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Ng WH, Abu Zaid Z, Mohd Yusof BN, Amin Nordin S, Lim PY. Association between dietary inflammatory index and body fat percentage among newly diagnosed breast cancer patients. Ann Med 2024; 55:2303399. [PMID: 38242100 PMCID: PMC10802798 DOI: 10.1080/07853890.2024.2303399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Obesity, particularly excessive body fat, is an established risk factor and substantial prognostic determinant in breast cancer. Recent studies suggested that diet-related inflammation plays a key role in obesity. This study aimed to determine the association between energy-adjusted dietary inflammatory index (E-DII) and body composition, particularly body fat percentage, among patients with newly diagnosed breast cancer. MATERIALS AND METHODS This cross-sectional study was conducted on 124 breast cancer outpatients within the first year of diagnosis and yet to commence oncological treatment. Body composition parameters [body weight, body mass index (BMI), body fat percentage, fat mass over fat-free mass ratio (FM/FFM), muscle mass, and visceral fat] were obtained using a bioelectrical impedance analyzer. Body fat percentage was categorized into two groups which were normal (<35%) and high (≥35%). The E-DII was calculated from the validated 165-items Food Frequency Questionnaire (FFQ) and categorized into three groups or tertiles. Multiple logistic regression analysis was used to determine the association between the E-DII and body fat percentage. RESULTS Mean body weight, body fat percentage, FM/FFM, and visceral fat increased as E-DII increased from the lowest tertile (T1) to the most pro-inflammatory tertile (T3) (p for trend <0.05). E-DII was positively associated with body fat percentage (OR 2.952; 95% CI 1.154-7.556; p = 0.024) and remained significant after adjustment for cancer stage, age, physical activity, ethnicity, smoking history, and presence of comorbidities. Compared to T1, participants in T3 had a significantly lower consumption of fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium, but a higher intake of total fat, saturated fat, and monounsaturated fatty acids. CONCLUSIONS A higher E-DII was associated with increased body fat percentage, suggesting the potential of advocating anti-inflammatory diet to combat obesity among newly diagnosed breast cancer patients.
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Affiliation(s)
- Wai Han Ng
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Dietetics and Food Service, National Cancer Institute, Ministry of Health, Putrajaya, Malaysia
| | - Zalina Abu Zaid
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Dietetics, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Selangor, Malaysia
| | - Barakatun Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Dietetics, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Selangor, Malaysia
| | - Syafinaz Amin Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Mansour R, Al-Ani A, Al-Hussaini M, Abdel-Razeq H, Al-Ibraheem A, Mansour AH. Modifiable risk factors for cancer in the middle East and North Africa: a scoping review. BMC Public Health 2024; 24:223. [PMID: 38238708 PMCID: PMC10797965 DOI: 10.1186/s12889-024-17787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
PURPOSE This scoping review examines controllable predisposing factors attributable to cancer in the Middle East and North Africa (MENA) region's adult population, highlighting opportunities to enhance cancer prevention programs. DESIGN We systematically searched the PubMed, Science Direct, and CINAHL, EMBASE, and Cochrane Library databases from 1997 to 2022 for articles reporting on the impact of modifiable risk factors on adult patients with cancer in the MENA region. RESULTS The review identified 42 relevant articles, revealing that tobacco consumption, obesity, physical inactivity, and diet are significant modifiable risk factors for cancer in the region. Tobacco smoking is a leading cause of lung, bladder, squamous cell carcinoma, and colorectal cancer. A shift towards a westernized, calorie-dense diet has been observed, with some evidence suggesting that a Mediterranean diet may be protective against cancer. Obesity is a known risk factor for cancer, particularly breast malignancy, but further research is needed to determine its impact in the MENA region. Physical inactivity has been linked to colorectal cancer, but more studies are required to establish this relationship conclusively. Alcohol consumption, infections, and exposure to environmental carcinogens are additional risk factors, although the literature on these topics is limited. CONCLUSION The review emphasizes the need for further research and the development of targeted cancer prevention strategies in the MENA region.
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Affiliation(s)
- Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas, USA
| | - Abdallah Al-Ani
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Asem H Mansour
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan.
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Ashari LS, Abd Rashid AA, Mohd Razif S, Yeong Yeh L, Jan Mohamed HJ. Diet is Linked to Colorectal Cancer Risk among Asian Adults: A Scoping Review. Malays J Med Sci 2023; 30:8-31. [PMID: 37425391 PMCID: PMC10325134 DOI: 10.21315/mjms2023.30.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/18/2022] [Indexed: 07/11/2023] Open
Abstract
This review aimed to map current evidence on the association between dietary factors and colorectal cancer (CRC) risk in Asia. This review was conducted based on Arksey and O'Malley methodological framework. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram was used to record the review process. For the purpose of searching for articles, three electronic databases namely PubMed, EBSCOHost and ScienceDirect were employed. The inclusion criteria for articles selection were articles with association analysis between diet and CRC risk among Asians, had adults as participants, articles were written in English, open-accessed and published between years 2009 and 2021. Thus, 35 out of 369 screened articles were eventually included in this review which covered 28 case-control studies, six prospective cohort studies and one randomised clinical trial. Foods such as meats, alcohol and westernised diet have been shown to be associated with increase of CRC risk while fruits, vegetables and traditional meals decreased the risk of CRC. Only a few interventional and dietary patterns studies were identified. Specific single foods and nutrients and dietary patterns have been found to increase the risk but also protected the Asian population against CRC. The findings of this review will guide health professionals, researchers and policy makers to conduct a suitable study design and topic for future research.
