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Plant-Based Diet and Liver Cancer Incidence and Chronic Liver Disease Mortality in the Women’s Health Initiative
Journal article   Open access   Peer reviewed

Plant-Based Diet and Liver Cancer Incidence and Chronic Liver Disease Mortality in the Women’s Health Initiative

Longgang Zhao, Esther Farley, Lihong Qi, Margaret S Pichardo, Su Yon Jung, Simin Liu, Rowan T Chlebowski, Robert B Wallace, Jean Wactawski-Wende, Yasmin Mossavar-Rahmani, …
Current developments in nutrition, Vol.10, 108154
07/2026
DOI: 10.1016/j.cdnut.2026.108154
url
https://doi.org/10.1016/j.cdnut.2026.108154View
Published (Version of record) Open Access

Abstract

Objectives: To evaluate associations of plant-based diet indices (PDI) with liver cancer incidence and chronic liver disease (CLD) mortality. Methods: We examined 98,432 postmenopausal women aged 50–79 years in the Women's Health Initiative Observational Study and Dietary Modification comparison arm. PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI) were derived from a validated food frequency questionnaire using literature–defined food groups of 7 healthful plant, 4 unhealthful plant, and 5 animal food groups. PDI scored all plant foods positively and animal foods inversely; hPDI scored healthful plant foods positively and unhealthful plant/animal foods inversely; uPDI scored unhealthful plant foods positively and healthful plant/animal foods inversely. Metabolomic signatures were assessed cross-sectionally in a subsample (n=882) using untargeted metabolomics (470 metabolites). Liver outcomes were ascertained annually and verified by medical record review. Multivariable Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 22 years, 240 women developed primary liver cancer and 174 died from CLD. Higher hPDI was suggestively associated with lower risk of liver cancer (Adjusted HR Tertile 3 vs 1 [95% CI]: 0.71 [0.50–1.00]) and CLD mortality (0.66 [0.44–1.00]), while uPDI was associated with increased risk of CLD mortality (1.58 [1.01–2.46]). Higher intake of tea/coffee and lower intake of refined grains and sugar-sweetened beverage (SSB) were associated with lower liver cancer risk. Higher intake of whole grains, vegetables, and tea/coffee and lower intake of SSB were associated with lower CLD mortality. Distinct metabolomic signatures were identified for PDI (n=20), hPDI (n=31), and uPDI (n=64). hPDI was associated with lower acylcarnitines and plasmalogen phosphatidylcholines, while uPDI was associated with lower triglycerides and several plasmalogens, and higher selected acylcarnitines and indoxyl sulfate. Conclusions: A healthful plant-based diet was associated with lower risks of liver cancer incidence and CLD mortality. Distinct metabolomic signatures associated with this dietary pattern suggest that metabolomics may provide insight into biologic pathways linking diet quality to liver health.

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