Inflammatory and insulinemic dietary patterns and risk of endometrial cancer among US women

Role of insulinemic and inflammatory dietary patterns on gut microbial composition and circulating biomarkers of metabolic health among older American men

Chronic low-grade inflammation and hyperinsulinemia are linked with metabolic dysfunction and dysbiosis. This study investigated the role of dietary inflammatory and insulinemic potential on gut microbiome and circulating health biomarkers in older men. Data from the Osteoporotic Fractures in Men (MrOS) study were analyzed. Reversed Empirical Dietary Inflammatory Pattern (rEDIP), Empirical Dietary Index for Hyperinsulinemia (rEDIH), and Healthy Eating Index (HEI)-2020 scores were computed from food frequency questionnaire data. Stool samples were profiled using 16S rRNA sequencing. Elastic net regression identified diet-associated microbial profiles and multivariable-adjusted linear regression assessed diet-biomarker associations. Higher rEDIP, rEDIH, and HEI-2020 scores were positively associated with gut microbiota alpha diversity. Specific genera, including Intestinibacter and Lachnospira, associated positively, while Dielma, Peptococcus, Feacalitalea, and Negativibaccilus associated inversely with healthier dietary patterns. When evaluating changes in dietary patterns between baseline and visit 4 ( ~ 14 years), these genera tended to define rEDIP, rEDIH more than HEI-2020. In addition, higher dietary quality was linked to better biomarker profiles, including lower creatinine, sodium, triglycerides, and insulin resistance. Beneficial effects of higher dietary quality on health may be mediated by the ability of diet to regulate gut microbial composition and metabolic biomarker profiles.

Genome-wide association analysis identified inflammatory mechanisms mediating the effects of lipid metabolism on endometrial carcinoma in situ

BACKGROUND

While lipids and inflammation are recognized as key modulators of tumor progression, their causal interplay in endometrial carcinoma in situ (ECIS)-the precursor of endometrial cancer-remains mechanistically undefined. Despite broad associations between lipid metabolism and cancer, the specific pathways driving ECIS initiation through inflammatory mediators are unknown.

METHOD

We pioneer an integrative Mendelian randomization (MR) framework combining multivariable MR, Bayesian weighted MR (BWMR), and sensitivity analyses to address pleiotropy. This approach was systematically applied to 179 lipids and 91 inflammatory factors. Methodological novelty further includes mediation analysis quantifying inflammatory factors' role in lipid-ECIS pathways.

RESULTS

First evidence reveals a phosphatidylcholine (O-18:0_16:1)-TNFSF12-ECIS axis: TNFSF12 mediates 4.894 % of phosphatidylcholine's effect (OR: 2.925; beta: 1.073; 95 % CI: 1.752-4.884; p = 4.032E-05), attenuating the direct lipid-ECIS association. This represents the inaugural demonstration of an inflammation-mediated lipid pathway in ECIS pathogenesis.

CONCLUSION

As the first MR study decoding lipid-ECIS causality, we establish the following.

Inflammatory and insulinemic dietary and lifestyle patterns and incidence of endometrial cancer: the multiethnic cohort

BACKGROUND

The incidence of endometrial cancer (EC) is increasing, particularly among racial and ethnic minority groups. Obesity is an established EC risk factor, and obesity-related inflammation and hyperinsulinemia may play an important role in EC etiology.

OBJECTIVES

We examined the association of 5 empirical hypothesis-oriented dietary and lifestyle indices, which assess the inflammatory and insulinemic potentials of diet and lifestyle, with risk of EC in ethnically diverse females.

METHODS

We included 60,441 female participants from the multiethnic cohort study, a cohort-based in the United States, who were African American, Japanese American, Latino, Native Hawaiian, or White, aged 45-75 y at baseline in 1993-1996. Using a quantitative food frequency questionnaire at baseline, we computed the empirical dietary inflammatory pattern (EDIP), empirical dietary index for hyperinsulinemia (EDIH), empirical lifestyle index for hyperinsulinemia (ELIH), empirical dietary index for insulin resistance (EDIR), and empirical lifestyle index for insulin resistance (ELIR). Multivariable Cox models adjusting for known risk factors for EC were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between each index (using quintiles) and EC risk.

