Page 62 - Today's Dietitian (February 2020)

Research Briefs

from 1986 through 2012. All new HCC
cases and deaths were confirmed. A low-
risk lifestyle group met all of the fol-
lowing criteria: never smoked or prior
smoking less than five pack-years, no or
moderate alcohol use, a BMI between
18.5 and 24.9, weekly physical activity,
and a healthful diet ranking in the upper
40% of the Alternative Healthy Eating
Index. All other study subjects were
placed in a high-risk group.
The researchers used Cox proportional
hazard regression modeling to estimate
multivariate-adjusted hazard ratios
(HRs) and 95% confidence intervals (CIs)
for incident HCC and cirrhosis-related
mortality. They calculated the population-
attributable risk (PAR) of nonadherence
to a low-risk lifestyle by comparing
relative risks and incidence rates between
the two groups, and then assessed the
PARs for each modifiable lifestyle risk
Lifestyle May Help Prevent factor to estimate the percentage of cases
that could be prevented by modifying
those factors in isolation.
Liver-Related Deaths 2,388,811 person-years, the researchers
Among 121,893 adults followed for
D ata from a new study pre- Simon, MD, an instructor of medicine at cirrhosis-related deaths. Multivariate-
confirmed 121 new HCC cases and 350
Harvard Medical School and Massachu-
sented at The Liver Meeting,
adjusted HRs for five vs zero modifiable
setts General Hospital, and the study’s
recently held by the Ameri-
risk factors were 3.59 (95% CI 1.5–7.42)
can Association for the Study
56–98) for cirrhosis-related mortality.
of Liver Diseases, found that lead author. “We wanted to estimate for incident HCC and 4.27 (95% CI
how many cases of HCC and deaths from
a substantial burden of hepatocellu- cirrhosis could have been prevented in The PAR for a high-risk vs low-risk
lar carcinoma (HCC)– and cirrhosis- our study population if everyone had lifestyle was 90% (95% CI 2.06–11.69) for
related deaths may be prevented by adhered to a healthy lifestyle.” incident HCC and 89% (95% CI 43–98)
lifestyle modifications to diet, alcohol The study was driven by the rising for liver-related mortality. Women and
use, and exercise. epidemic of nonalcoholic fatty liver dis- men had similar associations. Overall,
HCC and cirrhosis incidences are on ease worldwide, and the need to develop overweight/obesity was the most
the rise in the United States, and deaths treatment approaches that are both significant modifiable risk factor, with a
related to these illnesses also are accel- feasible and effective at the population PAR of 36 for HCC incidence and 42 for
erating at an alarming pace, prompting level, Simon says. cirrhosis-related mortality.
researchers from Massachusetts General “Right now, there are not yet any “Our findings strongly support con-
Hospital and Harvard Medical School to effective medications to reverse liver tinued efforts to develop public health
analyze whether adopting a more health- fibrosis or prevent HCC. It is essen- policies for lifestyle modification to pre-
ful lifestyle might reduce HCC incidence tial that we focus on controlling risk vent HCC and liver-related mortality.
and deaths from cirrhosis. factors through primary prevention. Our data suggested that adherence to
“We wanted to conduct this study Lifestyle modification represents a pri- a healthy overall lifestyle could poten-
because there is growing evidence that mary prevention effort that is likely to tially prevent more than 30,000 liver-
both HCC- and cirrhosis-related mortal- be a more effective and feasible way related deaths in the United States each
ity are largely preventable. Several prior to prevent HCC and liver-related mor- year,” Simon says. “We are working to
studies have found that individual life- tality at the population level,” Simon validate these findings in additional
style factors, which include body weight, explains of the focus. population-based cohorts, and look for-
exercise, alcohol use, smoking, and diet, This nationwide, prospective cohort ward to planning large-scale studies
contribute to the risk for developing study included data on adult men and of multidimensional diet and lifestyle
HCC. However, no prior study had quan- women with no known liver disease at interventions for patients with estab-
tified the overall contribution of multiple the beginning of the study. Study par- lished liver disease.”
lifestyle factors on the risk for HCC and ticipants provided detailed clinical, life-
liver-related mortality,” says Tracey G. style, and dietary data every other year SOURCE: AMERICAN ASSOCIATION FOR THE STUDY
OF LIVER DISEASES
62 TODAY’S DIETITIAN • FEBRUARY 2020