Prospective study of the dietary inflammatory index and risk of breast cancer in postmenopausal women

Active Molecular Network Discovery Links Lifestyle Variables to Breast Cancer in the Long Island Breast Cancer Study Project

A healthy lifestyle has been associated with decreased risk of developing breast cancer. Using untargeted metabolomics profiling, which provides unbiased information regarding lifestyle choices such as diet and exercise, we aim to identify the molecular mechanisms connecting lifestyle and breast cancer through network analysis. A total of 100 postmenopausal women, 50 with breast cancer and 50 cancer-free controls, were selected from the Long Island Breast Cancer Study Project (LIBCSP). We measured untargeted plasma metabolomics using liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Using the "enet" package, we retained highly correlated metabolites representing active molecular network (AMN) clusters for analysis. LASSO was used to examine associations between cancer status and AMN metabolites and covariates such as BMI, age, and reproductive factors. LASSO was then repeated to examine associations between AMN metabolites and 10 lifestyle-related variables including smoking, physical activity, alcohol consumption, meat consumption, fruit and vegetable consumption, and supplemental vitamin use. Results were displayed as a network to uncover biological pathways linking lifestyle factors to breast cancer status. After filtering, 851 "active" metabolites out of 1797 metabolomics were retained in 197 correlation AMN clusters. Using LASSO, breast cancer status was associated with 71 "active" metabolites. Several of these metabolites were associated with lifestyle variables including meat consumption, alcohol consumption, and supplemental β-carotene, B12, and folate use. Those metabolites could potentially serve as molecular-level biological intermediaries connecting healthy lifestyle factors to breast cancer, even though direct associations between breast cancer and the investigated lifestyles at the phenotype level are not evident. In particular, DiHODE, a metabolite linked with inflammation, was associated with breast cancer status and connected to β-carotene supplement usage through an AMN. We found several plasma metabolites associated with lifestyle factors and breast cancer status. Future studies investigating the mechanistic role of inflammation in linking supplement usage to breast cancer status are warranted.

Association between dietary inflammatory index and body fat percentage among newly diagnosed breast cancer patients

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.

Dietary Inflammatory Potential and Bone Outcomes in Midwestern Post-Menopausal Women

Little is known about the inflammatory potential of diet and its relation to bone health. This cross-sectional study examined the association between the inflammatory potential of diet and bone-related outcomes in midwestern, post-menopausal women enrolled in the Heartland Osteoporosis Prevention Study (HOPS) randomized controlled trial. Dietary intake from the HOPS cohort was used to calculate Dietary Inflammatory Index (DII®) scores, which were energy-adjusted (E-DIITM) and analyzed by quartile. The association between E-DII and lumbar and hip bone mineral density (BMD) and lumbar trabecular bone scores (TBS; bone structure) was assessed using ANCOVA, with pairwise comparison to adjust for relevant confounders (age, education, race/ethnicity, smoking history, family history of osteoporosis/osteopenia, BMI, physical activity, and calcium intake). The cohort included 272 women, who were predominately white (89%), educated (78% with college degree or higher), with a mean BMI of 27 kg/m2, age of 55 years, and E-DII score of -2.0 ± 1.9 (more anti-inflammatory). After adjustment, E-DII score was not significantly associated with lumbar spine BMD (p = 0.53), hip BMD (p = 0.29), or TBS at any lumbar location (p > 0.05). Future studies should examine the longitudinal impact of E-DII scores and bone health in larger, more diverse cohorts.

Changes in Dietary Inflammatory Index Score over Time and Cancer Development in Rural Post-Menopausal Women

Inflammation plays a key role in cancer development. As an important modulator of inflammation, the role of diet should be explored. The purpose of this study was to determine the association between diets with a higher inflammatory potential, as measured by the Dietary Inflammatory Index (DII^®), and cancer development in a cohort of rural post-menopausal women. Dietary intake from a randomized controlled trial cohort of rural, post-menopausal women in Nebraska was used to compute energy-adjusted DII (E-DII^TM) scores at baseline and four years later (visit 9). A linear mixed model analysis and multivariate logistic regression evaluated the association between E-DII scores (baseline, visit 9, change score) and cancer status. Of 1977 eligible participants, those who developed cancer (n = 91, 4.6%) had a significantly larger, pro-inflammatory change in E-DII scores (Non-cancer: Δ 0.19 ± 1.43 vs. Cancer: Δ 0.55 ± 1.43, p = 0.02). After adjustment, odds of cancer development were over 20% higher in those with a larger change (more pro-inflammatory) in E-DII scores than those with smaller E-DII changes (OR = 1.21, 95% CI [1.02, 1.42], p = 0.02). Shifting to a more pro-inflammatory diet pattern over four years was associated with increased odds of cancer development, but not with E-DII at baseline or visit 9 alone.

Dietary Inflammatory Index and risk of breast cancer: evidence from a prospective cohort of 67,879 women followed for 20 years in France

BACKGROUND

Inflammation is implicated in breast cancer development, and diet is one of the modifiable risk factors involved in the regulation of chronic inflammation. Previous studies on the association between breast cancer risk and Dietary Inflammatory Indexes (DII) derived from food frequency questionnaires and data on inflammatory potential of dietary components have reported inconsistent results.

OBJECTIVE

To investigate the association between the DII and the risk of breast cancer using data from a large population-based cohort study.

DESIGN

A total of 67,879 women from the E3N cohort were followed from 1993 to 2014. A total of 5686 breast cancer cases were diagnosed during the follow-up. The food frequency questionnaire administered at baseline in 1993 was used to calculate an adapted DII. Cox proportional hazard models using age as the time scale were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Spline regression was used to determine any dose-response relationship. We also evaluated effect modification by menopausal status, body mass index, smoking status and alcohol consumption.

RESULTS

The median DII score of the study population was slightly pro-inflammatory (DII = + 0.39); ranged from - 4.68 in the lowest quintile to + 4.29 in the highest quintile. The HR increased linearly with the DII (HR per 1SD = 1.04 [95% CI: 1.01, 1.07]), and reached 1.13 [95% CI: 1.04, 1.23] in the 5th quintile group as compared to the first. A positive linear dose-response relationship was also observed when modeling DII with spline functions. Slightly higher HRs were observed in non-smokers (HR _{for 1-SD increase} 1.06 [95% CI: 1.02, 1.10]; p trend = 0.001) and in low-alcohol consumers (≤ 1 glass/day) (HR _{for 1-SD increase} 1.05 [95% CI: 1.01, 1.08]; p trend = 0.002).