RESULTS

We identified 1328 incident EC cases with a median follow-up of 25.2 y (IQR = 7.4 y). Females with higher ELIH had an increased risk of EC (HRQ5vsQ1 = 2.58, 95% CI: 2.16, 3.09; Ptrend < 0.01). Similarly, higher ELIR was significantly associated with an increased risk of EC (HRQ5vsQ1 = 2.89, 95% CI: 2.37, 3.53; Ptrend < 0.01). EDIP, EDIH, and EDIR were not associated with EC risk. Increased risk of EC with ELIH (all Ptrend < 0.01) and ELIR (all Ptrend < 0.01) was found in all racial and ethnic groups.

CONCLUSIONS

In this ethnically diverse cohort, lifestyle patterns with higher insulinemic potential were associated with an increased risk of EC. Lifestyle changes that include more physical activity and achieving a healthy body weight, in addition to reducing insulinemic and diets, may lower EC risk.

Tirzepatide as an innovative treatment strategy in a pre-clinical model of obesity-driven endometrial cancer

OBJECTIVE

Interventions that combat obesity and its associated metabolic perturbations may decrease incidence and improve outcomes of endometrial cancer (EC). Potential options for weight loss include pharmacotherapeutic interventions such as tirzepatide, a dual-acting glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP) receptor agonist. Given this, we explored the anti-obesity and anti-tumorigenic effects of tirzepatide in our pre-clinical mouse model of endometrioid EC.

METHODS

Starting at 4 weeks of age, Lkb1fl/flp53fl/fl mice were fed a low-fat diet vs a high-fat diet to generate a lean or obese phenotype. Nine weeks after induction of EC, obese and lean mice were randomized to receive tirzepatide for 4 weeks. Body and tumor weights, tumor transcriptomic and metabolomic profiles, and serum metabolic markers and chemokines were assessed.

RESULTS

Both obese and lean mice began to lose body weight after 2 weeks of tirzepatide treatment, ultimately achieving a significant weight loss of 20.1 % in obese mice and 16.8 % in lean mice. Tirzepatide improved obesity-induced serum adiponectin, leptin, GIP, and C-reactive protein levels. Furthermore, tirzepatide relative to vehicle, effectively reduced tumor growth in obese and lean mice, inhibited the ErbB signaling and glycolysis/gluconeogenesis in tumors of obese mice, and increased O-linked glycosylation biosynthesis and phospholipase D signaling in tumors of lean mice.

CONCLUSION

Tirzepatide decreased both mouse weight and tumor growth via effects on metabolic and immune pathways in the EC tumors that differed between obese and lean mice. This novel weight loss treatment deserves further evaluation as an innovative strategy in the management of EC.

Slower Pace of Epigenetic Aging and Lower Inflammatory Indicators in Females Following a Nutrient-Dense, Plant-Rich Diet Than Those in Females Following the Standard American Diet

Background

Plant-based diets are associated with lower inflammatory biomarkers and reduced risk of age-related chronic diseases. Epigenetic biomarkers of aging are DNA methylation-based tools that estimate biological age and rate of aging, providing insights into age-related health risks. Healthy diet and lifestyle indicators correlate with slower epigenetic aging.

Objectives

Neither inflammatory biomarkers nor epigenetic aging has yet been studied in the nutrient-dense, plant-rich (Nutritarian) diet, a plant-based diet that emphasizes specific plant foods, such as cruciferous vegetables, beans and other legumes, onions and garlic, mushrooms, berries, nuts, and seeds. We aimed to compare inflammatory status and epigenetic age acceleration in females following a Nutritarian diet with those of females following a standard American diet (SAD).

Methods

We investigated dietary inflammatory potential, epigenetic age acceleration using first, second, and third-generation clocks, and additional health-related epigenetic biomarkers in this retrospective cohort study of 48 females who habitually (≥5 y) follow a Nutritarian diet and 49 females without obesity who habitually (≥5 y) follow a SAD. Participants completed a series of online questionnaires and provided a blood sample.

