Abstract 730: Fruit and vegetable consumption and risk of liver cancer and liver disease mortality: A prospective cohort study
Authors: Zhao Longgang , Jin Lina , Petrick Jessica L. , Wang Fenglei , Li Tang , Zeng Hongmei , Smith-Warner Stephanie A. , Eliassen A. Heather , Zhang Fang Fang , Campbell Peter T. , Giovannucci Edward , Liao Linda M. , Steck Susan E. , McGlynn Katherine A. , Zhang Xuehong 
Published: June 2022

Abstract
Background: In the US, liver cancer incidence has been tripled since the 1980s. Beyond alcohol and coffee, the relationship between other dietary factors and liver cancer remains poorly understood. One objective of this study is to comprehensively evaluate the relationship between overall and specific botanical groups of fruit and vegetable intake with liver cancer risk. Although liver disease mortality is the 11th leading cause of death in the US, its relationship with diet remains unclear. We also aimed to evaluate the association between fruit and vegetable intake and liver disease mortality.
Methods: The study was conducted in the US NIH-AARP Diet and Health Study with 470,653 participants aged 50-71 years in 1995-1996. Fruits (14 items plus fruit juice) and vegetables (23 items without white potatoes included) were estimated using a validated Food Frequency Questionnaire. Cox proportional hazards regression modeling was used to estimate the multivariable hazard ratios (HR) and 95% confidence intervals (95% CI) for liver cancer incidence and liver disease mortality. We adjusted a priori for potential confounders including age, sex, education, race, alcohol intake, body mass index, smoking, total energy intake, physical activity, diabetes, and aspirin use.
Results: During a median follow-up of 15.5 years, 899 incident liver cancers and 934 chronic liver disease deaths occurred. Higher intake of total vegetables was associated with a lower risk of liver cancer (HRQuintile 5 vs Quintile 1=0.66, 95%CI=0.53-0.82, Ptrend&lt;0.01). When further subclassified into botanical groups, the observed inverse association was mainly driven by Cruciferae (broccoli, cauliflower, cabbage, et. al., HRQ5 vs Q1=0.64, 95%CI=0.52-0.79, Ptrend&lt;0.01), Compositae (lettuce, HRQ5 vs Q1=0.67, 95%CI=0.54-0.83, Ptrend&lt;0.01), Leguminosae (dried beans, string beans and peas, HRQ5 vs Q1=0.77, 95%CI=0.62-0.94, Ptrend=0.01), and Umbelliferae (carrots, HRQ5 vs Q1=0.77, 95%CI=0.62-0.95, Ptrend=0.01). Additionally, higher total vegetable intake was associated with a lower risk of liver disease mortality (HRQ5 vs Q1=0.60, 95%CI=0.49-0.74, Ptrend&lt;0.01). Inverse associations were observed for lettuce, cruciferous vegetables, legumes, and carrots and liver disease mortality (all Ptrend&lt;0.01). In contrast, total fruit intake was not associated with liver cancer (HRQ5 vs Q1=0.96, 95%CI=0.77-1.19, Ptrend=0.29) or liver disease mortality (HRQ5 vs Q1=1.07, 95%CI=0.87-1.32, Ptrend=0.71).
Conclusions: Based on a large prospective US cohort study, higher intakes of total vegetables, and especially lettuce, cruciferous vegetables, legumes, and carrots, were associated with lower liver cancer incidence and liver disease mortality.
Citation Format: Longgang Zhao, Lina Jin, Jessica L. Petrick, Fenglei Wang, Tang Li, Hongmei Zeng, Stephanie A. Smith-Warner, A. Heather Eliassen, Fang Fang Zhang, Peter T. Campbell, Edward Giovannucci, Linda M. Liao, Susan E. Steck, Katherine A. McGlynn, Xuehong Zhang. Fruit and vegetable consumption and risk of liver cancer and liver disease mortality: A prospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 730.