CONCLUSION

Our results suggest a positive association between DII and breast cancer risk. Consequently, the promotion of anti-inflammatory diet may contribute to breast cancer prevention.

Is there any association between dietary inflammatory index and quality of life? A systematic review

Background

The inflammatory potential of unhealthy diets can lead to the development of chronic diseases and also exacerbating their complications. Therefore, the present systematic review aimed to evaluate the association of dietary inflammatory index (DII) and quality of life (QOL) in human subjects.

Methods

A systematic search was conducted in PubMed, Web of Science, and Scopus databases, using the combination of all search terms related to DII and QOL until May 2022. All eligible human studies published in English were included.

Results

Three hundred twenty-seven studies were obtained from the first systematic search of the databases although, only eight studies were eligible for the evaluation. Seven studies reported that there was a significant reverse association between DII scores and overall QOL and/or its subscales in different populations including patients with asthma, osteoarthritis, hemodialysis patients, multiple sclerosis, obese women, and also in healthy subjects. While, one study on postmenopausal women found no evidence of this association.

Conclusion

This systematic review demonstrated that an anti-inflammatory diet might be associated with better QOL. However, future well-designed clinical trials can provide better conclusions especially regarding the quantifying of this relationship.

Association of dietary and nutrient patterns with systemic inflammation in community dwelling adults

Purpose

Evidence investigating associations between dietary and nutrient patterns and inflammatory biomarkers is inconsistent and scarce. Therefore, we aimed to determine the association of dietary and nutrient patterns with inflammation.

Methods

Overall, 1,792 participants from the North-West Adelaide Health Study were included in this cross-sectional study. We derived dietary and nutrient patterns from food frequency questionnaire data using principal component analysis. Multivariable ordinal logistic regression determined the association between dietary and nutrient patterns and the grade of inflammation (normal, moderate, and severe) based on C-reactive protein (CRP) values. Subgroup analyses were stratified by gender, obesity and metabolic health status.

Results

In the fully adjusted model, a plant-sourced nutrient pattern (NP) was strongly associated with a lower grade of inflammation in men (OR_Q5vsQ1 = 0.59, 95% CI: 0.38–0.93, p-trend = 0.08), obesity (OR_Q5vsQ1 = 0.43; 95% CI: 0.24–0.77, p-trend = 0.03) and metabolically unhealthy obesity (OR_Q5vsQ1 = 0.24; 95% CI: 0.11–0.52, p-trend = 0.01). A mixed NP was positively associated with higher grade of inflammation (OR_Q5vsQ1 = 1.35; 95% CI: 0.99–1.84, p-trend = 0.03) in all participants. A prudent dietary pattern was inversely associated with a lower grade of inflammation (OR_Q5vsQ1 = 0.72, 95% CI: 0.52–1.01, p-trend = 0.14). In contrast, a western dietary pattern and animal-sourced NP were associated with a higher grade of inflammation in the all participants although BMI attenuated the magnitude of association (OR_Q5vsQ1 = 0.83, 95% CI: 0.55–1.25; and OR_Q5vsQ1 = 0.94, 95% CI: 0.63–1.39, respectively) in the fully adjusted model.

Conclusion

A plant-sourced NP was independently associated with lower inflammation. The association was stronger in men, and those classified as obese and metabolically unhealthy obese. Increasing consumption of plant-based foods may mitigate obesity-induced inflammation and its consequences.

Dietary inflammatory index and breast cancer risk: an updated meta-analysis of observational studies

This updated meta-analysis sought to determine whether the pro-inflammatory potential of diet is a risk factor for breast cancer (BrCa) development, for the first time focusing on the effects of design heterogeneity. The search was performed using Scopus, PubMed, and Embase databases. Data were extracted from twenty-one eligible studies, including eleven cohorts (336,085 participants/20,033 incidence cases), and ten case-control studies (9,833 cases/12,752controls). The random-effect was used to calculate the relative risk (RR) using STATA 16 software. The highest dietary inflammatory index (DII) vs. the lowest category showed 16% increased risk of BrCa (95% CI: 1.06-1.26; I² = 62.8%, P (I²) < 0.001). This was notable in post-menopausal status (RR = 1.13, 95% CI: 1.04-1.22), women with body mass index (BMI) ≥ 30 kg/m² (RR = 1.35, 95% CI: 1.07-1.63), and study populations from developing countries (RR = 1.79, 95% CI: 1.12-2.47). Methodological covariates were subject to subgroup meta-analyses and showed stronger results among case-control studies (RR = 1.50, 95% CI: 1.20-1.80), studies considered age-matched controls (RR = 1.56, 95% CI: 1.19-1.93) and hospital-based controls (RR = 2.11, 95% CI: 1.58-2.64), and cohort studies identified by prolong follow-up durations (RR = 1.13, 95% CI: 1.03-1.22). This updated meta-analysis highlighted the pro-inflammatory diet as a risk factor for BrCa, especially among women in post-menopausal status, obese groups, and developing countries. Meta-analysis in methodological subgroups could improve results, less affected by heterogeneity, and suggested subclassification with important implications for future epidemiological designs and even clinical management.

Association between the dietary inflammatory index and bone markers in postmenopausal women

Introduction

The health problem of postmenopausal women is emerging as an important problem due to the increased aging population. This study investigated the association between dietary inflammatory index (DII) and bone markers in postmenopausal women.

Methods

A cross-sectional study was conducted on 132 postmenopausal women aged 45–70 years. The DII score was calculated using the 3-day food records and divided into tertiles according to the DII score. The lifestyle factors that could affect bone mineral density (BMD) in postmenopausal women were investigated and included the EuroQol- 5 Dimension (EQ-5D), physical activity, and eating habits. Skeletal muscle index-weight (SMIw) was used to evaluate skeletal muscle mass, and alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BSALP), and phosphorus (P) measured as bone biomarkers. The BMD was measured using dual-energy X-ray absorptiometry, and the association between anthropometric, biochemistry, BMD, and DII was assessed.

