Primary liver cancer is the third leading cause of cancer related death worldwide. Hepatocellular carcinoma (HCC) is the most common (>80%) histological type of liver cancer. There are large variations in geographical distribution of liver cancer worldwide. The disease burden is the highest in areas with endemic hepatitis B virus (HBV) infection, such as in Asian countries, specifically in the East and South-East Asia, while North and South America have a relatively low incidence. About 72% of all liver cancer occurs in Asia, with China accounting for 47% of the global burden. Established risk factors of liver cancer include chronic infection with HBV or hepatitis C virus (HCV), excessive alcohol consumption, nonalcoholic fatty liver disease (NAFLD), and aflatoxin exposure.

Carbohydrates

Over the past decades, sugar-sweetened beverages (SSB) consumption has increased dramatically worldwide. Although still inconclusive, this rising trend in sugar consumption, practically simple sugar (mainly fructose consumption), has been positively associated with weight gain and obesity, insulin resistance and T2D, and NAFLD. As mentioned above, insulin resistance, obesity and NAFLD may lead to the establishment of HCC. Thus, SSB consumption, mainly fructose, could be thereby linked to HCC development.

Dietary fats/fatty acids

To date, the association between dietary fat intake and risk of HCC has not been well studied, and the existing epidemiologic evidence is limited and inconclusive.

Dietary proteins/amino acids

The three BCAAs, leucine, isoleucine and valine, are among the nine essential amino acids for humans. They have been shown to affect gene expression, protein metabolism, apoptosis and regeneration of hepatocytes, and insulin resistance. They have also been shown to inhibit the proliferation of liver cancer cells in vitro.

Dietary trace elements and vitamins

In the 2 cohorts of Shanghai Men's and Women's Health Study with 132,765 Chinese adults and over 500 liver cancer cases, it suggested that dietary manganese intake was inversely associated with liver cancer risk

Dairy products

Previous studies suggested that high dairy product intake may increase the levels of plasma IGF-1. The increased concentration of IGF-1, an important factor in the regulation of cell proliferation, differentiation, apoptosis, and carcinogenesis, might contribute to the development of several cancers including HCC in experimental studies.

Fruit, vegetable

Consistently, total fiber, vegetable fiber, especially cereal fiber, were possibly associated with lower HCC risk, while fiber from fruit did not seem to be associated with HCC risk.

Meats

In the Japanese Ministry of Education (JACC) cohort, showing no significant association between beef or pork intake and HCC mortality without adjustment for any risk factors. Intake of red meat particularly processed red meat may increase, while white meat possibly fish may decrease the risk of HCC

Coffee and alcohol

The evidence that coffee protects against liver cancer has been determined as “probable” but not “convincing”, Heavy alcohol intake (i.e., >45 grams/day, above ~3 drinks/day) has been determined as a convincing cause of liver cancer by World Cancer Research Fund International/American Institute for Cancer Research.

Biomarkers

Alpha-fetoprotein (AFP)

Usually, you have a very small amount of alpha-fetoprotein (AFP) in your body. But when you have liver disease, some types of cancer, or are pregnant, you'll usually have more of it in your blood. An AFP tumor marker test checks the level of this protein. A higher AFP level doesn't always mean you have a health problem. Some people simply have more AFP than is typical.

Therefore, AFP a glycoprotein and an oncofetal antigen has been the most widely used biomarker to aid in the diagnosis of HCC. Aberrant production of AFP is observed in almost 50% of all HCCs. A meta-analysis report found that AFP assays for HCC diagnosis had a pooled sensitivity of 51.9% and a specificity of 94%, yielding an area under the curve (AUC) value of 0.81. Most studies have assumed that AFP performs equally well in all patients, independent of liver disease etiology or severity.

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