Hepatocellular carcinoma and lifestyle: how do dietary patterns differ in those with metabolic and nonmetabolic dysfunction associated steatotic liver disease?

Abstract

Background: Metabolic- Associated Steatotic Liver Disease (MASLD) is now a major cause of liver morbidity and mortality, including hepatocellular carcinoma (HCC). Unhealthy dietary patterns are more likely to predispose to HCC development. The aim of this study was to explore dietary patterns among patients with established HCC comparing those with and without MASLD. Method(s): A multicentre, prospective cohort analysis of newly diagnosed HCC patients at six hepatology centres in metropolitan Melbourne (Victoria, Australia) was conducted from October 2020 to July 2022. A subset of seventy participants out of 313 recruited (22.4%) completed a three-day food diary. Food diaries were selfreported written records documenting the type, brand, and quantities of food and beverages consumed by participants, and recipes were provided where appropriate; they were entered and analysed the food diaries using the software FoodWorks 9TM. Food diaries were used to measure adherence to MedDiet Score (0-45 points); higher scores indicating higher adherence. Demographic and clinical data was prospectively collected from hospital electronic medical records. All statistical analysis for this subgroup analysis was performed using the R programming environment. Result(s): Seventy patients with HCC were included in the study of which: 35 (50%) had no features of MASLD (non-MASLD) and 35 (50%) had features of MASLD. There were no significant differences in baseline demographics between the groups except for age (Table 1). Cirrhosis was present in 77% of MASLD HCC, compared to 83% in non-MASLD group, and the majority were Child-Pugh A (55.7%) in both groups. An exploratory univariable analysis identified significant differences in daily energy intake (kJ) (p=0.03), processed meat serves (p=0.04), legumes serve (p=0.02), and yoghurt serves (p=0.03) but interestingly the daily energy intake (kJ) and processed meat serves were higher among the non-MASLD group. A multivariable analysis adjusting for energy, gender, BMI and age showed that processed meat serves (p = 0.04) were higher among non-MASLD than MASLD groups. There were no other dietary differences identified both on univariable and multivariable analysis between the non-MASLD and MASLD groups. The MedDiet Score which evaluates adherence to mediterranean dietary patterns was not significantly different between both groups. Conclusion(s): Differences in dietary patterns in patients with liver injury may contribute to the occurrence of HCC in patients with MASLD, and possibly in non-MASLD. However, further studies are required to explore habitual dietary intake and patterns that predispose to development of HCC.