Results

In the anti-inflammatory group, a high intake of fiber, vitamins, and minerals was observed. After adjusting for confound factors, with higher DII score, percent body fat increased (β = 0.168, p = 0.012), and SMIw decreased linear regression analysis (β = −0.329, p = 0.037, respectively). For biochemistry, confound factors were adjusted, with higher DII score, ALP, BSALP and P decreased and DII score increased (β = −0.057, p = 0.002, β = −0.167, p = 0.004, β = −1.799, p = 0.026, respectively). The relationship between DII and BMD was not significant, but osteopenia increased as DII score increased.

Conclusion

The low DII score is positively associated with low body fat, high muscle mass, elevated bone markers, and low risk of osteopenia.

The association between the inflammatory potential of diet and the risk of histopathological and molecular subtypes of breast cancer in northwestern Iran: Results from the Breast Cancer Risk and Lifestyle study

BACKGROUND

This study explored the association between diet-associated inflammation and the risk of different molecular subtypes of breast cancer (BrCA) in a large, population-based case-control study conducted in northwestern Iran.

METHODS

The study consisted of 1007 women with histopathologically confirmed BrCA and 1004 controls admitted to hospitals in Tabriz, northwestern Iran, for nonneoplastic conditions. Dietary Inflammatory Index scores and energy-adjusted Dietary Inflammatory Index (E-DII) scores, with and without supplements, were computed on the basis of dietary intake collected using a validated 136-item food frequency questionnaire.

RESULTS

Women with the highest E-DII scores (quartile 4) versus those with the lowest E-DII scores (quartile 1) showed a significantly increased BrCA risk (odds ratio for quartile 4 vs quartile 1 [OR_Q4vsQ1 ], 1.87; 95% confidence interval [CI], 1.42-2.47), particularly for lobular carcinoma (OR_Q4vsQ1 , 3.07; 95% CI, 1.34-7.02). Findings were similar for premenopausal women diagnosed with luminal A BrCA (OR_Q4vsQ1 , 2.71; 95% CI, 1.74-4.22) or luminal B BrCA (OR_Q4vsQ1 , 2.86; 95% CI, 1.39-5.89). Women consuming the most proinflammatory diets were 3 times more likely to have triple-negative BrCA (OR_Q4vsQ1 , 3.00; 95% CI, 1.002-8.96) while compared to luminal A BrCA. The BrCA risk for women consuming diets in the highest half of E-DII scores (E-DII > 0) was 59% greater than the risk for those in the lowest half (95% CI, 1.29-1.97). Also, higher E-DII scores that took into account supplements were associated with larger tumor sizes (T3 > 5 cm; P < .05).

CONCLUSIONS

A proinflammatory diet, as indicated by higher E-DII scores, appears to increase the risk of BrCA in Iranian women. Large increases in risk were seen in invasive molecular subtypes of BrCA. Anti-inflammatory diets are suggested to prevent the risk of overall BrCA and more aggressive forms of BrCA in particular.

Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women's Health Initiative (WHI)

Aim

To investigate the association between dietary patterns and total and obesity-related cancers risk. Additionally, to examine if acculturation modifies this relationship.

Subject and Methods

Dietary intake of postmenopausal Hispanic women (N=5,482) enrolled in the Women's Health Initiative was estimated from a Food Frequency Questionnaire and used to calculate dietary pattern scores; Healthy Eating Index-2015 (HEI-2015), Mexican Diet (MexD) score, alternate Mediterranean Diet Score (aMED), and the energy adjusted-Dietary Inflammatory Index (E-DII™). Associations were evaluated using Cox proportional hazards regression models.

Results

631 cancers and 396 obesity-related cancers were diagnosed over a mean-follow up of 12 years. Across dietary scores, there were no significant associations with cancer risk or mortality. Trend analysis suggest a potentially lower risk for total cancer related to the highest MexD score (HR 0.68, 95% CI 0.45-1.04, P-trend=0.03), and lower risk for obesity-related cancer mortality related to the highest score category for MexD (HR 0.65, 95% CI 0.37-1.16, P-trend=0.02), and aMED (HR 0.87, 95% CI 0.45-1.67, P-trend=0.04). Further analysis suggests less acculturated women with higher MexD scores had 56% lower risk for any cancer (HR 0.44, 95% CI 0.22-0.88, P-trend=0.03) and 83% lower risk for cancer mortality (HR 0.17, 95% CI 0.04-0.76, P-trend=0.01) compared to more acculturated Hispanic women.

Conclusions

Dietary patterns were not associated with cancer risk and mortality in postmenopausal Hispanic women. Less-acculturated, Spanish-preferred speakers, who reported consuming a more traditional Mexican diet may experience a lower risk for cancer and cancer mortality.

Inflammatory potential of the diet and risk of breast cancer in the European Investigation into Cancer and Nutrition (EPIC) study

The role of chronic inflammation on breast cancer (BC) risk remains unclear beyond as an underlying mechanism of obesity and physical activity. We aimed to evaluate the association between the inflammatory potential of the diet and risk of BC overall, according to menopausal status and tumour subtypes. Within the European Prospective Investigation into Cancer and Nutrition cohort, 318,686 women were followed for 14 years, among whom 13,246 incident BC cases were identified. The inflammatory potential of the diet was characterized by an inflammatory score of the diet (ISD). Multivariable Cox regression models were used to assess the potential effect of the ISD on BC risk by means of hazard ratios (HR) and 95% confidence intervals (CI). ISD was positively associated with BC risk. Each increase of one standard deviation (1-Sd) of the score increased by 4% the risk of BC (HR = 1.04; 95% CI 1.01-1.07). Women in the highest quintile of the ISD (indicating a most pro-inflammatory diet) had a 12% increase in risk compared with those in the lowest quintile (HR = 1.12; 95% CI 1.04-1.21) with a significant trend. The association was strongest among premenopausal women, with an 8% increased risk for 1-Sd increase in the score (HR = 1.08; 95% CI 1.01-1.14). The pattern of the association was quite homogeneous by BC subtypes based on hormone receptor status. There were no significant interactions between ISD and body mass index, physical activity, or alcohol consumption. Women consuming more pro-inflammatory diets as measured by ISD are at increased risk for BC, especially premenopausal women.