Results

Epigenetic age acceleration, indicated by the third-generation clock DunedinPACE, was significantly slower in the Nutritarian group than that in the SAD group (P = 4.26 × 10-6). The Nutritarian diet group showed lower dietary inflammatory potential, as indicated by Empirical Dietary Inflammatory Pattern and Dietary Inflammatory Index. We observed differences in methylation-predicted immune cell subsets (lower neutrophils and higher T regulatory cells) and a lower epigenetic biomarker proxy for C-reactive protein, both of which suggested a lower inflammatory status in the Nutritarian group. Epigenetic biomarker proxies for LDL cholesterol, body mass index (BMI), insulin-like growth factor binding protein 5, and blood glucose were also lower in the Nutritarian group.

Conclusions

Our findings suggest the Nutritarian diet could help reduce chronic inflammation and slow epigenetic aging.

Causal effect of C-reaction protein and endometrial cancer: Genetic evidence of the role of inflammation in endometrial cancer

Consensus remains elusive regarding the relationship between C-reactive protein (CRP) levels and endometrial cancer (EC). Our study sought to elucidate the causal association between CRP and EC, aiming to contribute to the understanding of this complex interplay. We primarily utilized the random-effects inverse variance-weighted method. This approach served as the foundation for our analysis, complemented by 3 additional techniques, including Mendelian randomization-Egger, weighted-median, and weighted mode. A series of sensitivity analyses were also conducted to affirm the stability and reliability of our results. Employing the inverse variance-weighted method, our findings indicated that a one-unit increment in log-transformed CRP concentrations (mg/L) was associated with a relatively 9.7% increased risk of overall EC (odds ratio [OR] = 1.097, 95% confidence interval [CI]: 0.996-1.208, P = .061), an 11% higher risk of endometrioid endometrial cancer (OR = 1.110, 95% CI: 1.000-1.231, P = .049) and a 25% increased risk of non-endometrioid cancers (OR = 1.250, 95% CI: 1.005-1.555, P = .045). Sensitivity analyses did not reveal evidence of horizontal pleiotropy in the analysis of CRP and overall EC, endometrioid endometrial cancer, or non-endometrioid cancers (P > .05). In the reverse analysis, our data demonstrated that EC exert no reverse effect on CRP levels. Our study suggested causal relationships between CRP and an elevated risk of EC and its subtypes, which contribute to the ongoing discourse on the role of inflammation, as indicated by CRP levels, in the etiology of EC and its variants.

Association between Inflammatory Dietary Pattern and Mammographic Features

BACKGROUND

The empirical dietary inflammation pattern score (EDIP), which measures the ability of the diet to regulate chronic inflammation, is associated with both higher adiposity and breast cancer (BC) risk. Mammographic density (MD) is an important risk factor for BC.

OBJECTIVE

We examined the associations between EDIP and mammographic features overall and stratified by menopausal status, and assessed the extent to which these associations are mediated by adiposity.

METHODS

We included 4145 participants without BC in the Nurses' Health Study (NHS) and NHSII. Cumulative average EDIP was assessed by food frequency questionnaires every 4-6 y. We assessed MD parameters (percent MD, dense area, and nondense area) and V (measure of grayscale variation). MD parameters were square-root transformed. Multivariable-adjusted linear regression models were used to analyze the associations between EDIP score and MD parameters. Baron and Kenny's regression method was used to assess the extent to which the associations of EDIP and mammographic traits were mediated by BMI.

RESULTS

In multivariable-adjusted models, EDIP was significantly inversely associated with percent MD [top compared with bottom quartile, β = -0.57; 95% confidence interval (CI): -0.78, -0.36]. Additional adjustment for BMI attenuated the association (β = -0.15; 95% CI: -0.34, 0.03), with 68% (β = 0.68, 20; 95% CI: 0.54, 0.86) mediation via BMI. In addition, EDIP was positively associated with nondense area after adjusting for BMI and other covariates. No associations were observed for dense area and V measure. Results were similar when stratified by menopausal status.

CONCLUSIONS

EDIP score was inversely associated with percent MD and positively associated with nondense area, and these associations were largely mediated by BMI.

