Annals of Oncology Advance Access published online on June 23, 2009
Annals of Oncology, doi:10.1093/annonc/mdp058
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Dietary glycemic load and hepatocellular carcinoma with or without chronic hepatitis infection
1 Department of Epidemiology, ‘Mario Negri’ Institute for Pharmacological Research, Milan, Italy
2 International Epidemiology Institute, Rockville, MD
3 Department of Medicine, Vanderbilt University Medical Center and Vanderbilt—Ingram Cancer Center, Nashville, TN, USA
4 Epidemiology and Biostatistics Unit, Aviano Cancer Centre, Aviano
5 Department of Epidemiology, Fondazione ‘G. Pascale’, National Cancer Institute, Naples
6 Institute of Hygiene and Epidemiology, University of Udine, Udine, Italy
7 Epidemiology and Biology Cluster, International Agency for Research on Cancer, Lyon, France
8 Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
9 Institute of Medical Statistics and Biometry ‘G. A. Maccacaro’, University of Milan, Milan, Italy
* Correspondence to: Prof. C. La Vecchia, Department of Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri’, via La Masa 19, 20156 Milan, Italy. Tel: +39-02-39014-527; Fax: +39-02-33200231; E-mail: lavecchia{at}marionegri.it
Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the major risk factors for hepatocellular carcinoma (HCC). The association of diabetes mellitus with HCC suggests that dietary glycemic load (GL) may influence HCC risk. We have examined the association between dietary GL and HCC.
Patients and methods: We conducted a hospital-based case–control study in Italy in 1999–2002, including 185 HCC cases and 412 controls who answered a validated food frequency questionnaire and provided blood samples. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed using unconditional multiple logistic regression.
Results: We observed a positive association between GL and HCC overall, with an OR of 3.02 (95% CI 1.49–6.12) for the highest quintile of GL compared with the lowest and a significant trend. The OR among HCC cases with evidence of chronic infection with HBV and/or HCV was 3.25 (95% CI 1.46–7.22), while the OR among those with no evidence of infection was 2.45 (95% CI 0.69–8.64), with no significant trend. The association was not explained by the presence of cirrhosis or diabetes.
Conclusions: High dietary GL is associated with increased risk for HCC. The positive association was most pronounced among HCC cases with HBV and/or HCV markers.
diabetes mellitus, diet, glycemic load, hepatitis B virus, hepatitis C virus, hepatocellular carcinoma
Received for publication January 7, 2009. Accepted for publication February 13, 2009.