Duarte-Salles T, Fedirko V, Stepien M, Trichopoulou A, Bamia C, Lagiou P, Lukanova A, Trepo E, Overvad K, Tjonneland A, Halkjaer J, Boutron-Ruault MC, Racine A, Cadeau C, Kuhn T, Aleksandrova K, Trichopoulos D, Tsiotas K, Boffetta P, Pa - 45414 N - Int J Cancer 2014 ; in press.
Dairy products intake has been associated with risk of some cancers, but findings are often inconsistent and information on hepatocellular carcinoma (HCC) risk is limited, particularly from prospective settings. The aim of this study was to investigate the association between consumption of total and specific dairy products (milk/cheese/yoghurt) and their components (calcium/vitamin D/fats/protein), with first incident HCC (Ncases =191) in the EPIC cohort, including a nested case-control subset (Ncases =122) with assessment of HBV/HCV infections status, liver damage, and circulating IGF-I levels. For cohort analyses, multivariate adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CI). For nested case-control analyses, conditional logistic regression was used to calculate odds ratios (ORs) and 95%CI. A total of 477,206 participants were followed-up for an average of 11 years (person-years follow-up=5,415,385). In the cohort study, a significant positive HCC risk association was observed for total dairy products (highest vs. lowest tertile, HR=1.66, 95%CI:1.13-2.43; Ptrend =0.012), milk (HR=1.51, 95%CI:1.02-2.24; Ptrend =0.049), and cheese (HR=1.56, 95%CI:1.02-2.38; Ptrend =0.101), but not yoghurt (HR=0.94, 95%CI:0.65-1.35). Dietary calcium, vitamin D, fat and protein from dairy sources were associated with increased HCC risk, while the same nutrients coming from non-dairy sources showed inverse or null associations. In the nested case-control study, similar results were observed among hepatitis-free individuals. Results from this large prospective cohort study suggest that higher dairy products consumption, particularly milk and cheese, may be associated with increased HCC risk. Validation of these findings in other populations is necessary. Potential biologic mechanisms require further exploration. (c) 2014 Wiley Periodicals, Inc.