Empirical dietary inflammatory pattern could increase the odds of breast cancer: a case-control study

BACKGROUND

It has been shown that chronic inflammation is a significant factor in cancer development and progression. The current study aimed to investigate whether a higher score on the empirical dietary inflammatory pattern (EDIP), which indicates a more pro-inflammatory diet, is related to higher odds of breast cancer in Iranian women.

METHODS

In the present case-control study, subjects in the case (n = 133) and control (n = 265) groups were chosen from the hospitals in Tehran, Iran. The cases consisted of women with newly diagnosed breast cancer, while the controls were selected from other parts of the same hospital and had no history of cancer or hormone therapy. Individuals whose reported energy intake deviated by three standard deviations above or below the mean energy intake of the population were excluded from the study. A reliable and valid semi-quantitative food frequency questionnaire was used to determine the participants' dietary intake. Additionally, the association between breast cancer and EDIP was evaluated by logistic regression analysis in both crude and adjusted models.

RESULTS

The median scores of EDIP in the case and control groups were 0.65 and 0.61, respectively. The findings also indicated that, in the adjusted model, the odds of developing breast cancer significantly increased in the last tertile of EDIP compared to the first tertile (odds ratio (OR) = 1.859; 95% confidence interval (CI): 1.059-3.265; P = 0.031). Additionally, after adjusting for potential confounders, higher odds of breast cancer were observed in the last tertile of EDIP compared to the first tertile in postmenopausal women (OR = 2.516; 95% CI: 1.081-5.856; P = 0.033).

CONCLUSIONS

The current study indicated that individuals with a higher pro-inflammatory diet score were more likely to develop breast cancer.

The association between empirical dietary inflammatory pattern and risk of cancer and cancer-specific mortality: a systematic review and meta-analysis of prospective cohort studies

Background/aim

Current evidence indicates a correlation between the inflammatory potential of diet and the risk of cancer and cancer-specific mortality. This study aimed to assess the association between empirical dietary inflammatory pattern (EDIP), which has recently been designed based on the inflammatory potential of the diet, and the risk of cancer and cancer-specific mortality.

Methods

A systematic literature search was conducted across the PubMed/Medline, Scopus, and Web of Science databases from January 2016 to March 2024. A random effects model was used to calculate the pooled effect size (ES) and 95% confidence intervals (95% CI). Heterogeneity between studies was assessed using the Cochran Q test and the I 2 statistic.

Results

From the initial 229 records, 24 prospective cohort studies with 2,683,350 participants and 37,091 cancer incidence cases, as well as 20,819 cancer-specific mortality, were included in our study. Pooled results indicated a significant association between higher adherence to the EDIP and an increased risk of total cancer (ES: 1.10; 95% CI: 1.05-1.15; I 2 = 41.1), colorectal cancer (ES: 1.19; 95% CI: 1.11-1.27; I 2 = 41.1), and liver cancer (ES: 1.48; 95% CI: 1.14-1.94; I 2 = 36.9). However, no significant association between increased adherence to the EDIP and an increased risk of ovarian or endometrial cancer was found. Furthermore, greater adherence to the EDIP was significantly associated with an increased risk of cancer-specific mortality (ES: 1.18; 95% CI: 1.05-1.33; I 2 = 45.4).

Conclusion

Our results showed that a diet with higher inflammatory properties is associated with an increased risk of cancer and cancer-specific mortality.

Systematic review registration

PROSPERO registration no. CRD42024496912.

Dietary and Lifestyle Insulinemic Potential Indices and Risk Factors of Metabolic Syndrome Among Overweight and Obese Individuals: A Cross-Sectional Study

Background

As a worldwide pandemic, metabolic syndrome (MetS) is related with high disease burden. The emergence of multiple chronic diseases can be attributed to unfavorable dietary and lifestyle choices made by individuals, with hyperinsulinemia and insulin resistance as the underlying causes. Current study sought to assess the relationship between the Empirical Dietary Index for Hyperinsulinemia (EDIH) and the Empirical Lifestyle Index for Hyperinsulinemia (ELIH) and MetS risk factors.

