Abstract

Abstract Background We aimed to prospectively evaluate the association between a diabetes risk reduction diet (DRRD) score and the risk of liver cancer development and chronic liver disease‐specific mortality. Methods We included 98,786 postmenopausal women from the Women's Health Initiative‐Observational Study and the usual diet arm of the Diet Modification trial. The DRRD score was derived from eight factors: high intakes of dietary fiber, coffee, nuts, polyunsaturated fatty acids, low intakes of red and processed meat, foods with high glycemic index, sugar‐sweetened beverages (SSBs), and trans fat based on a validated Food‐Frequency Questionnaire administered at baseline (1993–1998). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for liver cancer incidence and chronic liver disease mortality were estimated using Cox proportional hazards regression models. Results and conclusion After a median follow‐up of 22.0 years, 216 incident liver cancer cases and 153 chronic liver disease deaths were confirmed. A higher DRRD score was significantly associated with a reduced risk of developing liver cancer (HR Tertile 3 vs. Tertile 1 = 0.69; 95% CI: 0.49–0.97; P trend = 0.03) and chronic liver disease mortality (HR T3 vs. T1 = 0.54; 95% CI: 0.35–0.82; P trend = 0.003). We further found inverse associations with dietary fiber and coffee, and positive associations with dietary glycemic index, SSBs, and trans fat. A higher DRRD score was associated with reduced risk of developing liver cancer and chronic liver disease mortality among postmenopausal women.