Dietary fat, fat subtypes and hepatocellular carcinoma in a large European cohort

Talita Duarte-Salles, Veronika Fedirko, Magdalena Stepien, Krasimira Aleksandrova, Christina Bamia, Pagona Lagiou, Anne Sofie Dam Laursen, Louise Hansen, Kim Overvad, Anne Tjønneland, Marie Christine Boutron-Ruault, Guy Fagherazzi, Mathilde His, Heiner Boeing, Verena Katzke, Tilman Kühn, Antonia Trichopoulou, Elissavet Valanou, Maria Kritikou, Giovanna MasalaSalvatore Panico, Sabina Sieri, Fulvio Ricceri, Rosario Tumino, H. B. Bueno-De-Mesquita, Petra H. Peeters, Guri Skeie, Elisabete Weiderpass, Eva Ardanaz, Catalina Bonet, Maria Dolores Chirlaque, Miren Dorronsoro, J. Ramõn Quirõs, Ingegerd Johansson, Bodil Ohlsson, Klas Sjöberg, Maria Wennberg, Kay Tee Khaw, Ruth C. Travis, Nick Wareham, Pietro Ferrari, Heinz Freisling, Isabelle Romieu, Amanda J. Cross, Marc Gunter, Yunxia Lu, Mazda Jenab

Research output: Contribution to journalArticlepeer-review


The role of amount and type of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) is poorly understood, despite suggestive biological plausibility. The associations of total fat, fat subtypes and fat sources with HCC incidence were investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which includes 191 incident HCC cases diagnosed between 1992 and 2010. Diet was assessed by country-specific, validated dietary questionnaires. A single 24-hr diet recall from a cohort subsample was used for measurement error calibration. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazard models. Hepatitis B and C viruses (HBV/HCV) status and biomarkers of liver function were assessed separately in a nested case-control subset with available blood samples (HCC = 122). In multivariable calibrated models, there was a statistically significant inverse association between total fat intake and risk of HCC (per 10 g/day, HR = 0.80, 95% CI: 0.65-0.99), which was mainly driven by monounsaturated fats (per 5 g/day, HR = 0.71, 95% CI: 0.55-0.92) rather than polyunsaturated fats (per 5 g/day, HR = 0.92, 95% CI: 0.68-1.25). There was no association between saturated fats (HR = 1.08, 95% CI: 0.88-1.34) and HCC risk. The ratio of polyunsaturated/monounsaturated fats to saturated fats was not significantly associated with HCC risk (per 0.2 point, HR = 0.86, 95% CI: 0.73-1.01). Restriction of analyses to HBV/HCV free participants or adjustment for liver function did not substantially alter the findings. In this large prospective European cohort, higher consumption of monounsaturated fats is associated with lower HCC risk. What's new? The rise of hepatocellular carcinoma (HCC) incidence in high- and middle-income countries, where relatively high-fat diets are common, suggests a possible etiological role for dietary fat. In the present study, potential associations between HCC and total fat intake, intake of fat subtypes and intake of fat from different sources were explored with data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Total fat intake, where monounsaturated fats predominated, was inversely associated with HCC risk. By contrast, no risk associations were detected for polyunsaturated or saturated fat intake or fat source.

Original languageEnglish
Pages (from-to)2715-2728
Number of pages14
JournalInternational Journal of Cancer
Issue number11
Publication statusPublished - Dec 1 2015


  • cohort study
  • dietary fats
  • European populations
  • hepatocellular carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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