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(OR09-01-26) Plant-Based Diet and Liver Cancer Incidence and Chronic Liver Disease Mortality in the Women’s Health Initiative

Sunday, July 26, 2026
10:30 AM - 10:42 AM ET
Location: Maryland Ballroom D
Emerging Leaders in Nutrition Science Poster Competition

    Presenting Author(s)

  • Longgang Zhao, PhD

    Postdoctoral Associate
    Yale School of Nursing
    Orange, Connecticut, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • EF

    Esther Farley

    School of Nursing, University at Buffalo (SUNY), United States

  • LQ

    Lihong Qi

    University of California, Davis School of Medicine, United States

  • MP

    Margaret S. Pichardo

    University of Pennsylvania, United States

  • SJ

    Su Yon Jung

    Translational Sciences Section, School of Nursing, Epidemiology, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, University of California, United States

  • SL

    Simin Liu

    University of California, Irvine, United States

  • RC

    Rowan T. Chlebowski

    The Lundquist Institute, United States

  • RW

    Robert B. Wallace

    University of Iowa, United States

  • JW

    Jean Wactawski-Wende

    University at Buffalo (SUNY), United States

  • YM

    Yasmin Mossavar-Rahmani

    Albert Einstein College of Medicine, United States

  • Marian L. Neuhouser, PhD, RD (she/her/hers)

    Professor
    Public Health Sciences Division, Cancer Prevention Program, Fred Hutchinson Cancer Center
    Seattle, Washington, United States

  • LT

    Lesley F. Tinker

    Public Health Sciences Division, Cancer Prevention Department, Fred Hutchinson Cancer Center, United States

  • XZ

    Xuehong Zhang

    Yale University, United States

Disclosure(s):
Longgang Zhao, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Marian L. Neuhouser, PhD, RD: No relevant financial relationship(s) with ineligible companies to disclose.
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.

Funding Sources: NCI, NHLBI, and ACS