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

Zamora-Ros, Raul; Fedirko, Veronika; Trichopoulou, Antonia; Gonzalez, Carlos A.; Bamia, Christina; Trepo, Elisabeth; Noethlings, Ute; Duarte-Salles, Talita; Serafini, Mauro and Bredsdorff, Lea, et al. (2013) In International Journal of Cancer 133(10). p.2429-2443
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... (More)
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. (Less)
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keywords
flavonoids, lignans, dietary intake, antioxidant capacity, hepatocellular carcinoma, EPIC
in
International Journal of Cancer
volume
133
issue
10
pages
2429 - 2443
publisher
John Wiley & Sons
external identifiers
  • wos:000324072300019
  • scopus:84883748351
ISSN
0020-7136
DOI
10.1002/ijc.28257
language
English
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yes
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397fb50d-2b73-421f-af7a-4e3746d781fd (old id 4106235)
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2013-11-07 13:29:17
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2019-03-19 01:05:32
@article{397fb50d-2b73-421f-af7a-4e3746d781fd,
  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.},
  author       = {Zamora-Ros, Raul and Fedirko, Veronika and Trichopoulou, Antonia and Gonzalez, Carlos A. and Bamia, Christina and Trepo, Elisabeth and Noethlings, Ute and Duarte-Salles, Talita and Serafini, Mauro and Bredsdorff, Lea and Overvad, Kim and Tjonneland, Anne and Halkjaer, Jytte and Fagherazzi, Guy and Perquier, Florence and Boutron-Ruault, Marie-Christine and Katzke, Verena and Lukanova, Annekatrin and Floegel, Anna and Boeing, Heiner and Lagiou, Pagona and Trichopoulos, Dimitrios and Saieva, Calogero and Agnoli, Claudia and Mattiello, Amalia and Tumino, Rosario and Sacerdote, Carlotta and Bueno-de-Mesquita, H. Bas and Peeters, Petra H. M. and Weiderpass, Elisabete and Engeset, Dagrun and Skeie, Guri and Argueelles, Marcial Vicente and Molina-Montes, Esther and Dorronsoro, Miren and Tormo, Maria Jose and Ardanaz, Eva and Ericson, Ulrika and Sonestedt, Emily and Sund, Malin and Landberg, Rikard and Khaw, Kay-Tee and Wareham, Nicholas J. and Crowe, Francesca L. and Riboli, Elio and Jenab, Mazda},
  issn         = {0020-7136},
  keyword      = {flavonoids,lignans,dietary intake,antioxidant capacity,hepatocellular carcinoma,EPIC},
  language     = {eng},
  number       = {10},
  pages        = {2429--2443},
  publisher    = {John Wiley & Sons},
  series       = {International Journal of Cancer},
  title        = {Dietary flavonoid, lignan and antioxidant capacity and risk of hepatocellular carcinoma in the European prospective investigation into cancer and nutrition study},
  url          = {http://dx.doi.org/10.1002/ijc.28257},
  volume       = {133},
  year         = {2013},
}