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Affiliation(s)
- Lydiatul Shima Ashari
- Nutrition Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Shahril Mohd Razif
- Nutritional Science Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lee Yeong Yeh
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Hamid Jan Jan Mohamed
- Nutrition Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Dietary Inflammatory Index, Obesity, and the Incidence of Colorectal Cancer: Findings from a Hospital-Based Case-Control Study in Malaysia. Nutrients 2023; 15:nu15040982. [PMID: 36839339 PMCID: PMC9965675 DOI: 10.3390/nu15040982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/18/2023] Open
Abstract
Obesity-mediated inflammation represents a key connection between the intake of foods with high inflammatory potential and colorectal cancer (CRC) risk. We aimed to explore the association between energy-adjusted dietary inflammatory index (E-DII) in relation to CRC risk in both obese and non-obese subjects. This study included 99 histopathologically confirmed CRC cases, 73 colonic polyps cases, and 141 healthy controls from tertiary medical centres in both urban and suburban areas in Peninsular Malaysia. The subjects were categorised into body mass index (BMI) < 25 kg/m2 and BMI ≥ 25 kg/m2 groups. E-DII scores were computed based on dietary intake assessed using a validated food frequency questionnaire (FFQ). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential cofounders. The mean dietary energy intake and mean BMI values of the subjects tended to increase as the E-DII scores increased (p for trend < 0.001). E-DII was significantly related to CRC risk only in obese subjects (OR = 1.45; 95% CI = 1.30-1.77; p < 0.001 for trend). Stratified analyses of risk factors showed significant associations between E-DII and CRC risk by age group (p for interaction = 0.030), smoking status (p for interaction = 0.043), and anthropometric indices for both males and females (p for interaction < 0.001) in the most pro-inflammatory E-DII quartile vs. the lowest E-DII quartile. Overall, pro-inflammatory diets were associated with an increased incidence of CRC in the Malaysian population, particularly in obese subjects.
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Syed Soffian SS, Mohammed Nawi A, Hod R, Ja’afar MH, Isa ZM, Chan HK, Hassan MRA. Meta-Analysis of the Association between Dietary Inflammatory Index (DII) and Colorectal Cancer. Nutrients 2022; 14:nu14081555. [PMID: 35458117 PMCID: PMC9031004 DOI: 10.3390/nu14081555] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 02/07/2023] Open
Abstract
The Dietary Inflammatory Index (DII) was extensively used to examine the inflammatory potential of diet related to colorectal cancer (CRC). This meta-analysis aimed to update the evidence of the association between the DII and CRC across various culture-specific dietary patterns. Literature search was performed through online databases (Scopus, Web of Science, PubMed, and EBSCOHost). Observational studies exploring the association between the DII and CRC, published between 2017 and 2021, were included. The risk ratio (RR) and 95% confidence interval (CI) were separately computed for 12 studies comparing the highest and lowest DII scores and for 3 studies that presented continuous DII scores. A high DII score was associated with a higher risk of CRC (RR:1.16; 95% CI, 1.05–1.27). In the subgroup analysis, significant associations were seen in cohort design (RR: 1.24; 95% CI, 1.06–1.44), those lasting for 10 years or longer (RR: 2.95; 95% CI, 2.47–3.52), and in adjustment factor for physical activity (RR: 1.13; 95% CI, 1.07–1.20). An increase of one point in the DII score elevates the risk of CRC by 1.34 (95% CI: 1.15–1.55) times. The findings call for standardized measurement of the inflammatory potential of diet in future studies to enable the establishment of global guidelines for CRC prevention.
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Affiliation(s)
- Sharifah Saffinas Syed Soffian
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (S.S.S.S.); (R.H.); (M.H.J.); (Z.M.I.)
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (S.S.S.S.); (R.H.); (M.H.J.); (Z.M.I.)
- Correspondence:
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (S.S.S.S.); (R.H.); (M.H.J.); (Z.M.I.)
| | - Mohd Hasni Ja’afar
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (S.S.S.S.); (R.H.); (M.H.J.); (Z.M.I.)
| | - Zaleha Md Isa
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (S.S.S.S.); (R.H.); (M.H.J.); (Z.M.I.)
| | - Huan-Keat Chan
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar 05400, Malaysia; (H.-K.C.); (M.R.A.H.)
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Sultanah Bahiyah Hospital, Alor Setar 05400, Malaysia; (H.-K.C.); (M.R.A.H.)
