for the development of HCC. The aim of this systematic review is to determine whether there is an association between diet and the development of HCC. Using the PRISMA guidelines, three databases (MEDLINE Complete, CINAHL and Embase) were systematically searched, and studies published until July 2020 were included. Thirty observational studies were selected. The protocol was registered with PROSPERO (CRD42019135240). Higher adherence to the Mediterranean dietary pattern, Alternative Healthy Eating Index-2010, the Urban Prudent Dietary Pattern, the Traditional Cantonese Dietary Pattern, intake of vegetables, wholegrains, fish, poultry, coffee, macronutrients such as monounsaturated fats and micronutrients such as vitamin E, vitamin B9, β-carotene, manganese and potassium were associated with a reduced risk of HCC. The results suggest a potential role of diet in the development of HCC. Further quantitative research needs to be undertaken within a range of populations to investigate diet and the relationship with HCC risk.
Highlights
Liver cancer is the seventh leading cause of cancer-related mortality in Australia, and the incidence continues to increase [1,2,3]
Seventy-six studies were eligible for full text screening and 46 of these were excluded for the following reasons: abstract only (n = 11), included only one nutrient (n = 9), wrong article type or study design (n = 4), too broad such as studying overall lifestyle habits rather than a focus on diet (n = 16), looking at metabolicassociated fatty liver disease (MAFLD) not Hepatocellular carcinoma (HCC) (n = 1) and looking at serum/biomarkers (n = 5)
Current epidemiological evidence supports that diet and dietary patterns are relevant factors related to the risk of HCC
Summary
Liver cancer is the seventh leading cause of cancer-related mortality in Australia, and the incidence continues to increase [1,2,3]. Liver cirrhosis confers a very high risk of developing HCC, with between 5% and 30% of cirrhotic patients being diagnosed with HCC within the first five years [4]. Other identified risk factors for HCC include obesity, diabetes and MAFLD [10]. Diet has been recognised as a potential lifestyle-related risk factor for the development of HCC [11,12,13,14,15,16]. A healthy diet may play a preventative role in the development of some cancers, while a poor diet has been shown to increase cancer risk [11,14]. There is no clear consensus of what a protective diet is composed of for HCC risk [11]
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