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. 2025 Feb 13;7(5):101355.
doi: 10.1016/j.jhepr.2025.101355. eCollection 2025 May.

Associations between fruit and vegetable consumption and HCC occurrence in patients with cirrhosis

Florian Manneville  1 , Zineb Zouakia  1 , Séverine Donneger  2 , Leopold K Fezeu  1 , Alice Bellicha  1 , Pierre Nahon  2   3   4 , Mathilde Touvier  1 , Nathalie Ganne-Carrié  2   3   4 , Chantal Julia  1   5
Affiliations

Associations between fruit and vegetable consumption and HCC occurrence in patients with cirrhosis

Florian Manneville et al. JHEP Rep. .

Abstract

Background & aims: Prospective studies are needed to increase knowledge of fruit and vegetable consumption effects on hepatocellular carcinoma (HCC) risk. This study aimed to investigate the association between fruit and vegetable consumption and incident HCC in French patients with cirrhosis.

Methods: This study used data from a French prospective observational cohort nested in two national prospective cohorts of patients with histologically proven compensated alcohol-related or viral cirrhosis. Fruit and vegetable consumption was assessed by a trained dietitian using a semiquantitative food-frequency questionnaire validated in French and analyzed as binary exposure according to predefined thresholds (≥240 g/day for fruit or vegetables and ≥400 g/day for fruit and vegetables combined). Incident HCC was primary outcome. Propensity scores were used in Poisson regression models.

Results: Among 179 patients analyzed, 20 HCC were diagnosed during follow-up (median 7.3 [Q1-Q3: 4.1-8.0] years). A significant association was observed between HCC incidence and vegetable consumption ≥240 g/day (adjusted relative risk [RR] 0.35, 95%CI [0.13; 0.98], p = 0.04), but not with consumption of fruit and vegetable ≥400 g/day (RR = 0.49, 95%CI [0.18; 1.32], p = 0.16), nor with fruit consumption ≥240 g/day (RR = 0.80, 95% CI [0.28; 2.31], p = 0.68).

Conclusions: This longitudinal study documented insufficient fruit and/or vegetable consumption in 42.5% of patients with cirrhosis and a 65% reduction of HCC incidence in those with vegetable consumption ≥240 g/day. Reproduction of results in a larger sample are necessary to explore the potential of fruit and vegetables as protective factors in HCC.

Impact and implications: The association between fruit and vegetable consumption and the risk of hepatocellular carcinoma (HCC) is poorly documented in the population of patients with cirrhosis, while such knowledge is crucial for adapting HCC prevention messages. Our study shows 57.5% of patients with cirrhosis reported consuming fruit and/or vegetables at or above the French and WHO threshold of 400 g/day, with a higher proportion of patients consuming at least 240 g/day of vegetables compared with those consuming at least 240 g/day of fruit (47.5% vs. 38.6%). The results suggest that consuming at least 240 g/day of vegetables reduces the risk of HCC by 65% in patients with cirrhosis.

Keywords: Cohort study; Eating behavior; Liver cancer.

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Conflict of interest statement

PN has received grant support from ASTRA ZENECA, BMS, and EISAI. He has also received consultancy fees and payments or honoraria for lectures, presentations, speakers bureaus, manuscript preparation, or educational activities from GILEAD, ASTRA ZENECA, BMS, and ROCHE. He has also received support for attendance at meetings and/or travel from ROCHE and ASTRA ZENECA. The other authors have nothing to disclose. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

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Graphical abstract
Fig 1
Fig. 1
Flowchart of the study.
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