The Correlation of Glycemic Index, Glycemic Load, and Carbohydrates with the Risk of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Background Glycemic index (GI), glycemic load (GL), and carbohydrates have been shown to be associated with a variety of cancers, but their correlation with hepatocellular carcinoma (HCC) remains controversial. The purpose of our study was to investigate the correlation of GI, GL and carbohydrate with risk of HCC.Methods Systematic searches were conducted in PubMed, Embase and Web of Science until November 2020. According to the size of heterogeneity, the random effect model or the fixed effect model was performed to calculate the pooled relative risks (RRs) and 95% confidence intervals (CIs) for the correlation of GI, GL, and carbohydrates with the risk of HCC.Results Seven cohort studies involving 1,193,523 participants and 1,004 cases, and 3 case-control studies involving 827 cases and 5,502 controls were eventually included. The pooled results showed no significant correlation of GI (RR=1.11, 95%CI 0.80-1.53, I2= 62.2%), GL (RR=1.09, 95%CI 0.76-1.55, I2 = 66%), and carbohydrate (RR=1.09, 95%CI 0.84-1.32, I2=0%) with the risk of HCC in general population. Subgroup analysis revealed that in hepatitis B virus (HBV) or/and hepatitis C virus (HCV)-positive group, GI was not correlated with the risk of HCC (RR=0.65, 95%CI 0.32-1.32, p=0.475, I2=0.0%), while GL was significantly correlated with the risk of HCC (RR=1.52, 95%CI 1.04-2.23, p=0.016, I2=70.9%). In contrast, in HBV and HCV-negative group, both GI (RR=1.23, 95%CI 0.88-1.70, p=0.222, I2=33.6%) and GL (RR=1.17, 95% CI 0.83-1.64, p=0.648, I2=0%) were not correlated with the risk of HCC. Conclusion A high GL diet is correlated with a higher risk of HCC in people with hepatitis virus. A low GL diet may be recommended for patients with viral hepatitis to reduce the risk of HCC.