Dietary inflammatory index and odds of breast cancer: A case-control study

Breast cancer (BrCA) is one of the most commonly diagnosed cancers and is the leading cause of cancer deaths in women worldwide. This study aimed to examine the association between the dietary inflammatory index (DII®) and BrCA among Jordanian women. A total of 400 adult women were enrolled into this case-control study. Cases were 200 women recently diagnosed with BrCA selected from the two hospitals that provide cancer therapy in Jordan. They were matched on age, income, and marital status with 200 BrCA-free controls. DII scores were calculated from dietary data that were collected in a face-to-face interview conducted between October 2016 and September 2017 using a validated food frequency questionnaire. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% CIs. The study results revealed no significant associations between DII scores in relation to the odds of developing BrCA after multivariable adjustment including age, education, total energy, BMI, number of pregnancy, contraceptive use, lactation, smoking, and family history of BrCA. Stratified analyses by obesity status showed that overweight/obese participants in the highest DII tertile had a >75% increased BrCA risk (OR of 1.77 [95% CI, 1.01-3.12]) compared with participants in the lowest tertile, after adjusting for age. The results from this study showed no significant relationship between the proinflammatory potential of the diet and BrCA risk in the overall study population. However, results stratified by weight category indicated an effect of diet-associated inflammation on BrCA risk in the overweight/obese group. Results of the study are consistent with a recommendation aimed at maintaining higher diet quality, that is, adopting healthy diets characterized by low DII scores in order to reduce the risk for BrCA.

A case-control study in France showing that a pro-inflammatory diet is associated with a higher risk of breast cancer

Dietary regimens promoting inflammatory conditions have been implicated in breast cancer development, but studies on the association between pro-inflammatory diet and breast cancer risk have reported inconsistent results. We investigated the association between the inflammatory potential of diet and breast cancer risk in a case-control study in France including 872 breast cancer cases and 966 population controls. All women completed a food frequency questionnaire that was used to compute a Dietary Inflammatory Index (DII) based on the inflammatory weight of 33 dietary components. The DII ranged from a median of - 3.22 in the lowest quartile (anti-inflammatory) to + 2.96 in the highest quartile (pro-inflammatory). The odds ratio contrasting quartile 4 to quartile 1 was 1.31 (95% CI 1.00, 1.73; p-trend = 0.02). Slightly higher odds ratios were observed in post-menopausal women, particularly those with body mass index > 25 kg/m2 (odds ratio 1.62; 95% CI 0.92, 2.83; p-trend = 0.02), and among ever smokers (odds ratio 1.71; 95% CI 1.11, 2.65; p-trend 0.01). The analyses by breast cancer subtype showed that the DII was associated with breast tumors that expressed either the estrogen (ER) or progesterone (PR) hormone receptors or the Human Epidermal Growth Factor Receptor-2 (HER2), but no association was seen for the triple negative breast tumor subtype. Our results add further evidence that a pro-inflammatory diet is associated with breast cancer risk with possible effect variation according to tumor subtype.

Dietary Inflammatory Index and Breast Cancer: report from a Large-Scale Case-Control Study

OBJECTIVE

The relationship between diet, including its inflammatory potential, and breast cancer has led to inconsistent results. We investigated the association between a dietary inflammatory index (DII) and the odds of breast cancer in a large case-control study among women.

METHODS

This case-control study was carried out on 412 women with pathologically confirmed breast cancer and 456 apparently healthy controls. DII scores were calculated from dietary intake data. Multi-variable adjusted logistic regression was used to obtain odds ratios for breast cancer across quartiles of DII.

RESULTS

A total participants aged 45 ± 10.8 years were included in the present study. After adjustment for potential confounders, individuals in the highest quartile of DII scores had 1.5 times higher odds of breast cancer than those with the lowest (OR= 1.56; 95%CI: 1.04-2.35, Ptrend=0.02). Premenopausal women with the greatest DII had higher odds for breast cancer, compared with those with the lowest DII (OR= 1.92; 95% CI: 1.14-3.25, Ptrend=0.01). No significant association was seen between DII and odds of breast cancer in postmenopausal women.

CONCLUSION

Dietary inflammatory index might be directly associated with odds of breast cancer particularly in premenopausal women. Prospective cohort studies are needed to confirm these findings.

Dietary inflammatory potential, oxidative balance score, and risk of breast cancer: Findings from the Sister Study

Diet, inflammation, and oxidative stress may be important in breast carcinogenesis, but evidence on the role of the inflammatory and prooxidative potential of dietary patterns is limited. Energy adjusted-Dietary Inflammatory Index (E-DII™) and dietary oxidative balance score (D-OBS) were calculated for 43 563 Sister Study cohort participants who completed a Block 1998 food frequency questionnaire at enrollment in 2003-2009 and satisfied eligibility criteria. D-OBS was validated using measured F2 -isoprostanes and metabolites. High E-DII score and low D-OBS represent a more proinflammatory and prooxidant diet, respectively, and associations of quartiles of each index with breast cancer (BC) risk were estimated using multivariable Cox proportional hazards regression. There were 2619 BCs diagnosed at least 1 year after enrollment (mean follow-up 8.4 years). There was no overall association between E-DII and BC risk, whereas there was a suggestive inverse association for the highest vs lowest quartile of D-OBS (HR 0.92 [95% CI, 0.81-1.03]). The highest quartile of E-DII was associated with risk of triple-negative BC (HR 1.53 [95% CI, 0.99-2.35]). When the two indices were combined, a proinflammatory/prooxidant diet (highest tertile of E-DII and lowest tertile of D-OBS) was associated with increased risk for all BC (HR 1.13 [95% CI, 1.00-1.27]) and for triple-negative BC (1.72 [95% CI, 1.10-2.70]), compared to an antiinflammatory/antioxidant diet (lowest tertile of E-DII and highest tertile of D-OBS). Diets with increased inflammatory potential and reduced oxidative balance were positively associated with overall and triple-negative BC.

Factors associated with the inflammatory potential of the Brazilian population's diet

The aim of the study was to assess the inflammatory potential of the Brazilian population's diet and its association with demographic, socio-economic and anthropometric characteristics. A cross-sectional study was performed with 34 003 individuals aged 10 years and older, evaluated by the National Diet and Nutrition Survey from the Consumer Expenditure Survey (POF 2008-2009). The Energy-adjusted Dietary Inflammatory Index (E-DII™) was determined using thirty-four dietary parameters calculated through non-consecutive 2-d dietary records. Positive scores indicate a pro-inflammatory diet, while negative scores indicate an anti-inflammatory diet. A bivariate and multivariate linear regression analysis based on a hierarchical theoretical model was performed to verify the factors associated with the E-DII. The mean of the E-DII was 1·04 (range of -4·77 to +5·98). The highest values of the pro-inflammatory E-DII were found among adolescents (1·42; P < 0·001) and individuals with higher income (1·10; P < 0·001) and level of education (1·18; P < 0·001). In the final model, the E-DII was associated with higher income quartiles and was higher in the Northeast and South regions, in white people, individuals with ≥9 years of education and adults and adolescents age group. The Brazilian population consumes a diet with high inflammatory potential, especially adolescents, white people and those with higher income and level of education. Thus, the index presented uneven distribution among the population, emphasising groups with higher dietary inflammatory potential. The socio-economic risk profile of a diet with higher inflammatory potential in medium-income countries is different from what is observed in high-income nations.

