Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study

C. Bamia; P. Lagiou; M. Jenab; K. Aleksandrova; V. Fedirko; D. Trichopoulos; K. Overvad; A. Tjønneland; A. Olsen; F. Clavel-Chapelon; M. C. Boutron-Ruault; M. Kvaskoff; V. A. Katzke; T. Kühn; H. Boeing; U. Nöthlings; D. Palli; S. Sieri; S. Panico; R. Tumino; A. Naccarati; H. B. Bueno-de-Mesquita; P. H.M. Peeters; E. Weiderpass; G. Skeie; J. R. Quirós; A. Agudo; M. D. Chirlaque; M. J. Sanchez; E. Ardanaz; M. Dorronsoro; U. Ericson; L. M. Nilsson; M. Wennberg; K. T. Khaw; N. Wareham; T. J. Key; R. C. Travis; P. Ferrari; M. Stepien; T. Duarte-Salles; T. Norat; E. Riboli; A. Trichopoulou

doi:10.1038/bjc.2014.654

Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study

C. Bamia^*, P. Lagiou, M. Jenab, K. Aleksandrova, V. Fedirko, D. Trichopoulos, K. Overvad, A. Tjønneland, A. Olsen, F. Clavel-Chapelon, M. C. Boutron-Ruault, M. Kvaskoff, V. A. Katzke, T. Kühn, H. Boeing, U. Nöthlings, D. Palli, S. Sieri, S. Panico, R. TuminoA. Naccarati, H. B. Bueno-de-Mesquita, P. H.M. Peeters, E. Weiderpass, G. Skeie, J. R. Quirós, A. Agudo, M. D. Chirlaque, M. J. Sanchez, E. Ardanaz, M. Dorronsoro, U. Ericson, L. M. Nilsson, M. Wennberg, K. T. Khaw, N. Wareham, T. J. Key, R. C. Travis, P. Ferrari, M. Stepien, T. Duarte-Salles, T. Norat, E. Riboli, A. Trichopoulou

^*Corresponding author for this work

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Abstract

Background: Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations.

Methods: In 486 799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d1 increments of vegetable/fruit intakes.

Results: Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d1 increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d1 increment): 1.01; 95% CI: 0.92-1.11.

Conclusions: Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.

Original language	English
Pages (from-to)	1273-1282
Number of pages	10
Journal	British Journal of Cancer
Volume	112
Early online date	05 Mar 2015
DOIs	https://doi.org/10.1038/bjc.2014.654
Publication status	Published - 31 Mar 2015
Externally published	Yes

Bibliographical note

Funding Information:
The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. This work was in part supported by the French National Cancer Institute (L’Institut National du Cancer) (grant number 2009-139; PI: M Jenab).The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (BMBF, Germany); Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC), National Research Council, HuGeF Foundation, Compagnia di San Paolo, Sicilian Government, AIRE ONLUS Ragusa (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund and Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health, Norwegian Research Council (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/ 0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council (UK). We thank Ms Carine Biessy for her efforts and work in conducting part of the statistical analyses for this project and B Hemon for his assistance in database preparation. We also thank Dr E Trepo (Labo Republique, Lyon) for her contribution to the project and biomarker analyses in the nested case–control component.

Publisher Copyright:
© 2015 Cancer Research UK. All rights reserved.

Keywords

Cohort
EPIC
Fruit
Hepatocellular carcinoma
Liver cancer
Vegetable

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/bjc.2014.654Licence: CC BY

Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study
Copyright 2015 the authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
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Bamia, C., Lagiou, P., Jenab, M., Aleksandrova, K., Fedirko, V., Trichopoulos, D., Overvad, K., Tjønneland, A., Olsen, A., Clavel-Chapelon, F., Boutron-Ruault, M. C., Kvaskoff, M., Katzke, V. A., Kühn, T., Boeing, H., Nöthlings, U., Palli, D., Sieri, S., Panico, S., ... Trichopoulou, A. (2015). Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study. British Journal of Cancer, 112, 1273-1282. https://doi.org/10.1038/bjc.2014.654

@article{f4afe381473f4e1588657438d3d1467e,

title = "Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study",

abstract = "Background: Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. Methods: In 486 799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d1 increments of vegetable/fruit intakes. Results: Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d1 increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d1 increment): 1.01; 95% CI: 0.92-1.11. Conclusions: Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.",

keywords = "Cohort, EPIC, Fruit, Hepatocellular carcinoma, Liver cancer, Vegetable",

author = "C. Bamia and P. Lagiou and M. Jenab and K. Aleksandrova and V. Fedirko and D. Trichopoulos and K. Overvad and A. Tj{\o}nneland and A. Olsen and F. Clavel-Chapelon and Boutron-Ruault, {M. C.} and M. Kvaskoff and Katzke, {V. A.} and T. K{\"u}hn and H. Boeing and U. N{\"o}thlings and D. Palli and S. Sieri and S. Panico and R. Tumino and A. Naccarati and Bueno-de-Mesquita, {H. B.} and Peeters, {P. H.M.} and E. Weiderpass and G. Skeie and Quir{\'o}s, {J. R.} and A. Agudo and Chirlaque, {M. D.} and Sanchez, {M. J.} and E. Ardanaz and M. Dorronsoro and U. Ericson and Nilsson, {L. M.} and M. Wennberg and Khaw, {K. T.} and N. Wareham and Key, {T. J.} and Travis, {R. C.} and P. Ferrari and M. Stepien and T. Duarte-Salles and T. Norat and E. Riboli and A. Trichopoulou",