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Gao Y, Byrd DA, Prizment A, Lazovich D, Bostick RM. Associations of Novel Lifestyle- and Whole Foods-Based Inflammation Scores with Incident Colorectal Cancer Among Women. Nutr Cancer 2022; 74:1356-1369. [PMID: 34296959 PMCID: PMC9281615 DOI: 10.1080/01635581.2021.1952629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic inflammation, associated with lifestyle and dietary factors, may contribute to colorectal carcinogenesis. To address this, we investigated associations of previously validated, inflammation biomarker panel-weighted, novel, 4-component lifestyle (LIS) and 19-component predominately whole foods-based dietary (DIS) inflammation scores with incident colorectal cancer (CRC) in the prospective Iowa Women's Health Study (IWHS; 1986-2012; n = 34,254, of whom 1,632 developed CRC). METHODS We applied the published scores' components' weights, summed the weighted components to constitute the scores (higher scores reflect a higher balance of pro-inflammatory exposures), and investigated LIS- and DIS-CRC associations using multivariable Cox proportional hazards regression. RESULTS The multivariable-adjusted hazards ratios (HR) and their 95% confidence intervals (CI) for CRC among participants in the highest relative to the lowest LIS and DIS quintiles were 1.47 (1.26, 1.72; Ptrend < 0.01) and 1.07 (0.91, 1.25; Ptrend = 0.22), respectively. The corresponding findings for distal colon cancers were HR 1.78 (1.29, 2.47) and HR 1.34 (0.98, 1.84), respectively. Among those in the highest relative to the lowest joint LIS/DIS quintile, the HR for CRC was 1.60 (95% CI 1.30, 1.98). CONCLUSIONS Our results suggest that a more pro-inflammatory lifestyle, alone and jointly with a more pro-inflammatory diet, may be associated with higher CRC risk.
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Affiliation(s)
- Yasheen Gao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Doratha A. Byrd
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anna Prizment
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Nojomi M, Tehrani Banihashemi A, Niksima H, Hashemian M, Mottaghi A, Malekzaddeh R. The relationship between dietary patterns, dietary quality index, and dietary inflammatory index with the risk of all types of cancer: Golestan cohort study. Med J Islam Repub Iran 2021; 35:48. [PMID: 34268236 PMCID: PMC8271224 DOI: 10.47176/mjiri.35.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Indexed: 01/29/2023] Open
Abstract
Background: Dietary patterns and diet quality index (DQI) are widely discussed in relation with different health conditions and have recently been taken into consideration for all cancer types. Since chronic inflammation has been recognized as an important biologic risk factor for cancer occurrence, especially in epithelial tissues, proinflammatory or anti-inflammatory characteristics of diet has become the center of attention. In the present study, we aimed to identify whether a specific dietary pattern, Mediterranean dietary score (MDs), and dietary inflammatory index (DII) were associated with overall cancer risk in Iranian population.
Methods: This study was performed in the context of the Golestan cohort study. Participants with extreme daily energy intake or those who did not answer more than 30 question of the Food Frequency questionnaire (FFQ) were excluded. Dietary patterns, MDs, and DII were measured from FFQ. Age, sex, total energy, place of residence, smoking, wealth score, ethnicity, opiate use, BMI, education, marital status, and physical activity score were considered as confounding variables. Using Cox proportional hazards regression models, hazard ratios (HRs) and 95% confidence interval of cancer were estimated.
Results: HRs (95% CIs) of all cancers by quartiles of Western dietary pattern, DII, and MDs showed that the forth quartile of the Western dietary pattern is attributed to 23% higher cancer risk (HRs: 1.23, CI: 1.09-1.40, P< 0.001, adjusted for age and sex) compared to the first quartile. It also remained significant after further adjustments (HRs = 1.20, CI: 1.06-1.36, P< 0.001). There was a higher cancer risk in the fourth quartile of DII in comparison with the first quartile (HRs = 1.16, CI: 1.01-1.32, P trend < 0.001, adjusted for age and sex). The lower adherence to the Mediterranean dietary pattern also largely contributes to 27% higher cancer risk (HRs: 1.27, CI: 1.12-1.44), P trend < 0.001, adjusted for age and sex), which also remained remarkable after further adjustments ((HRs =1.19, CI: 1.05-1.35, P trend < 0.001).
Conclusion: Cancer is highly correlated to dietary intake and dietary patterns, such as the Western dietary pattern, while the Mediterranean diet score was inversely associated with cancer risk. Further investigations are required to get a broader insight into cancer determinants in population.
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Affiliation(s)
- Marzieh Nojomi
- Preventive Medicine & Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Department of Sociology & Anthropology, Nipissing University, North Bay, Ontario, Canada
| | - Arash Tehrani Banihashemi
- Preventive Medicine & Public Health Research Center, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Niksima
- Preventive Medicine & Public Health Research Center, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Hashemian
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Azadeh Mottaghi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzaddeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Barekzai AM, Aminianfar A, Mousavi SM, Esmaillzadeh A. The Association between Dietary Inflammatory Potential and Gastric Cancer: A Case Control Study. Nutr Cancer 2021; 74:463-471. [PMID: 33560151 DOI: 10.1080/01635581.2021.1883682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE No report is available about diet-disease associations in the understudied region of Afghanistan. Although the inflammatory potential of diet has been linked with several cancers, information about gastric cancer is scarce. The present study aimed to investigate the relationship between the inflammatory potential of the diet and odds of gastric cancer in Afghanistan. METHODS In this hospital-based case-control study, we enrolled 90 newly-diagnosed cases of gastric cancer and 180 age (±5) and sex-matched controls. All cases were pathologically confirmed gastric cancer patients, with no history of any type of other pathologically confirmed cancers. Controls were healthy individuals and relatives of patients in the hospital. Dietary assessment was done by a pre-tested food frequency questionnaire. DII was calculated based on energy-adjusted amounts of several foods and nutrients with inflammatory or anti-inflammatory potential, as introduced by earlier studies. RESULTS Mean age of study participants was 54 years, of them 73% were males. After adjustment for age and sex, individuals in the highest tertile of the inflammatory potential of the diet were 2.47 times (95% CI: 1.31-4.66) more likely to have gastric cancer compared with those in the lowest tertile. Further adjustment for other potential confounders did not substantially affect the association; such that participants with the greatest inflammatory potential of the diet had approximately 3.59 times (95% CI: 1.16-11.02) increased odds of gastric cancer than those with the lowest adherence. Additional adjustment for BMI strengthened the association (OR: 3.75; 95% CI: 1.14-12.30). CONCLUSION We found a significant positive association between inflammatory potential of the diet and risk of gastric cancer. Further studies with prospective nature are required to confirm this association.
