Association of Intake of Whole Grains and Dietary Fiber With Risk of Hepatocellular Carcinoma in US Adults
Yang W, Ma Y, Liu Y, Smith-Warner SA, Simon TG, Chong DQ, Qi Q, Meyerhardt JA, Giovannucci EL, Chan AT, Zhang X
JAMA oncology · 71 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food frequency questionnaire
Who paid for it
- Funding
- Independent funding
- Government
- National Institutes of Health
Based on 1 listed funder(s).
Publication
- Published
- 2019-02-21 · JAMA Oncol · vol. 5 · issue 6 · p. 879
- Publisher
- American Medical Association
- Cited
- 110 citations · more than 99% of similar papers · 9.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 59 works
- Access
- Open access (hybrid journal) · CC-BY
- Research areas
- Food composition and properties · Nutritional Studies and Diet · Liver Disease Diagnosis and Treatment
- Keywords
- Medicine, Whole grains, Refined grains, Bran, Hepatocellular carcinoma, Lower risk, Hazard ratio, Proportional hazards model, Dietary fiber, Cohort study, Cohort, Internal medicine, Physiology, Food science, Confidence interval, Biology
- MeSH
- humans, fruit, vegetables, carcinoma, hepatocellular, liver neoplasms, risk factors, cohort studies, follow-up studies, dietary fiber, adult, aged, aged, 80 and over, middle aged, united states, female, male, whole grains
11 authors
From US, CN, SG
- Wanshui YangBrigham and Women's Hospital; Harvard University; Anhui Medical University
- Yanan MaBrigham and Women's Hospital; Harvard University; China Medical University
- Yue LiuBrigham and Women's Hospital; Harvard University; Beijing University of Chinese Medicine
- Stephanie A. Smith‐WarnerHarvard University
- Tracey G. SimonMassachusetts General Hospital
- Dawn Qingqing ChongNational Cancer Centre Singapore
Abstract
Importance
Increased intake of whole grain and dietary fiber has been associated with lower risk of insulin resistance, hyperinsulinemia, and inflammation, which are known predisposing factors for hepatocellular carcinoma (HCC). Therefore, we hypothesized that long-term intake of whole grains and dietary fiber may be associated with lower risk of HCC.
Objective
To assess the associations of whole grain and dietary fiber intake with the risk of HCC.
Design, setting, and participants
Cohort study of the intake of whole grains, their subcomponents (bran and germ), and dietary fiber (cereal, fruit, and vegetable) in 125 455 participants from 2 cohorts from the Nurses' Health Study and the Health Professionals Follow-up Study.
Exposures
Intake of whole grains, their subcomponents (bran and germ), and dietary fiber (cereal, fruit, and vegetable) were collected and updated almost every 4 years using validated food frequency questionnaires.
Main outcomes and measures
Multivariable hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression model after adjusting for most known HCC risk factors.
Results
After an average follow-up of 24.2 years, we identified 141 patients with HCC among 125 455 participants (77 241 women and 48 214 men (mean [SD] age, 63.4 [10.7] years). Increased whole grain intake was significantly associated with lower risk of HCC (the highest vs lowest tertile intake: HR, 0.63; 95% CI, 0.41-0.96; P = .04 for trend). A nonsignificant inverse HCC association was observed for total bran (HR, 0.70; 95% CI, 0.46-1.07; P = .11 for trend), but not for germ. Increased intake of cereal fiber (HR, 0.68; 95% CI, 0.45-1.03; P = .07 for trend), but not fruit or vegetable fiber, was associated with a nonsignificant reduced risk of HCC.
Conclusions and relevance
Increased intake of whole grains and possibly cereal fiber and bran could be associated with reduced risk of HCC among adults in the United States. Future studies that carefully consider hepatitis B and C virus infections are needed to replicate our findings, to examine these associations in other racial/ethnic or high-risk populations, and to elucidate the underlying mechanisms.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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