Associations between fruit and vegetable consumption and HCC occurrence in patients with liver cirrhosis

Background & Aims

Prospective studies are needed to increase knowledge of fruit and vegetable consumption effects on hepatocellular carcinoma (HCC) risk. This study aimed to investigate the association between fruit and vegetable consumption and incident HCC in French patients with liver cirrhosis.

Methods

This study used data from a French prospective observational cohort nested in two national prospective cohorts of patients with histologically proven compensated alcohol-related or viral liver cirrhosis. Fruit and vegetable consumption was assessed by a trained dietitian using semi-quantitative food-frequency questionnaire validated in French and analyzed as binary exposure according to predefined thresholds (≥ 240 g/day for fruit or vegetables and ≥ 400 g/day for fruit and vegetables combined). Incident HCC was primary outcome. Propensity scores were used in Poisson regression models.

Results

Among 179 patients analyzed, 20 HCC were diagnosed during follow-up (median 7.3 [Q1-Q3: 4.1-8.0] years). A significant association was observed between HCC incidence and vegetable consumption ≥ 240 g/day (adjusted RR 0.35, 95%CI [0.13; 0.98], p = 0,04), but not with consumption of fruit and vegetable ≥ 400 g/day (RR 0.49, 95%CI [0.18; 1.32], p =0,16), nor with fruit consumption ≥ 240 g/day (RR= 0.80, 95% CI [0.28; 2.31], p=0.68).

Conclusions

This longitudinal study documented insufficient fruit and/or vegetable consumption in 42.5% of patients with liver cirrhosis and a 65% reduction of HCC incidence in those with vegetable consumption ≥ 240 g/day. Reproduction of results in a larger sample are necessary to explore the potential of fruit and vegetables as protective factors in HCC.

Impact and implications

The association between fruit and vegetable consumption and the risk of hepatocellular carcinoma (HCC) is poorly documented in the population of cirrhotic patients, while such knowledge is crucial for adapting HCC prevention messages. Our study shows 57.5% of patients with liver cirrhosis reported consuming fruit and/or vegetables at or above the French and WHO threshold of 400g/day, with a higher proportion of patients consuming at least 240g/day of vegetable compared with those consuming at least 240g/day of fruit (47.5% versus 38.6%). The results suggest that consuming at least 240g/day of vegetables reduces the risk of HCC by 65% in patients with liver cirrhosis.