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Affiliation(s)
- Ahmad Mujtaba Barekzai
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Aminianfar
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Science, Kashan, Iran
| | - Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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The Dietary Inflammatory Index Is Positively Associated with Colorectal Cancer Risk in a Chinese Case-Control Study. Nutrients 2020; 12:nu12010232. [PMID: 31963221 PMCID: PMC7019221 DOI: 10.3390/nu12010232] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022] Open
Abstract
Diet may modulate chronic inflammation. The aim of this study is to investigate whether the dietary inflammatory index (DII®) was associated with the risk of colorectal cancer in a Chinese population. A case-control study was conducted from July 2010 to April 2019, in Guangzhou, China. A total of 2502 eligible cases were recruited along with 2538 age- (5-year interval) and sex-matched controls. Dietary data derived from a validated food frequency questionnaire were used to calculate the energy-adjusted DII (E-DII) scores. Odds ratios (ORs) and 95% confidence intervals (CIs) for colorectal cancer risk were estimated using unconditional logistic regression models. In this study, E-DII scores ranged from -5.96 (the most anti-inflammatory score) to +6.01 (the most pro-inflammatory score). A positive association was found between the E-DII and colorectal cancer risk, with the OR = 1.40 (95% CI 1.16, 1.68; Ptrend < 0.01) for the highest E-DII quartile compared with the lowest quartile after adjusting for potential confounders. When stratified based on cancer subsite, sex, body mass index, and smoking status, significant associations were not observed in women or underweight individuals. Results from this study confirmed that a higher E-DII score was associated with an increased risk of colorectal cancer in a Chinese population.
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Phillips CM, Chen LW, Heude B, Bernard JY, Harvey NC, Duijts L, Mensink-Bout SM, Polanska K, Mancano G, Suderman M, Shivappa N, Hébert JR. Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review. Nutrients 2019; 11:E1873. [PMID: 31408965 PMCID: PMC6722630 DOI: 10.3390/nu11081873] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022] Open
Abstract
There are over 1,000,000 publications on diet and health and over 480,000 references on inflammation in the National Library of Medicine database. In addition, there have now been over 30,000 peer-reviewed articles published on the relationship between diet, inflammation, and health outcomes. Based on this voluminous literature, it is now recognized that low-grade, chronic systemic inflammation is associated with most non-communicable diseases (NCDs), including diabetes, obesity, cardiovascular disease, cancers, respiratory and musculoskeletal disorders, as well as impaired neurodevelopment and adverse mental health outcomes. Dietary components modulate inflammatory status. In recent years, the Dietary Inflammatory Index (DII®), a literature-derived dietary index, was developed to characterize the inflammatory potential of habitual diet. Subsequently, a large and rapidly growing body of research investigating associations between dietary inflammatory potential, determined by the DII, and risk of a wide range of NCDs has emerged. In this narrative review, we examine the current state of the science regarding relationships between the DII and cancer, cardiometabolic, respiratory and musculoskeletal diseases, neurodevelopment, and adverse mental health outcomes. We synthesize the findings from recent studies, discuss potential underlying mechanisms, and look to the future regarding novel applications of the adult and children's DII (C-DII) scores and new avenues of investigation in this field of nutritional research.
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Affiliation(s)
- Catherine M Phillips
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
- HRB Centre for Diet and Health Research, School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Co. Cork, Ireland.
| | - Ling-Wei Chen
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Barbara Heude
- Research Team on the Early Life Origins of Health (EAROH), Centre for Research in Epidemiology and Statistics (CRESS), INSERM, Université de Paris, F-94807 Villejuif, France
| | - Jonathan Y Bernard
- Research Team on the Early Life Origins of Health (EAROH), Centre for Research in Epidemiology and Statistics (CRESS), INSERM, Université de Paris, F-94807 Villejuif, France
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
- Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Sara M Mensink-Bout
- The Generation R Study Group, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Kinga Polanska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - Giulia Mancano
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Nitin Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - James R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Connecting Health Innovations LLC, Columbia, SC 29201, USA
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11
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Dietary Inflammatory Index, Dietary Non-Enzymatic Antioxidant Capacity, and Colorectal and Breast Cancer Risk (MCC-Spain Study). Nutrients 2019; 11:nu11061406. [PMID: 31234427 PMCID: PMC6628286 DOI: 10.3390/nu11061406] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 02/06/2023] Open
Abstract
Inflammation and antioxidant capacity have been associated with colorectal and breast cancer. We computed the dietary inflammatory index (DII®), and the total dietary non-enzymatic antioxidant capacity (NEAC) and associated them with colorectal and breast cancer risk in the population-based multi case-control study in Spain (MCC-Spain). We included 1852 colorectal cancer and 1567 breast cancer cases, and 3447 and 1486 population controls, respectively. DII score and NEAC were derived using data from a semi-quantitative validated food frequency questionnaire. Unconditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) for energy-adjusted DII (E-DII), and a score combining E-DII and NEAC. E-DII was associated with colorectal cancer risk (OR = 1.93, highest quartile versus lowest, 95%CI:1.60–2.32; p-trend: <0.001); this increase was observed for both colon and rectal cancer. Less pronounced increased risks were observed for breast cancer (OR = 1.22, highest quartile versus lowest, 95%CI:0.99–1.52, p-trend: >0.10). The combined score of high E-DII scores and low antioxidant values were associated with colorectal cancer risk (OR = 1.48, highest quartile versus lowest, 95%CI: 1.26–1.74; p-trend: <0.001), but not breast cancer. This study provides evidence that a pro-inflammatory diet is associated with increased colorectal cancer risk while findings for breast cancer were less consistent.
