Dietary Patterns and the Risk of Liver Cancer and Chronic Liver Disease Mortality

Jaewon Khil; Longgang Zhao; Xinyuan Zhang; Yun Chen; Su Yon Jung; Margaret S Pichardo; Melissa Lopez-Pentecost; Thomas Rohan; Nazmus Saquib; Yangbo Sun; Fred K Tabung; Tongzhang Zheng; Jean Wactawski-Wende; JoAnn E Manson; Marian L Neuhouser; NaNa Keum; Xuehong Zhang

doi:10.1016/j.tjnut.2026.101557

Dietary Patterns and the Risk of Liver Cancer and Chronic Liver Disease Mortality

J Nutr. 2026 Apr 28;156(7):101557. doi: 10.1016/j.tjnut.2026.101557. Online ahead of print.

Authors

Jaewon Khil¹, Longgang Zhao², Xinyuan Zhang³, Yun Chen², Su Yon Jung⁴, Margaret S Pichardo⁵, Melissa Lopez-Pentecost⁶, Thomas Rohan⁷, Nazmus Saquib⁸, Yangbo Sun⁹, Fred K Tabung¹⁰, Tongzhang Zheng¹¹, Jean Wactawski-Wende¹², JoAnn E Manson¹³, Marian L Neuhouser¹⁴, NaNa Keum¹⁵, Xuehong Zhang¹⁶

Affiliations

¹ Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
² Yale University School of Nursing, Orange, CT, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
³ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁴ Department of Epidemiology, Fielding School of Public Health, Translational Sciences Section, School of Nursing, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States.
⁵ Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States.
⁶ Medical Oncology, University of Miami Miller School of Medicine, Miami, FL, United States.
⁷ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
⁸ Clinical Sciences Department, College of Medicine, Sulaiman AlRajhi University, Al Bukayriah, Kingdom of Saudi Arabia.
⁹ Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
¹⁰ Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.
¹¹ Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States.
¹² Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.
¹³ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
¹⁴ Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States.
¹⁵ Department of Food Science and Biotechnology, Dongguk University, Seoul, Republic of Korea. Electronic address: nak212@mail.harvard.edu.
¹⁶ Yale University School of Nursing, Orange, CT, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States. Electronic address: xuehong.zhang@yale.edu.

PMID: 42061715
DOI: 10.1016/j.tjnut.2026.101557

Abstract

Background: Accumulating evidence suggests that diet plays an important role in the development of liver disease. Compared with individual nutrients or foods, dietary patterns better represent overall eating behaviors, but their associations with liver cancer and chronic liver disease (CLD) remain poorly understood.

Objectives: We evaluated whether greater adherence to healthy dietary patterns was associated with lower liver cancer risk and CLD mortality.

Methods: We analyzed data from 78,345 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Four dietary patterns [Alternative Healthy Eating Index-2010 (AHEI-2010), Healthy Eating Index-2020 (HEI-2020), alternate Mediterranean Diet (aMED), Dietary Approach to Stop Hypertension (DASH)] were calculated using dietary data collected via a validated food-frequency questionnaire. Liver cancer incidence and CLD death were ascertained by review of medical records or linkage to the National Death Index. Cox proportional hazards regression was performed to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: During a median follow-up of 22.1 y, 176 liver cancer cases and 128 CLD deaths were documented. For liver cancer, significant inverse associations were observed with HEI-2020 (HR Quartile 4 compared with Quartile 1 = 0.58, 95% CI: 0.37, 0.93, P-trend = 0.02) and DASH (HR Q4 compared with Q1 = 0.58, 95% CI: 0.35, 0.98, P-trend = 0.07). For CLD mortality, significant inverse associations were observed with AHEI-2010 (HR Q4 compared with Q1 = 0.50, 95% CI: 0.27, 0.92, P-trend = 0.02), HEI-2020 (HR Q4 compared with Q1 = 0.59, 95% CI: 0.33, 1.04, P-trend = 0.04), aMED (HR Q4 compared with Q1 = 0.48, 95% CI: 0.25, 0.90, P-trend = 0.02), and DASH (HR Q4 compared with Q1 = 0.49, 95% CI: 0.25, 0.95, P-trend = 0.02).

Conclusions: Maintaining an overall healthy diet may be associated with lower liver cancer risk and CLD mortality among postmenopausal women.

Keywords: chronic liver disease; dietary patterns; liver cancer; postmenopausal women; prospective cohort study.