ABSTRACT

Background:
Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third leading cause of cancer-related deaths. Accumulating evidence suggests that dietary patterns and indices, nutritional exposures, and lifestyle behaviors may influence HCC risk. Therefore, this review critically appraises current evidence regarding the role of these modifiable factors in HCC prevention.

Methods:
Through searching 4 databases (PubMed, Web of Science, Embase and the Cochrane Library) from inception to June 2026, we selected studies about dietary patterns and indexes, nutrition and lifestyle in the prevention of HCC and conducted a narrative review on this topic.

Results:
Mediterranean, prudent, plant-based, dietary approaches to stop hypertension, the traditional Cantonese diet and high-quality dietary index, are generally associated with lower HCC risk, whereas Western dietary patterns, processed meat, ultra-processed foods, sugar-sweetened beverages, alcohol consumption, and smoking are associated with higher HCC or liver disease risk. Vegetables, fruits, fish, white meat, tea, coffee, and physical activity may also contribute to risk reduction, although the strength and directness of evidence vary across exposures. Importantly, most available studies are observational and rely on self-reported dietary assessments, with residual confounding, measurement error, reverse causality, and heterogeneous exposure definitions limiting causal interpretation.

Conclusion:
Dietary, nutritional and lifestyle recommendations should be interpreted cautiously and incorporated into comprehensive HCC prevention strategies, including vaccination, antiviral therapy, alcohol abstinence, metabolic risk control, and surveillance for high-risk individuals. Further studies with standardized dietary assessment and validated HCC endpoints are needed to strengthen the evidence base for clinically actionable prevention.

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