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12
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Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women's Health Initiative. Eur J Nutr 2019; 59:965-977. [PMID: 30955051 DOI: 10.1007/s00394-019-01956-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/24/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Dietary factors may influence colorectal cancer (CRC) survival through effects on inflammation. We examined the association between post-CRC diagnosis inflammatory potential of diet and all-cause and cancer-specific mortality in the Women's Health Initiative. METHODS The study included 463 postmenopausal women who developed CRC during follow-up and completed a food frequency questionnaire (FFQ), on average 1.7 years after diagnosis. Women were followed from CRC diagnosis until death, censoring, or the end of follow-up in October 2014. Energy-adjusted dietary inflammatory index (E-DII)® scores were calculated from the FFQ and dietary supplement inventory. Cox proportional hazards models were fitted to estimate multivariable-adjusted HRs and 95% confidence intervals (CIs) for all-cause, total cancer, and CRC-specific mortality with the most pro-inflammatory E-DII scores (tertile 3) as referent. RESULTS After a median 11.6 years of follow-up, 162 deaths occurred, including 77 from CRC. Lowest tertile (i.e., most anti-inflammatory) E-DII scores from diet plus supplements were associated with significantly lower all-cause mortality (HRT1vsT3 = 0.49; 95% CI 0.31-0.79) compared to the most pro-inflammatory E-DII tertile. Modest associations with total cancer mortality or CRC-specific mortality were observed, though 95% CIs included 1. CONCLUSIONS Consuming a dietary pattern and supplements with more anti-inflammatory potential after CRC diagnosis may improve overall survival among postmenopausal women.
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13
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Hébert JR, Shivappa N, Wirth MD, Hussey JR, Hurley TG. Perspective: The Dietary Inflammatory Index (DII)-Lessons Learned, Improvements Made, and Future Directions. Adv Nutr 2019; 10:185-195. [PMID: 30615051 PMCID: PMC6416047 DOI: 10.1093/advances/nmy071] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/20/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022] Open
Abstract
The literature on the role of inflammation in health has grown exponentially over the past several decades. Paralleling this growth has been an equally intense focus on the role of diet in modulating inflammation, with a doubling in the size of the literature approximately every 4 y. The Dietary Inflammatory Index (DII) was developed to provide a quantitative means for assessing the role of diet in relation to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. Based on literature from a variety of different study designs ranging from cell culture to observational and experimental studies in humans, the DII was designed to be universally applicable across all human studies with adequate dietary assessment. Over the past 4 y, the DII has been used in >200 studies and forms the basis for 12 meta-analyses. In the process of conducting this work, lessons were learned with regard to methodologic issues related to total energy and nutrient intake and energy and nutrient densities. Accordingly, refinements to the original algorithm have been made. In this article we discuss these improvements and observations that we made with regard to misuse and misinterpretation of the DII and provide suggestions for future developments.
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Affiliation(s)
- James R Hébert
- Cancer Prevention and Control Program
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
| | - Nitin Shivappa
- Cancer Prevention and Control Program
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
| | - Michael D Wirth
- Cancer Prevention and Control Program
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
- College of Nursing, University of South Carolina, Columbia, SC
| | - James R Hussey
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
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14
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Ratjen I, Shivappa N, Schafmayer C, Burmeister G, Nöthlings U, Hampe J, Hébert JR, Lieb W, Schlesinger S. Association between the dietary inflammatory index and all-cause mortality in colorectal cancer long-term survivors. Int J Cancer 2018; 144:1292-1301. [PMID: 30303515 DOI: 10.1002/ijc.31919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/30/2018] [Accepted: 09/07/2018] [Indexed: 02/03/2023]
Abstract
Pro-inflammatory dietary factors have been shown to be associated with the incidence of a range of cancers. However, there are many fewer studies on the association between the inflammatory potential of diet and survival after cancer diagnosis. We examined the association between post-diagnosis dietary inflammatory index (DII®) scores and all-cause mortality in long-term survivors of colorectal cancer (CRC). DII scores were calculated from dietary data of 1,404 CRC survivors collected at a median of 6 years after CRC diagnosis. Using multivariable-adjusted Cox proportional hazards regression models, hazard ratios (HR) and 95% confidence intervals (CI) were estimated for the association of DII scores, modeled continuous and in quartiles, with all-cause mortality. After a median follow-up time of 7 years (after dietary assessment), 204 study participants had died. Overall, in the fully adjusted model there was a suggestion of a positive association between DII score and all-cause mortality (HRDIIquartile4vs1 : 1.36; 95% CI: 0.88-2.09 and HRDIIcontinuous : 1.08; 95% CI: 0.97-1.20). However, in subgroup analyses, we found significant differences in individuals with metastatic disease (HRDIIcontinuous : 1.34; 95% CI: 1.07-1.67) and the absence of stoma (HRDIIcontinuous : 1.15; 95% CI: 1.02-1.29). Overall, the post-diagnosis DII was not statistically significantly associated with all-cause mortality in CRC long-term survivors; however, there was suggestive evidence of an association in select subgroups.
