November 18, 2013

Mediterranean Diet and Hepatocellular Carcinoma

Journal of Hepatology

Article in Press

Federica Turati, Dimitrios Trichopoulos, Jerry Polesel, Francesca Bravi, Marta Rossi, Renato Talamini, Silvia Franceschi, Maurizio MontellaAntonia Trichopoulou, Carlo La Vecchia, Pagona Lagiou

Received 14 June 2013; received in revised form 16 October 2013; accepted 31 October 2013. published online 18 November 2013.
Accepted Manuscript


Background & aims

Hepatocellular carcinoma (HCC) has a very poor prognosis and any effort to identify additional risk factors, besides those already established, would be important for the prevention of the disease. Data on the role of diet on HCC risk are still controversial.


We have evaluated the association of adherence to the Mediterranean diet with HCC risk, as well as the interaction of this dietary pattern with chronic hepatitis infection, by combining two case-control studies undertaken in Italy and Greece, including overall 518 cases of HCC and 772 controls. Adherence to the traditional Mediterranean diet was assessed through the Mediterranean diet score (MDS), which ranges between 0 (lowest adherence) and 9 (highest adherence). Odds ratios (OR) for HCC were obtained through multiple logistic regression models, controlling for potentially confounding variables, including chronic infection with hepatitis B/C viruses.


Compared to MDS of 0-3, the ORs for HCC were 0.66 (95% confidence interval (CI), 0.41-1.04) for MDS equal to 4 and 0.51 (95% CI, 0.34-0.75) for MDS > or eaqual to 5, with a significant trend (p<0.001). The detrimental effect of poor adherence to Mediterranean diet on HCC risk was disproportionally high among those chronically infected with hepatitis B and/or C viruses, with a suggestion of super-additivity additive interaction, albeit statistically non-significant.


Closer adherence to the Mediterranean diet appears to be protective against HCC. Our results also point to potential benefits from adhering to a Mediterranean dietary pattern for patients chronically infected with hepatitis viruses.

Abbreviations: HCC, Hepatocellular carcinoma, HBV, hepatitis B virus, HCV, hepatitis C virus, HBsAg, hepatitis B surface antigen, anti-HCV, antibodies against hepatitis C virus, MDS, Mediterranean diet score, Odds ratio, OR, CI, confidence interval, BMI, body mass index,RERI, excess risk due to interaction, S, synergy index


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