Little is known about the role of low‐carbohydrate diets (LCDs) in the development of hepatocellular carcinoma (HCC)..
..During 3,664,769 person years of follow‐up, there were 156 incident HCC cases. Although there were no associations between overall or animal‐based LCD score and risk of HCC, plant‐based LCD score was inversely associated with HCC risk (HR: 0.83; 95% CI: 0.70‐0.98; Ptrend=0.03). Carbohydrate intake, especially from refined grains (HR: 1.18; 95% CI: 1.00‐1.39; Ptrend=0.04) was positively, while plant fat (HR: 0.78; 95% CI: 0.65‐0.95; Ptrend=0.01) was inversely associated with HCC risk. Substituting 5% of energy from plant fat and protein for carbohydrate (HR: 0.74; 95% CI: 0.58‐0.93; Ptrend=0.01) or refined grains (HR: 0.70; 95% CI: 0.55‐0.90; Ptrend=0.006) was associated with lower HCC risk.
In conclusion, a plant‐based LCD and dietary restriction of carbohydrate from refined grains were associated with a lower risk of HCC. Substituting plant fat and protein for carbohydrate, particularly refined grains, may decrease HCC incidence. Our findings support a potential benefit in emphasizing plant sources of fat and protein in the diet for HCC primary prevention. Additional studies that carefully consider hepatitis B and C virus infections and chronic liver diseases are needed to confirm our findings