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Affiliation(s)
- Ilka Ratjen
- Institute of Epidemiology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Connecting Health Innovations LLC, Columbia, SC
| | - Clemens Schafmayer
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Greta Burmeister
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ute Nöthlings
- Nutritional Epidemiology, Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technical University Dresden, Dresden, Germany
| | - James R Hébert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Connecting Health Innovations LLC, Columbia, SC
| | - Wolfgang Lieb
- Institute of Epidemiology, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
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15
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McMahon DM, Burch JB, Hébert JR, Hardin JW, Zhang J, Wirth MD, Youngstedt SD, Shivappa N, Jacobsen SJ, Caan B, Van Den Eeden SK. Diet-related inflammation and risk of prostate cancer in the California Men's Health Study. Ann Epidemiol 2018; 29:30-38. [PMID: 30503073 DOI: 10.1016/j.annepidem.2018.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk. METHODS Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials. RESULTS Time to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04-1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74-1.32, Ptrend = .74), suggesting a nonlinear dose-response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease. CONCLUSIONS Relationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.
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Affiliation(s)
- Daria M McMahon
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - James B Burch
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; WJB Dorn Department of Veterans Affairs Medical Center, Columbia, SC
| | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; Connecting Health Innovations, LLC, Columbia, SC.
| | - James W Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Michael D Wirth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; Connecting Health Innovations, LLC, Columbia, SC
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation, Arizona State University, Phoenix; Phoenix VA Health Care System, Phoenix, AZ
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia; Cancer Prevention and Control Program, University of South Carolina, Columbia; Connecting Health Innovations, LLC, Columbia, SC
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Bette Caan
- Division of Research, Kaiser Permanente Northern California, Oakland
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16
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Jalali S, Shivappa N, Hébert JR, Heidari Z, Hekmatdoost A, Rashidkhani B. Dietary Inflammatory Index and Odds of Breast Cancer in a Case-Control Study from Iran. Nutr Cancer 2018; 70:1034-1042. [PMID: 30235017 DOI: 10.1080/01635581.2018.1494843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic inflammation is implicated in breast cancer (BrCa) development; however, studies on the association of the inflammatory potential of diet and breast cancer have produced conflicting results. With this as background, we investigated the association between dietary inflammatory index (DII®) scores and BrCa risk in an Iranian case-control study. In this study, 136 newly diagnosed breast cancer patients and 272 hospitalized controls were recruited using convenience sampling. DII scores were computed from dietary intake data collected through a validated food frequency questionnaire (FFQ). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between the DII and BrCa risk were estimated by logistic regression. After controlling for multiple potential confounders, a significantly increased BrCa odds was observed in the highest quartile of DII score compared to the lowest quartile (ORquartile 4 vs. 1 = 2.64, 95% CI: 1.12-6.25; Ptrend = 0.01). In subanalysis based on menopausal status, a positive association was observed between the DII and BrCa risk among premenopausal women (ORquartile 4 vs. 1 = 5.51, 95% CI: 1.45-20.93; Ptrend = 0.005); however, no association was detected in postmenopausal women. Our findings suggest that more proinflammatory diets, indicated by higher DII scores, may increase the odds of BrCa, especially among premenopausal women.
