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Br J Nutr. 2016 Jan 28;115(2):324-31. doi: 10.1017/S0007114515004419. Epub 2015 Nov 11.

Inflammatory potential of diet and risk for hepatocellular cancer in a case-control study from Italy.

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1Cancer Prevention and Control Program,University of South Carolina,Columbia,SC 29208,USA.
3Epidemiology and Biostatistics Unit,CRO Aviano,National Cancer Institute,33081 Aviano,Italy.
4Department of Epidemiology,'Fondazione G. Pascale',Istituto Nazionale Tumori,80133 Naples,Italy.
5Infections and Cancer Epidemiology Group,International Agency for Research on Cancer,Lyon 69372,France.
6Department of Clinical Sciences and Community Health,Università degli Studi di Milano,via G. Venezian 1,20133 Milan,Italy.


Inflammation and diet have been suggested to be important risk factors for hepatocellular cancer (HCC). This Italian multicentre hospital-based case-control study conducted between 1999 and 2002 and including 185 cases with incident, histologically confirmed HCC, and 404 controls hospitalised for acute non-neoplastic diseases provided an opportunity to investigate the association between HCC and the dietary inflammatory index (DII). The DII was computed on the basis of dietary intake assessed 2 years before the date of interview by a validated sixty-three-item FFQ. Logistic regression models were used to estimate OR adjusted for age, sex, study centre, education, BMI, smoking, physical activity, serum markers of hepatitis B and C infection and energy intake. Energy adjustment for DII was performed using the residual method. Participants in the highest tertile of DII scores (i.e. with a more pro-inflammatory diet) had a higher risk for HCC (ORtertile 3 v, 1 2·43; 95 % CI 1·27, 4·68; P trend=0·03). When stratified by the presence or absence of hepatitis B/C infection and sex, DII was strongly associated with HCC in hepatitis B- and C-negative participants (ORtertile 3 v. 1 4·18; 95 % CI 1·53, 11·39; P trend=0·02) and among males (ORtertile 3 v. 1 3·60; 95 % CI 1·65, 7·87; P trend=0·001). These results indicate that a pro-inflammatory diet is associated with increased risk for HCC, in those without a history of hepatitis B/C infection and among males.


DII dietary inflammatory index; Dietary surveys and nutritional epidemiology; Diets; HCC hepatocellular cancer; Hepatocellular cancer; Inflammation; Italy

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