A diet-wide association study for liver cancer risk: findings from a prospective cohort study in Chinese women

Abstract

Although dietary factors have been examined as potential risk factors for liver cancer, the evidence is still inconclusive. Using a diet-wide association analysis, our research evaluated the associations of 126 foods and nutrients on the risk of liver cancer in a Chinese population. We obtained the diet consumption of 72,680 women in the Shanghai Women's Health Study using baseline dietary questionnaires. The association between each food and nutrient and liver cancer risk was quantified by Cox regression model. A false discovery rate of 0.05 was used to determine the foods and nutrients which need to be verified. Totally 256 incident liver cancer cases were identified in 1,267,391 person-years during the follow-up duration. At the statistical significance level (P ≤ 0.05), higher intakes of cooked wheaten foods, pear, grape and copper were inversely associated with liver cancer risk, while spinach, leafy vegetables, eggplant and carrots showed the positive associations. After considering multiple comparisons, no dietary variable was associated with liver cancer risk. Similar findings were seen in the stratification, secondary and sensitivity analyses. Our findings observed no significant association between dietary factors and liver cancer risk after considering multiple comparisons in Chinese women. More evidence is needed to explore the associations between diet and female liver cancer occurrence.

Keywords: BMI, body mass index; CI, confidence interval; Cohort study; DWAS, Diet-wide association study; Diet; Diet-wide association study; EPIC, European Prospective Investigation into Cancer and Nutrition; FDR, false discovery rate; FFQ, food frequency questionnaire; GWAS, genome-wide association studies; HBV, Hepatitis B virus; HCC, hepatocellular carcinoma; HCV, Hepatitis C virus; HPFS, Health Professionals Follow-up Study; HR, hazard ratio; IL-6, interleukin-6; IQR, Inter quartile range; Liver cancer; MET, metabolic equivalent; NHS, Nurses’ Health Study; NIH-AARP, National Institutes of Health-American Association of Retired Persons Diet and Health Study cohort; Nutrition; PYs, person-years; SWHS, Shanghai women’s health study; T2DM, type 2 diabetes mellitus; Women.

Figure 1.

Study process of diet-wide association study analytical method to test associations between foods and nutrients intake and risk of liver cancer in the Shanghai Women’s Health Study.

Figure 2.

Volcano plot showing results from the diet-wide association study regarding the association between 126 dietary factors and liver cancer risk in the Shanghai Women’s Health Study. The y-axis shows the false discovery rate (FDR) adjusted P values in –log10 scale from the Cox proportional hazards regression models for each dietary factor. The x-axis shows the estimated HR for each dietary factor per 1-SD increase in daily consumption. The dashed horizontal line represents the level of significance corresponding to FDR of 0.05 and P value of 0.05. The models were adjusted for age, BMI, calorie intake, physical activity, education, menopause status, smoking, alcohol drinking, family history of liver cancer, medical history of chronic hepatitis and type 2 diabetes mellitus.