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Affiliation(s)
- Saba Jalali
- a Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Nitin Shivappa
- b Cancer Prevention and Control Program , University of South Carolina , Columbia , South Carolina , USA.,c Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,d Connecting Health Innovations , Columbia , South Carolina , USA
| | - James R Hébert
- b Cancer Prevention and Control Program , University of South Carolina , Columbia , South Carolina , USA.,c Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , South Carolina , USA.,d Connecting Health Innovations , Columbia , South Carolina , USA
| | - Zeinab Heidari
- a Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Azita Hekmatdoost
- a Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Bahram Rashidkhani
- a Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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17
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Jayedi A, Emadi A, Shab-Bidar S. Dietary Inflammatory Index and Site-Specific Cancer Risk: A Systematic Review and Dose-Response Meta-Analysis. Adv Nutr 2018; 9:388-403. [PMID: 30032224 PMCID: PMC6054175 DOI: 10.1093/advances/nmy015] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 03/06/2018] [Indexed: 12/12/2022] Open
Abstract
Existing evidence suggests a link between the inflammatory potential of diet and risk of cancer. This study aimed to test the linear and potential nonlinear dose-response associations of the Dietary Inflammatory Index (DII), as being representative of inflammatory features of the diet, and site-specific cancer risk. A systematic search was conducted with the use of PubMed and Scopus from 2014 to November 2017. Prospective cohort or case-control studies reporting the risk estimates of any cancer type for ≥3 categories of the DII were selected. Studies that reported the association between continuous DII score and cancer risk were also included. Pooled RRs were calculated by using a random-effects model. Eleven prospective cohort studies (total n = 1,187,474) with 28,614 incident cases and 29 case-control studies with 19,718 cases and 33,229 controls were identified. The pooled RRs for a 1-unit increment in the DII were as follows: colorectal cancer, 1.06 (95% CI: 1.04, 1.08; I2 = 72.5%; n = 9); breast cancer, 1.03 (95% CI: 1.00, 1.07; I2 = 84.0%; n = 7); prostate cancer, 1.06 (95% CI: 0.97, 1.15; I2 = 56.2%; n = 6); pancreatic cancer, 1.16 (95% CI: 1.05, 1.28; I2 = 61.6%; n = 2); ovarian cancer, 1.08 (95% CI: 1.03, 1.13; I2 = 0%; n = 2); esophageal squamous cell carcinoma, 1.24 (95% CI: 1.10, 1.38; I2 = 64.3%; n = 2); renal cell carcinoma, 1.08 (95% CI: 1.02, 1.13; I2 = 0%; n = 2); and esophageal adenocarcinoma, 1.26 (95% CI: 1.13, 1.39; I2 = 0%; n = 2). A nonlinear dose-response meta-analysis showed that, after a somewhat unchanged risk within initial scores of the DII, the risk of colorectal cancer increased linearly with increasing DII score. In the analyses of breast and prostate cancers, the risk increased with a very slight trend with increasing DII score. In conclusion, the results showed that dietary habits with high inflammatory features might increase the risk of site-specific cancers.
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Affiliation(s)
- Ahmad Jayedi
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Emadi
- Department of Information Technologies, Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences, Tehran, Iran,Address correspondence to SS-B (e-mail: )
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18
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Li D, Hao X, Li J, Wu Z, Chen S, Lin J, Li X, Dong Y, Na Z, Zhang Y, Dai H, Song Y. Dose-response relation between dietary inflammatory index and human cancer risk: evidence from 44 epidemiologic studies involving 1,082,092 participants. Am J Clin Nutr 2018; 107:371-388. [PMID: 29566194 DOI: 10.1093/ajcn/nqx064] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/06/2017] [Indexed: 12/15/2022] Open
Abstract
Background A newly developed dietary inflammatory index (DII) to evaluate the inflammatory potential of diets was published recently. Many studies have investigated the link between diet-related inflammation and human cancer risk, but the results remain controversial. Objective We sought to determine the dose-response relation between DII and human cancer risk based on published epidemiologic literature. Design To summarize evidence, we performed a dose-response meta-analysis to investigate the association between DII and cancer incidence. We systematically searched PubMed, Embase, Web of Science, and the Cochrane library up to 5 November 2017. After data extraction, pooled RRs were calculated and dose-response analyses were performed using a restricted cubic spline model with 4 knots. Subgroup analyses, sensitivity analyses, and tests for publication bias were also performed. Results In all, 44 high-quality studies with 1,082,092 participants were included. The results showed that an elevated DII (continuous-RR: 1.13; 95% CI: 1.09, 1.16; category DIIhighest vs lowest-RR: 1.58; 95% CI: 1.45, 1.72) independently indicated higher cancer risk except for lung cancer and Australian studies. A linear dose-response relation between DII and overall cancer risk was found, with an 8.3% increase in the risk of cancer per DII score. The pooled RR of DII and cancer risk was 1.86 (95% CI: 1.63, 2.13) from 30 case-control studies but was lower in 14 prospective cohorts (RR: 1.29; 95% CI: 1.19, 1.40). The sensitivity analysis and Egger's test supported the main results. Conclusions Our analysis indicated that higher DII is significantly correlated with cancer risk. More prospective studies with large sample sizes, involving more ethnic groups and different cancer types, are required in the future. This review was registered with PROSPERO as CRD42017077075.
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Affiliation(s)
| | | | | | - Zhenhai Wu
- Department of Oncology, Zhejiang Hospital, Hangzhou, Zejiang, PR China
| | | | | | | | | | - Zhijing Na
- The Second Clinical Academy of China Medical University, Shenyang, Liaoning, PR China
| | - Yalin Zhang
- Clinical Nutrition, Shengjing Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Huixu Dai
- Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, PR China
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19
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Shivappa N, Hebert JR, Neshatbini Tehrani A, Bayzai B, Naja F, Rashidkhani B. A Pro-Inflammatory Diet Is Associated With an Increased Odds of Depression Symptoms Among Iranian Female Adolescents: A Cross-Sectional Study. Front Psychiatry 2018; 9:400. [PMID: 30210375 PMCID: PMC6124384 DOI: 10.3389/fpsyt.2018.00400] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/09/2018] [Indexed: 01/24/2023] Open
Abstract
Background: The relation between dietary inflammation and risk of depression has not been widely explored. We examined the association between the inflammatory effect of the diet and the odds of depression among Iranian female adolescents. Methods: Using a stratified cluster sampling technique, 300 female adolescents aged 15-18 years were recruited from schools in Tehran between years 2014-2015. Depression was assessed using the Depression, Anxiety and Stress Scale (DASS)- a 21-point scale. The dietary inflammatory index (DII®) was used to evaluate the inflammatory potential of the diet. Dietary intake was assessed using a validated food frequency questionnaire. In addition to descriptive statistics, multivariable linear and logistic regression were used to calculate confounder-adjusted beta estimates and odds ratios. Results: In total, 88 females (30%) had at least a moderate level of depressive symptoms (DASS > 6). Females with the most pro-inflammatory diet had higher DASS depression score (β = 1.67; 95% CI = 0.03, 3.31) and were at 3.96 (95% CI = 1.12, 13.97) times higher odds of having at least moderate depressive symptoms, compared to females with the least anti-inflammatory diets. Conclusion: These data suggest that Iranian adolescent females eating a pro-inflammatory diet, as indicated by higher DII scores, had greater odds of having at least moderate depressive symptoms.
