Dietary flavonoid, lignan and antioxidant capacity and risk of hepatocellular carcinoma in the European prospective investigation into cancer and nutrition study

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Abstract

Limited epidemiological evidence suggests a protective role for plant foods rich in flavonoids and antioxidants in hepatocellular cancer (HCC) etiology. Our aim was to prospectively investigate the association between dietary intake of flavonoids, lignans and nonenzymatic antioxidant capacity (NEAC) and HCC risk. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 477,206 subjects (29.8% male) recruited from ten Western European countries, was analyzed. Flavonoid, lignan and NEAC intakes were calculated using a compilation of existing food composition databases linked to dietary information from validated dietary questionnaires. Dietary NEAC was based on ferric reducing antioxidant capacity (FRAP) and total radical-trapping antioxidant parameter (TRAP). Hepatitis B/C status was measured in a nested case-control subset. During a mean follow-up of 11-years, 191 incident HCC cases (66.5% men) were identified. Using Cox regression, multivariable adjusted models showed a borderline nonsignificant association of HCC with total flavonoid intake (highest versus lowest tertile, HR=0.65, 95% CI: 0.40-1.04; p(trend)=0.065), but not with lignans. Among flavonoid subclasses, flavanols were inversely associated with HCC risk (HR=0.62, 95% CI: 0.39-0.99; p(trend)=0.06). Dietary NEAC was inversely associated with HCC (FRAP: HR 0.50, 95% CI: 0.31-0.81; p(trend)=0.001; TRAP: HR 0.49, 95% CI: 0.31-0.79; p(trend)=0.002), but statistical significance was lost after exclusion of the first 2 years of follow-up. This study suggests that higher intake of dietary flavanols and antioxidants may be associated with a reduced HCC risk. What's new? Coffee, tea, fruits and vegetables, and certain other foods may protect against hepatocellular carcinoma (HCC), thanks to their antioxidant ingredients. This study lends fresh support to that idea, revealing specifically that dietary flavanols, which possess antioxidant activity, could play a favourable role in HCC prevention. Dietary antioxidant capacity from coffee intake in particular was found to be inversely associated with HCC risk, though statistical significance was lost after exclusion of the first two years of follow-up. Assessment of the bioavailability of flavonoids and other antioxidants is needed to confirm links between antioxidant intake and HCC risk.

Details

Authors
  • Raul Zamora-Ros
  • Veronika Fedirko
  • Antonia Trichopoulou
  • Carlos A. Gonzalez
  • Christina Bamia
  • Elisabeth Trepo
  • Ute Noethlings
  • Talita Duarte-Salles
  • Mauro Serafini
  • Lea Bredsdorff
  • Kim Overvad
  • Anne Tjonneland
  • Jytte Halkjaer
  • Guy Fagherazzi
  • Florence Perquier
  • Marie-Christine Boutron-Ruault
  • Verena Katzke
  • Annekatrin Lukanova
  • Anna Floegel
  • Heiner Boeing
  • Pagona Lagiou
  • Dimitrios Trichopoulos
  • Calogero Saieva
  • Claudia Agnoli
  • Amalia Mattiello
  • Rosario Tumino
  • Carlotta Sacerdote
  • H. Bas Bueno-de-Mesquita
  • Petra H. M. Peeters
  • Elisabete Weiderpass
  • Dagrun Engeset
  • Guri Skeie
  • Marcial Vicente Argueelles
  • Esther Molina-Montes
  • Miren Dorronsoro
  • Maria Jose Tormo
  • Eva Ardanaz
  • Malin Sund
  • Rikard Landberg
  • Kay-Tee Khaw
  • Nicholas J. Wareham
  • Francesca L. Crowe
  • Elio Riboli
  • Mazda Jenab
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology

Keywords

  • flavonoids, lignans, dietary intake, antioxidant capacity, hepatocellular carcinoma, EPIC
Original languageEnglish
Pages (from-to)2429-2443
JournalInternational Journal of Cancer
Volume133
Issue number10
Publication statusPublished - 2013
Publication categoryResearch
Peer-reviewedYes