Strong association between the dietary inflammatory index(DII) and breast cancer: a systematic review and meta-analysis

The association between the Dietary Inflammatory Index (DII) and breast cancer risk has been widely reported in recent years, but there is still controversy about whether a pro-inflammatory diet is a risk factor for breast cancer. We conducted a meta-analysis to investigate the relationship between the DII and breast cancer risk in pre-menopausal and post-menopausal women. We comprehensively searched PubMed, Embase and the Cochrane Library in January 2021 to identify articles reporting an association between the DII and breast cancer risk. A pooled analysis was conducted with 14 studies covering 312,885 participants. Overall, women in the most pro-inflammatory diet category were at greater risk for breast cancer than those in the most anti-inflammatory category (relative risk [RR]=1.37, 95% confidence interval [CI] 1.17-1.60, P<0.001). This association was strong in both pre-menopausal women (RR=1.87, 95% CI 1.17-2.99, P=0.001) and post-menopausal women (RR=1.23, 95% CI 1.08-1.40, P<0.001). Thus, a strong and independent association was observed between a pro-inflammatory diet (assessed using the DII score) and breast cancer risk, irrespective of menopausal status. Further studies will be required to determine the relationship between a pro-inflammatory diet and different subtypes of breast cancer.

Dietary inflammatory index and dietary energy density are associated with menopausal symptoms in postmenopausal women: a cross-sectional study

OBJECTIVES

No previous study has evaluated the association of the dietary inflammatory index (DII) and dietary energy density (DED) with menopausal symptoms and its subclasses in postmenopausal women. The aim of this study was to evaluate the association of DII score and DED with menopausal symptoms and its subtypes in Iranian postmenopausal women.

METHODS

This cross-sectional study was conducted on 393 postmenopausal women who attended health centers in the south of Tehran, Iran. The DII score was calculated using dietary factors obtained by a validated food frequency questionnaire. DED was defined as average daily energy intake (kcal) per gram of food. The Menopause Rating Scale questionnaire was used to evaluate the menopausal symptoms. The total Menopause Rating Scale score (TMRSS) was the sum of the somatic score (SS), psychological score (PS), and urogenital score. Linear regression analysis was used to assess the association of the DII score and DED with menopausal symptoms.

RESULTS

After adjusting for covariates, participants in the highest tertile of DII score had greater SS compared to those in the lowest tertile (βDIIt3vs1= 0.032, 95% confidence interval (CI): 0.004-0.068, P = 0.04). No significant relationship was found between DII score and PS, urogenital score or TMRSS. Furthermore, higher DED was associated with greater SS (βDIIt3vs1 = 0.071, 95% CI: 0.028-0.115, P = 0.001), PS (βDIIt3vs1 = 0.065, 95% CI: 0.012-0.121, P = 0.01) and TMRSS (βDIIt3vs1 = 0.053, 95% CI: 0.017-0.088, P = 0.004).

CONCLUSION

A proinflammatory diet was associated with higher menopause-specific somatic symptoms and higher DED was positively associated with menopausal symptoms.

The relationship between dietary patterns, dietary quality index, and dietary inflammatory index with the risk of all types of cancer: Golestan cohort study

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.

The Association between Dietary Inflammatory Potential and Gastric Cancer: A Case Control Study

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.

Hybrid Dietary-Blood Inflammatory Profiles and Postmenopausal Breast Cancer: A Case-Control Study

The carcinogenesis process is associated with inflammation, which can be modified by diet. There is limited evidence regarding the inflammatory status and diet in association with breast cancer (BC). The aim of this study was to investigate the association of hybrid dietary-blood inflammatory profiles (HD-BIPs) with postmenopausal breast cancer occurrence. The case-control study was conducted among 420 women (230 controls, 190 primary BC cases) aged 40–79 years from north-eastern Poland. Blood levels of C-reactive protein (CRP), interleukin-6 (IL-6) and leukocyte count were marked in 129 postmenopausal women (82 controls, 47 cases). The 62-item food frequency questionnaire (FFQ-6) was used to the dietary data collection. Two HD-BIPs were found using the Principal Component Analysis (PCA). The “Pro-healthy/Neutral-inflammatory” profile was characterized by the frequent consumption of wholemeal cereals/coarse groats, legumes, vegetables, fruits, nuts/seeds and fish. The “Unhealthy/Pro-inflammatory” profile was characterized by the frequent consumption of red/processed meats, animal fats, sugar/honey/sweets, refined cereals/fine groats, and an increased concentration of CRP, IL-6 and granulocyte-to-lymphocyte ratio. The lower odds ratio (OR) of breast cancer was associated with the higher adherence to the “Pro-healthy/Neutral-inflammatory” profile (OR = 0.38; 95% Cl: 0.18–0.80; p < 0.01 for the higher level vs. lower level, crude model; OR for one-point score increment: 0.61; 95% Cl: 0.42–0.87; p < 0.01, adjusted model). The higher OR of breast cancer was associated with the higher adherence to the “Unhealthy/Pro-inflammatory” profile (OR = 3.07; 95%Cl: 1.27–7.44; p < 0.05 for the higher level v.s. lower level, adjusted model; OR for one-point score increment: 1.18; 95%Cl: 1.02–1.36; p < 0.05, adjusted model). This study revealed that the consumption of highly processed, high in sugar and animal fat foods should be avoided because this unhealthy diet was positively associated with postmenopausal breast cancer occurrence through its pro-inflammatory potential. Instead, the frequent consumption of low-processed plant foods and fish should be recommended since this pro-healthy diet was inversely associated with the cancer occurrence even though its anti-inflammatory potential has not been confirmed in this study sample.