note = "Funding Information: The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. This work was in part supported by the French National Cancer Institute (L{\textquoteright}Institut National du Cancer) (grant number 2009-139; PI: M Jenab).The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G{\'e}n{\'e}rale de l{\textquoteright}Education Nationale, Institut National de la Sant{\'e} et de la Recherche M{\'e}dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (BMBF, Germany); Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC), National Research Council, HuGeF Foundation, Compagnia di San Paolo, Sicilian Government, AIRE ONLUS Ragusa (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund and Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health, Norwegian Research Council (Norway); Health Research Fund (FIS), Regional Governments of Andaluc{\'i}a, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/ 0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Sk{\aa}ne and V{\"a}sterbotten (Sweden); Cancer Research UK, Medical Research Council (UK). We thank Ms Carine Biessy for her efforts and work in conducting part of the statistical analyses for this project and B Hemon for his assistance in database preparation. We also thank Dr E Trepo (Labo Republique, Lyon) for her contribution to the project and biomarker analyses in the nested case–control component. Publisher Copyright: {\textcopyright} 2015 Cancer Research UK. All rights reserved.",

year = "2015",

month = mar,

day = "31",

doi = "10.1038/bjc.2014.654",

language = "English",

volume = "112",

pages = "1273--1282",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Springer Nature",

}

Bamia, C, Lagiou, P, Jenab, M, Aleksandrova, K, Fedirko, V, Trichopoulos, D, Overvad, K, Tjønneland, A, Olsen, A, Clavel-Chapelon, F, Boutron-Ruault, MC, Kvaskoff, M, Katzke, VA, Kühn, T, Boeing, H, Nöthlings, U, Palli, D, Sieri, S, Panico, S, Tumino, R, Naccarati, A, Bueno-de-Mesquita, HB, Peeters, PHM, Weiderpass, E, Skeie, G, Quirós, JR, Agudo, A, Chirlaque, MD, Sanchez, MJ, Ardanaz, E, Dorronsoro, M, Ericson, U, Nilsson, LM, Wennberg, M, Khaw, KT, Wareham, N, Key, TJ, Travis, RC, Ferrari, P, Stepien, M, Duarte-Salles, T, Norat, T, Riboli, E & Trichopoulou, A 2015, 'Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study', British Journal of Cancer, vol. 112, pp. 1273-1282. https://doi.org/10.1038/bjc.2014.654

TY - JOUR

T1 - Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study

AU - Bamia, C.

AU - Lagiou, P.

AU - Jenab, M.

AU - Aleksandrova, K.

AU - Fedirko, V.

AU - Trichopoulos, D.

AU - Overvad, K.

AU - Tjønneland, A.

AU - Olsen, A.

AU - Clavel-Chapelon, F.

AU - Boutron-Ruault, M. C.

AU - Kvaskoff, M.

AU - Katzke, V. A.

AU - Kühn, T.

AU - Boeing, H.

AU - Nöthlings, U.

AU - Palli, D.

AU - Sieri, S.

AU - Panico, S.

AU - Tumino, R.

AU - Naccarati, A.

AU - Bueno-de-Mesquita, H. B.

AU - Peeters, P. H.M.

AU - Weiderpass, E.

AU - Skeie, G.

AU - Quirós, J. R.

AU - Agudo, A.

AU - Chirlaque, M. D.

AU - Sanchez, M. J.

AU - Ardanaz, E.

AU - Dorronsoro, M.

AU - Ericson, U.

AU - Nilsson, L. M.

AU - Wennberg, M.

AU - Khaw, K. T.

AU - Wareham, N.

AU - Key, T. J.

AU - Travis, R. C.

AU - Ferrari, P.

AU - Stepien, M.

AU - Duarte-Salles, T.

AU - Norat, T.

AU - Riboli, E.

AU - Trichopoulou, A.

N1 - Funding Information: The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. This work was in part supported by the French National Cancer Institute (L’Institut National du Cancer) (grant number 2009-139; PI: M Jenab).The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (BMBF, Germany); Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC), National Research Council, HuGeF Foundation, Compagnia di San Paolo, Sicilian Government, AIRE ONLUS Ragusa (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund and Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health, Norwegian Research Council (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/ 0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council (UK). We thank Ms Carine Biessy for her efforts and work in conducting part of the statistical analyses for this project and B Hemon for his assistance in database preparation. We also thank Dr E Trepo (Labo Republique, Lyon) for her contribution to the project and biomarker analyses in the nested case–control component. Publisher Copyright: © 2015 Cancer Research UK. All rights reserved.

PY - 2015/3/31

Y1 - 2015/3/31

N2 - Background: Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. Methods: In 486 799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d1 increments of vegetable/fruit intakes. Results: Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d1 increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d1 increment): 1.01; 95% CI: 0.92-1.11. Conclusions: Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.

AB - Background: Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. Methods: In 486 799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d1 increments of vegetable/fruit intakes. Results: Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d1 increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d1 increment): 1.01; 95% CI: 0.92-1.11. Conclusions: Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.

KW - Cohort

KW - EPIC

KW - Fruit

KW - Hepatocellular carcinoma

KW - Liver cancer

KW - Vegetable

U2 - 10.1038/bjc.2014.654

DO - 10.1038/bjc.2014.654

M3 - Article

C2 - 25742480

AN - SCOPUS:84938548614

SN - 0007-0920

VL - 112

SP - 1273

EP - 1282

JO - British Journal of Cancer

JF - British Journal of Cancer

ER -

Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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