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Affiliation(s)
- Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Asal Neshatbini Tehrani
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bita Bayzai
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naja
- Nutrition and Food Sciences Department, American University of Beirut, Beirut, Lebanon
| | - Bahram Rashidkhani
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute (WHO Collaborating Center), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Zhang C, Wang W, Zhang D. Association Between Dietary Inflammation Index and The Risk of Colorectal Cancer: A Meta-Analysis. Nutr Cancer 2017; 70:14-22. [DOI: 10.1080/01635581.2017.1374418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Caixia Zhang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, People's Republic of China
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21
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Shivappa N, Godos J, Hébert JR, Wirth MD, Piuri G, Speciani AF, Grosso G. Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis. Nutrients 2017; 9:nu9091043. [PMID: 28930191 PMCID: PMC5622803 DOI: 10.3390/nu9091043] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 08/31/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022] Open
Abstract
Diet and chronic inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet, measured through the Dietary Inflammatory Index (DII®), and CRC has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from nine studies were eligible, of which five were case-control and four were cohort studies. Results from meta-analysis showed a positive association between increasing DII scores, indicating a pro-inflammatory diet, and CRC. Individuals in the highest versus the lowest (reference) DII category showed an overall 40% increased risk of CRC with moderate evidence of heterogeneity [relative risk (RR) = 1.40, 95% confidence interval (CI): 1.26, 1.55; I2 = 69%, p < 0.001]. When analyzed as a continuous variable, results showed an increased risk of CRC of 7% for a 1-point increase in the DII score. Results remained unchanged when analyses were restricted to the four prospective studies. Results of our meta-analysis support the importance of adopting a healthier anti-inflammatory diet in preventing CRC. These results further substantiate the utility of DII as tool to characterize the inflammatory potential of diet and to predict CRC.
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Affiliation(s)
- Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
- Connecting Health Innovations LLC, Columbia, SC 29201, USA.
| | - Justyna Godos
- Inflammation Society, Church Hill, Orpington, London BR6OHH, UK.
| | - James R Hébert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
- Connecting Health Innovations LLC, Columbia, SC 29201, USA.
| | - Michael D Wirth
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
- Connecting Health Innovations LLC, Columbia, SC 29201, USA.
| | - Gabriele Piuri
- Inflammation Society, Church Hill, Orpington, London BR6OHH, UK.
| | | | - Giuseppe Grosso
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK.
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22
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Fan Y, Jin X, Man C, Gao Z, Wang X. Meta-analysis of the association between the inflammatory potential of diet and colorectal cancer risk. Oncotarget 2017; 8:59592-59600. [PMID: 28938662 PMCID: PMC5601758 DOI: 10.18632/oncotarget.19233] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/30/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The inflammatory potential of diet has been inconsistently linked to colorectal cancer (CRC) risk. This meta-analysis aimed to evaluate the association of the inflammatory potential of diet, as estimated by the dietary inflammatory index (DII) score, with CRC risk. MATERIALS AND METHODS The PubMed and Embase databases were searched for relevant studies from inception to February 2017. All cohort and case-control studies investigating the association of the DII score with CRC risk were selected. RESULTS Four prospective cohorts and four case-control studies, which enrolled a total of 880,380 participants, were included. The pooled adjusted risk ratio (RR) of CRC for the highest DII score versus the lowest category was 1.43 (95% confidence interval [CI]: 1.26-1.62). When stratified by study design, the RRs for the case-control and cohort studies were 1.27 (95% CI: 1.16-1.38) and 1.81 (95% CI: 1.48-2.22), respectively. Subgroup analysis showed that individuals with the highest category of DII score were independently associated with CRC risk in men (RR=1.51; 95% CI: 1.29-1.76), women (RR=1.25; 95% CI: 1.10-1.41), colon cancer (RR=1.39; 95% CI: 1.19-1.62), and rectal cancer (RR=1.32; 95% CI: 1.01-1.74). However, the pooled RR was 1.07 (95% CI: 0.87-1.31) for rectal cancer among the prospective cohort studies. CONCLUSIONS As estimated by a high DII score, pro-inflammatory diet is independently associated with increased CRC risk. This finding confirms that low inflammatory potential diet may reduce CRC risk. However, the gender- and cancer site-specific associations of the DII score with CRC risk need to be further investigated.
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Affiliation(s)
- Yu Fan
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Xin Jin
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Changfeng Man
- Institute of Molecular Biology and Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, 212002, China
| | - Zhenjun Gao
- Department of Digestive Disease, Central Hospital of Shanghai Qingpu District, Shanghai, 201700, China
| | - Xiaoyan Wang
- Department of Digestive Disease, The First People's Hospital of Suqian City, Suqian, Jiangsu, 223800, China
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