D. Custódio I, Silva ATF, C. C. Ferreira I, C. Marinho E, C. Caixeta D, V. Souza A, R. Teixeira R, Araújo TG, Shivappa N, R. Hébert J, Paiva CE, S. Espíndola F, Goulart LR, C. P. Maia Y. Overweight Women with Breast Cancer on Chemotherapy Have More Unfavorable Inflammatory and Oxidative Stress Profiles

Chronic inflammation and redox imbalance are strongly influenced by diet and nutritional status, and both are risk factors for tumor development. This prospective study aimed to explore the associations between inflammatory and antioxidant markers and nutritional status in women with breast cancer undergoing chemotherapy. The women were evaluated at three times: T0, after the infusion of the first cycle; T1, after infusion of the intermediate cycle; and T2, after the infusion of the last chemotherapy cycle. The consumption of antioxidant nutrients and the Total Dietary Antioxidant Capacity reduced between T0 and T2 and the Dietary Inflammatory Index scores increased throughout the chemotherapy. Blood samples taken at the end of the chemotherapy showed lower levels of glutathione reductase and reduced glutathione, with greater quantification of the transcripts for Interleukin-6 and Tumor Necrosis Factor α. It should be emphasized that the Total Dietary Antioxidant Capacity is lower and the Dietary Inflammatory Index is higher in the group of overweight patients at the end of the follow-up, besides showing lower levels of the redox status, especially the plasma levels of glutathione reductase (p = 0.039). In addition, trends towards higher transcriptional levels of cytokines in peripheral blood were observed more often in overweight women than in non-overweight women. In this study of 55 women with breast cancer, nine (16%) with metastases, diet became more pro-inflammatory with fewer antioxidants during the chemotherapy. Briefly, we have shown that chemotherapy is critical for high-risk overweight women due to their reduced intake of antioxidant nutrients, generating greater inflammatory and oxidative stress profiles, suggesting the adoption of healthier dietary practices by women with breast cancer throughout their chemotherapy.

The Inflammatory Potential of Diet is Associated with Breast Cancer Risk in Urban Argentina: A Multilevel Analysis

Dietary patterns have been associated with breast cancer (BC) in Argentina. However, little evidence exists relating the inflammatory potential of diet and BC in Latin American countries and how this may relate to rurality.The aim of the present study was to evaluate the association between the Dietary Inflammatory Index (DII^®) and BC considering urbanization contexts in Córdoba, Argentina.A frequency-matched case-control study (317 BC cases, 526 controls) was conducted from 2008 through 2016. DII scores were computed based on dietary intake assessed by a validated food frequency questionnaire. Multi-level logistic regression models were fit to evaluate the association between DII and BC, following adjustment for age, body mass index, age at menarche, number of children, smoking habits, socio-economic status and family history of BC as first-level covariates and urbanization level as the contextual variable.Increasing DII score showed significant positive associations with BC risk (OR_{tertile3vs.tertile1} 1.34; 95%CI 1.05, 1.70). The association was stronger in overweight and obese women (OR_{tertile3vs.tertile1} 1.98; 95%CI 1.86, 2.10). The DII effect on BC was higher with increased urbanization.A pro-inflammatory diet, reflected by higher DII scores, was positively associated with BC, especially in overweight women and with increased urbanization.

Deep frying cooking oils promote the high risk of metastases in the breast-A critical review

Deep-frying is the most common food preparation method, manifestations of color, taste, flavor, and fried consistency. The beneficial role of vegetable oils become deteriorate when repeatedly treated with higher temperature and air. Repeatedly heated cooking oils (RCO) produce various byproducts, containing polycyclic aromatic hydrocarbons (PAHs) and aldehydes, well-known to be a carcinogenic, mutagenic, and tumorigenic properties. RCO is nowadays one of the often consumed media for cooking and frying, which intake can cause various unhealthy adverse effects including various cancer in the multiple organs. Hence, the present comprehensive study targets to provide the intake of RCO elevate the risks of human breast cancer. The data on RCO and its impacts were obtained via various electronic findings and library databases. Notable studies have confirmed that the effects of RCO have been attributed to their unfavorable effects, and underlying molecular mechanisms can also strongly promoting tumorigenic effects in the mammary organ.

The impact of a randomized dietary and physical activity intervention on chronic inflammation among obese African-American women

Lifestyle interventions may reduce inflammation and lower breast cancer (BrCa) risk. This randomized trial assessed the impact of the Sistas Inspiring Sistas Through Activity and Support (SISTAS) study on plasma C-reactive protein (CRP), interleukin-6 (IL-6) and Dietary Inflammatory Index (DII). This unblinded, dietary and physical activity trial was implemented in 337 obese (body mass index [BMI] ≥30 kg/m²) African American (AA) women recruited between 2011 and 2015 in South Carolina through a community-based participatory approach with measurements at baseline, 3 months, and 12 months. Participants were randomized into either intervention (n = 176) or wait-list control group (n = 161). Linear mixed-effect models were used for analyses of CRP and IL-6. Baseline CRP was significantly higher in those with greater obesity, body fat percentage, and waist circumference (all p <.01). No difference was observed between groups for CRP or IL-6 at 3 or 12 months; however, improvements in diet were observed in the intervention group compared to the control group (p = .02) at 3 months but were not sustained at 12 months. Although the intervention was not successful at reducing levels of CRP or IL-6, a significant decrease was observed in DII score for the intervention group, indicating short-term positive dietary change.

A Higher Dietary Inflammatory Index Score is Associated with a Higher Risk of Incidence and Mortality of Cancer: A Comprehensive Systematic Review and Meta-Analysis

Background:

Inflamation is widely known as an adaptive pathophysiological response in a variety of cancers. There is an expanding body of research on the key role of diet in inflammation, a risk factor for all types of cancer. Dietary inflammatory index (DII) was recently develpoed to evalute the inflammatory potential of a diet either as anti-inflammatory or pro-inflammatory. In fact, several studies have shown the association of DII and risk of different cancer types. The aim of this meta-analysis was to investigate the association of DII with risk of incidence and mortality of any cancer types.

Methods:

We searched PubMed-Medline, Scopus, and Web of Science databases for pertient studies util January, 2017. All studies conducted to investigate the association of DII and incidence, mortality, and hospitalization of all cancer types were included. According to degree of heterogeneity, fixed- or random-effect model was employed by STATA software.

