MedicalResearch.com Interview with:
Xuehong Zhang, MD, ScD
Assistant Professor in Medicine
Harvard Medical School
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: In the United States., liver cancer incidence is rapidly increasing and over 42,200 new cases were projected to be diagnosed in 2018. The majority of individuals with liver cancer are diagnosed at a late stage, are not eligible for curative therapy, and die within 1 year of diagnosis. Established risk factors for liver cancer are limited to hepatitis B and C virus (HBV/HCV) infections, metabolic disorders, and smoking. Clearly, identification of novel risk factors, particularly those that are modifiable, is urgently needed.
Dietary factors have been suspected as important, but only excessive alcohol use and aflatoxin-contaminated foods are considered to be established dietary risk factors for hepatocellular carcinoma (HCC). Consumption of whole grains and dietary fiber, especially cereal fiber, have been associated with lower risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease, which are known predisposing factors for HCC. We thus hypothesized that long-term intake of whole grains and dietary fiber may lower the risk of developing hepatocellular carcinoma (HCC) and tested this hypothesis using data from two large prospective cohort studies, the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS).
MedicalResearch.com: How common is liver cancer?
Response: The low number of cases in this report is primarily because of the very low incidence of liver cancer in the United States (< 5 per 100,000 individuals), although the incidence has been rapidly increasing in the past decades. In our cohorts, as expected, we have documented no more than 200 hepatocellular carcinoma cases, despite large sample size (more than 120,000) and long-term follow-up periods (an average follow-up of 24.2 years).
In our study, we have captured almost all incident liver cancer cases by self-reports on biennial questionnaires, and confirmed by their medical records and pathological reports. We further searched state cancer registries and the National Death Index to identify any potential unreported cases.
MedicalResearch.com: What are the main findings?
Response: In this prospective cohort study that included 125,455 U.S. women and men with an average follow-up of 24.2 years, a total of 141 hepatocellular carcinoma cases were documented.
Higher intake of whole grains, possibly cereal fiber, is associated with lower risk of developing hepatocellular carcinoma.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest that higher intake of whole grains, possibly cereal fiber, and bran was associated with reduced risk of hepatocellular carcinoma among U.S. adults.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future studies that carefully consider hepatitis B and C virus infections are needed to further examine these associations in other racial/ethnical or high risk populations, and to elucidate the underlying mechanisms. Pooled analyses across cohorts with large number of hepatocellular carcinoma cases would also be helpful, given the low incidence of the disease in the U.S.
Yang W, Ma Y, Liu Y, et al. Association of Intake of Whole Grains and Dietary Fiber With Risk of Hepatocellular Carcinoma in US Adults. JAMA Oncol. Published online February 21, 2019. doi:10.1001/jamaoncol.2018.7159
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