Alcohol and Tea Consumption in Relation to Liver Cancer Risk by Diabetes Status: A Prospective Cohort Study of 0.5 Million Chinese Adults

<b>Background:</b> Liver cancer is a significant disease burden, with metabolic factors potentially influencing its risk. Diabetics, due to metabolic abnormalities, may be more sensitive to environmental exposures. Beverages like tea and alcohol could impact liver cancer risk and may influence prevention in diabetics. <b>Methods</b>: This study included 30,289 diabetics and 482,292 non-diabetics aged 30-79 years from the China Kadoorie Biobank. Baseline alcohol and tea consumption during the past year was collected through questionnaires, including frequency, amount, duration, and types. Incident liver cancer cases were identified from the national health insurance system and local disease registries. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). <b>Results</b>: During a median follow-up of 9.6 years for diabetics and 10.1 years for non-diabetics, 193 (0.69 cases/1000 person-years) and 398 (0.45 cases/1000 person-years) incident liver cancer cases were documented, respectively. Weekly alcohol consumption was associated with higher liver cancer risk in both groups, stronger in diabetics (HR = 1.62; 95% CI: 1.12, 2.34) than in non-diabetics (HR = 1.20, 95% CI: 1.07, 1.35). Among diabetics, the risk was higher in some weekly alcohol consumption subgroups: high-level intake (HR = 2.21; 95% CI: 1.28, 3.80), ≥30 years (HR = 1.70; 95% CI: 1.06, 2.71), or spirit (≥50% alcohol) alcohol-specific consumption (HR = 1.91; 95% CI: 1.20, 3.04), and these associations were stronger than those in non-diabetics. For weekly tea consumption, low-level intake (HR = 0.82; 95% CI: 0.68, 0.99), <10 years (HR = 0.74; 95% CI: 0.58, 0.93), 10-29 years (HR = 0.84; 95% CI: 0.71, 0.99), and green tea-specific consumption (HR = 0.86; 95% CI: 0.75, 0.98) were associated with reduced liver cancer risk in non-diabetics. However, these associations were not significant in those with diabetes. <b>Conclusions</b>: Weekly alcohol consumption is significantly associated with an increased risk of liver cancer, especially in diabetics, while tea consumption appears to lower risk only in non-diabetics, highlighting the need for alcohol reduction in diabetics.