Results:

Total 38 studies were eligible for the meta-analysis. The results show that a higher level of DII increases the risk for all cancer types incidence by 32% (OR: 1.32; 95% CI: 1.22-1.42) including digestive tract cancers (OR: 1.55; 95% CI: 1.33-1.78), hormone-dependent cancers (OR: 1.14; 95% CI: 1.04-1.24), respiratory tract cancers (OR: 1.64; 95% CI: 1.11-2.17), and urothelial cancers (OR: 1.36; 95% CI: 1.01-1.73). Moreover, a higher level of DII is in association with a higher risk for mortality caused by all types of cancer by 16% (OR: 1.16; 95% CI: 1.01-1.32). In addition, meta-regression analysis reveals that the design of study can have a significant effect on the association of DII and incidence of all cancer types (slope: 0.54; P= 0.05). The stratified meta-analysis shows that the association of DII and incidence of all cancer types in case-control studies (OR: 1.53; 95% CI: 1.36-1.71) were more prominent than cohort studies (OR: 1.18; 95% CI: 1.07-1.30).

Conclusions:

This study shows that a higher level of DII is associated with a higher risk of incidence and mortality of all cancer types. The findings of the present study suggest that modifying inflammatory properties of dietary patterns can reduce the risk of incidence and mortality of all cancer types.

Higher Dietary Inflammatory Index Scores are Associated with Increased Odds of Benign Breast Diseases in a Case-Control Study

Purpose

Dietary inflammatory index (DII) is a new tool for assessing the inflammatory potential of diet. Since there is no study that has investigated the association of DII and benign breast diseases (BBD), the aim of our study was to compare DII scores in patients with and without BBD.

Methods

One hundred and eleven (111) subjects with BBD and 104 healthy women attending the Iranian Center for Breast Cancer affiliated with the Academic Center for Education, Culture and Research were enrolled in a case–control study. Dietary data collected using a 168‑item validated food frequency questionnaire (FFQ). Energy-adjusted DII was calculated based on FFQ. Socio demographic data were collected by interview. In addition, physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Weight, height and waist circumference were also measured.

Results

After adjustment for multiple confounding variables, participants at the highest tertile of DII had increased OR for BBD (OR=1.7, 95% CI=0.75–3.95) (P-trend =0.04).

Conclusion

The increased chance of BBD was suggested with a higher consumption of diets with inflammatory potential. However, this result should be interpreted with caution as OR was not statistically significant. Interventional studies are warranted to elucidate the role of inflammatory diets in the development of BBD.

Dietary Inflammatory Index and Risk of Breast Cancer Based on Hormone Receptor Status: A Case-Control Study in Korea

Breast cancer is the most common cancer in women globally, and the risk of developing breast cancer is associated with inflammation. The present study aimed to examine the association between the Dietary Inflammatory Index (DII^®) and breast cancer in Korean women and investigate whether the tumor’s hormone receptor status affects this association. In this case-control study, we enrolled 364 breast cancer patients and 364 age-matched controls. DII scores were calculated from dietary intake evaluated by a 106-item food frequency questionnaire. The DII score was significantly higher in cases than in controls. After adjusting for potential confounders, the odds ratio (OR) of breast cancer was higher in the highest DII tertile (OR = 3.68, 95% confidence interval (CI): 2.34–5.80, p for trend < 0.0001) than in the lowest tertile. We found that higher DII scores were related to an increased risk of breast cancer for estrogen receptor (ER)+/progesterone receptor (PR)+ tumors regardless of menopausal status (OR = 2.59, 95% CI: 1.37–4.88 in the highest DII category, p for trend = 0.01 for premenopausal women; OR = 11.00, 95% CI: 2.93–41.30 in the highest DII category, p for trend = 0.0004 for postmenopausal women), but not for ER−/PR− status. Our results suggested that the DII scores are positively associated with breast cancer risk in Korean women and that this relationship is more robust in ER+/PR+ tumors.

Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review

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.

Dietary Inflammatory Index, Dietary Non-Enzymatic Antioxidant Capacity, and Colorectal and Breast Cancer Risk (MCC-Spain Study)

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.

Dietary inflammatory index and risk of gynecological cancers: a systematic review and meta-analysis of observational studies

OBJECTIVE

There has been growing body of literatures showing that chronic inflammation might play an important role in cancer development. This meta-analysis aimed to assess the association between the dietary inflammation index (DII) score and gynecological cancers.

METHODS

A systematic search of PubMed, EMBASE and Web of Science up until October 20, 2018 was carried out to retrieve all related cohort and case-control studies. The summary risk assessments were pooled using random-effects models. The dose-response relationship was estimated by linear relationship model.

RESULTS

Twelve case-control studies (10,774 cases/15,958 controls) and six prospective cohort studies (330,363 participants/23,133 incident cases) were included in this meta-analysis. The pooled adjusted relative risk (RR) of gynecological cancers for the highest DII category compared to the lowest category was 1.38, (95% confidence intervals [CIs], 1.21-1.56, p<0.001]. A positive dose-response relationship was also noticed. Stratified by study design indicated that, the pooled RRs was significantly higher for case-control studies than cohort studies (p for interaction<0.001), for studies conducted among participants with body mass index (BMI) ≥25 kg/m² than participants with BMI <25 kg/m² (p for interaction=0.026), among participants with ovarian cancer and endometrial cancer than participants with breast cancer (p for interaction = 0.038). Meta-regression analysis further confirmed that study design significantly contributed to inter-study heterogeneity (p<0.001).

CONCLUSION

This meta-analysis suggests that elevated DII is independently associated with a higher risk of gynecological cancers, especially patients with ovarian cancer and endometrial cancer and among obese participants.

The inflammatory potential of diet in determining cancer risk; A prospective investigation of two dietary pattern scores

Purpose

Inflammation-related mechanisms may contribute to the link between diet and cancer. We sought to investigate the inflammatory impact of diet on cancer risk using the Dietary inflammatory index (DII) and an adapted Mediterranean diet score (MDS).

Methods

This population-based, prospective cohort study used self-reported dietary data from the Västerbotten Intervention Programme, including 100,881 participants, of whom 35,393 had repeated measures. Associations between dietary patterns and cancer risk were evaluated using Cox proportional hazards regression. We also used restricted cubic splines to test for potential non-linear associations.

Results

A total of 9,250 incident cancer cases were diagnosed during a median follow-up of 15 years. The two dietary patterns were moderately correlated to each other and had similar associations with cancer risk, predominantly lung cancer in men (DII per tertile decrease: Hazard ratio (HR) 0.81 (0.66–0.99), MDS per tertile increase: HR 0.86 (0.72–1.03)), and gastric cancer in men (DII: 0.73 (0.53–0.99), MDS: 0.73 (0.56–0.96)). Associations were, in general, found to be linear. We found no longitudinal association between 10-year change in diet and cancer risk.

