Diet Habits and Hepatocellular Carcinoma-Potential Implication for Clinical Practice

Abstract

Context: Chronic hepatitis infections and alcohol abuse traditionally have been major causes of hepatocellular carcinoma (HCC), but they are now being gradually outweighed by metabolic disorders such as obesity, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD). Western dietary patterns along with a sedentary lifestyle are key contributors to the ongoing global metabolic disease epidemic. Little is known about the role of dietary habits in the modulation of HCC risk.

Objective: The aim of this review was to comprehensively examine established and putative links between dietary components and HCC risk.

Methods: Information provided in International Agency for Research on Cancer monographs and the 2018 World Cancer Research Fund/American Institute for Cancer Research report was used to identify foods, dietary components, and contaminants indicated as confirmed or potential risk factors for HCC. For each identified item, we performed a search in the PubMed database using the Medical Subject Heading terms of the indicated food items, as well as the generic name of the food item. The search was restricted to systematic reviews and meta-analyses, without publication date restrictions.

Results: Consumption of red and processed meat, high intake of saturated fatty acids, foods with high glycemic load, and even moderate alcohol intake are associated with higher HCC risk. Cellular damage from low-grade chronic inflammation (meta-inflammation), insulin resistance, and alterations to the composition and metabolic activity of the gut microbiota are potential mechanisms whereby Western pattern diets promote liver carcinogenesis. Conversely, consumption of greater amounts of vegetables, legumes, fruits, and whole grain-derived products could provide the proper amount of fiber intake, polyphenols, and low-glycemic index carbohydrates and alleviate the protumorigenic hepatic microenvironment.

Conclusions: Nutritional intervention promoting healthy dietary habits is an attractive long-term strategy to reduce HCC risk. Patients with MASLD without advanced fibrosis, excluded from current HCC screening strategies, might be the main target population.

Keywords: MASLD; Mediterranean diet; Western diet; diet habit; fiber; gut microbiota; liver cancer.