Methods

This cross-sectional study involved 339 individuals between the ages of 20 and 50, who were either obese or overweight, and were recruited from Tabriz, Iran. In this study, a validated semi-quantitative Food Frequency Questionnaire (FFQ) with 168 questions was used to assess individuals' food consumption. Blood tests were performed to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG) levels, as well as blood glucose and insulin levels.

Results

After multivariable adjustment, among tertiles of EDIH, systolic blood pressure (SBP) and TG were significantly different. Also, SBP, diastolic blood pressure (DBP), and HDL-C significantly differed across tertiles of ELIH. In multivariate-adjusted models, individuals classified in the highest tertile of EDIH demonstrated elevated ORs in relation to FBG levels [OR: 1.035 (1.004-1.068; P < .05)], and the second tertile of ELIH was inversely associated with SBP [OR: 0.966 (0.935-0.999; P < .05)], DBP [OR: 0.972 (0.948-0.997; P < .05)], TG in the model I [OR: 0.991 (0.983-0.999; P < .05)], and model II [OR: 0.991 (0.983-0.999; P < .05)].

Conclusion

Considering the findings of our study, higher insulinemic dietary potential, indicated by EDIH, can be related to higher odds of FBG and decreased odds of TG as risk factors of MetS. Furthermore, our findings suggest that individuals with a higher ELIH may potentially exhibit lower SBP and DBP levels. Nevertheless, further experimental and long-term investigations are necessary to fully comprehend this association.

Prognostic impact of metabolic syndrome in patients with primary endometrial cancer: a retrospective bicentric study

PURPOSE

Endometrial cancer (EC) is the most common gynaecological cancer. Its incidence has been rising over the years with ageing and increased obesity of the high-income countries' populations. Metabolic syndrome (MetS) has been suggested to be associated with EC. The aim of this study was to assess whether MetS has a significant impact on oncological outcome in patients with EC.

METHODS

This retrospective study included patients treated for EC between January 2010 and December 2020 in two referral oncological centers. Obesity, arterial hypertension (AH) and diabetes mellitus (DM) were criteria for the definition of MetS. The impact of MetS on progression free survival (PFS) and overall survival (OS) was assessed with log-rank test and Cox regression analyses.

RESULTS

Among the 415 patients with a median age of 64, 38 (9.2%) fulfilled the criteria for MetS. The median follow-up time was 43 months. Patients suffering from MetS did not show any significant differences regarding PFS (36.0 vs. 40.0 months, HR: 1.49, 95% CI 0.79-2.80 P = 0.210) and OS (38.0 vs. 43.0 months, HR: 1.66, 95% CI 0.97-2.87, P = 0.063) compared to patients without MetS. Patients with obesity alone had a significantly shorter median PFS compared to patients without obesity (34.5 vs. 44.0 months, P = 0.029). AH and DM separately had no significant impact on PFS or OS (p > 0.05).

CONCLUSION

In our analysis, MetS in patients with EC was not associated with impaired oncological outcome. However, our findings show that obesity itself is an important comorbidity associated with significantly reduced PFS.

Trends in gynecologic cancer in Japan: incidence from 1980 to 2019 and mortality from 1981 to 2021

BACKGROUND

In Japan, comprehensive cancer statistics data have been collected through national cancer registries, but these data are rarely summarized and reported in research articles.

METHODS

Here, we compiled the national registry data on malignant tumors originating from gynecologic organs (ovary, corpus uteri, cervix uteri) in Japan.

RESULTS

The number of new patients in 2019 was 13,380, 17,880, and 10,879, respectively, and the number of deaths in 2021 was 5081, 2741, and 2894, respectively. Compared with 40 years ago, the incidence of ovarian cancer has tripled, the incidence of uterine corpus cancer (mainly endometrial cancer) has increased eightfold, the mortality rate of uterine corpus cancer has tripled, and the incidence of cervical intraepithelial cancer has increased ninefold in data standardized by the world population. Compared with the United States, the incidence rate of ovarian cancer has overtaken and the mortality rate of uterine corpus cancer is the same, while both the incidence and mortality rates of cervical cancer are higher in Japan.

CONCLUSION

The incidence of gynecologic cancer is increasing significantly in Japan.