Conclusion

We confirm small, but consistent and statistically significant associations between a more anti-inflammatory or healthier diet and reduced risk of cancer, including a lower risk of lung and gastric cancer in men. The dietary indexes produced similar associations with respect to the risk of cancer.

Association between the dietary inflammatory index and the incidence of cancer: a systematic review and meta-analysis of prospective studies

OBJECTIVE

Although many risk factors for cancers have been well defined, the effects of dietary inflammation have remained controversial. We aimed to summarize the association between the dietary inflammatory index (DII) and the risk of cancer.

STUDY DESIGN

A systematic review and meta-analysis on prospective studies.

METHODS

Electronic databases including PubMed/MEDLINE, Scopus, and Web of Science were searched to find relevant articles published in English up to February 2017. Prospective studies that reported the relative risk (RR) or hazard ratio for the most pro-inflammatory vs the most anti-inflammatory diets and cancer were included. Random effects model was used to pool the effect sizes.

RESULTS

Finally, 11 effect sizes from 10 prospective studies were included. Findings indicated that the most pro-inflammatory vs the most anti-inflammatory diets were significantly associated with an increased risk for total cancer (overall RR: 1.17; 95% confidence interval [CI]: 1.09-1.26) with a substantial heterogeneity (I²: 85.5%, P < 0.001). Subgroup analysis revealed that the association between DII and breast cancer was 1.04 (95% CI: 1.02, 1.07; I²:0%; P = 0.66), while it was 1.26 (95% CI: 1.17, 1.36; I² = 58.1%; P = 0.03) for colorectal cancer.

CONCLUSIONS

Although the findings of the current meta-analysis support the hypothesis that diets with high pro-inflammatory components can increase the risk of cancer, the heterogeneity was high. Therefore, further studies are required to clarify this association.

Dietary inflammatory index and incidence of breast cancer in the SUN project

BACKGROUND & AIMS

Breast cancer (BC) is the most commonly diagnosed cancer, and diet is suspected to play a role in its development. Dietary factors may mediate this process through modulation of inflammation, though findings from previous studies have not been consistent. We aimed to longitudinally assess the association between the dietary inflammatory index (DII^®), a frequently used method to assess the inflammatory potential of the diet, and incident BC.

METHODS

We included 10,713 middle-aged, Spanish female university graduates from the SUN cohort. DII^® scores were derived from a validated 136-item food-frequency questionnaire, and it was based on scientific evidence on the relationship between diet and inflammatory biomarkers. Diagnosis of BC was reported by the participant or, if deceased, by the next of kin or identified from death certificates. Self-reports of BC were confirmed by revision of medical reports by an experienced oncologist. Cox proportional hazard models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between quartiles of DII^® and incident BC.

RESULTS

After 10.3 years of median follow-up, we identified 100 confirmed and 168 probable incident BC cases. The multivariable-adjusted HR for participants in the 4th quartile to the 1st quartile was 1.44 (95% CI 0.76-2.72; p-trend: 0.339) when confirmed cases were analyzed, and 1.20 (95% CI 0.72-1.99; p-trend: 0.757) for the probable cases. We neither observed statistically significant differences in regard to menopausal status.

CONCLUSIONS

The apparent increase in risk between DII^® scores and BC in our cohort was not statistically significant, which could be partly explained by the small number of observed cases.

Association between inflammatory potential of diet and risk of lung cancer among smokers in a prospective study in Singapore

BACKGROUND

Diet and inflammation have been suggested to be important risk factors for lung cancer. We examined the ability of the dietary inflammatory index (DII^®) to predict lung cancer in the Singapore Chinese Health Study (SCHS). The DII is a diet quality index based on the literature linking foods and nutrients with inflammatory biomarkers.

PATIENTS AND METHODS

Using data from the SCHS for 60,232 participants, including 1851 lung cancer cases, we investigated the associations of baseline DII scores calculated from a food frequency questionnaire with risk of developing lung cancer over an average of 17.6 years of follow-up. Hazard ratios (HR) were estimated using Cox regression, adjusting for smoking status and other risk factors.

RESULTS

After excluding cancers diagnosed in the first 2 years of follow-up, the DII was non-significantly associated with risk of lung cancer (HR_Q5vsQ1 = 1.13; 95% CI 0.94-1.35; P-trend = 0.24) after adjusting for age, dialect group, sex, interview year, education, body mass index, total calorie intake, physical activity and various smoking variables. In stratified analysis, stronger, statistically significant associations were evident in current smokers (HR 1.44; 95% CI 1.11-1.86; P_trend = 0.03, P for interaction = 0.003) and in male ever-smokers (HR_Q5vsQ1 = 1.37; 95% CI 1.07-1.77; P-trend = 0.03).

CONCLUSION

A pro-inflammatory diet, as shown by higher DII scores, is associated with an elevated risk of lung cancer for subjects with a history of smoking. Public health measures should be adopted to promote consumption of a healthy, anti-inflammatory diet to reduce the risk of lung cancer, especially in current and former smokers.

Dietary Inflammatory Index and Odds of Breast Cancer in a Case-Control Study from Iran

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 (OR_{quartile 4 vs. 1} = 2.64, 95% CI: 1.12-6.25; P_trend = 0.01). In subanalysis based on menopausal status, a positive association was observed between the DII and BrCa risk among premenopausal women (OR_{quartile 4 vs. 1} = 5.51, 95% CI: 1.45-20.93; P_trend = 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.

Association between the Dietary Inflammatory Index and Risk for Cancer Recurrence and Mortality among Patients with Breast Cancer

The dietary inflammatory index (DII) has been associated with breast cancer incidence and survival. However, the association between DII and cancer recurrence and mortality among patients with breast cancer has not been investigated. Therefore, the present study aimed to investigate whether DII was positively associated with risk for cancer recurrence and overall mortality among patients with breast cancer. Among 511 women (51.9 ± 10.7 years; stage 0⁻3) who underwent breast cancer surgery, 88 had cancer recurrence, and 44 died during follow⁻up until 213 months (average disease free survival of 84.3 ± 42.4 months and overall survival of 69.3 ± 38.9 months). The DII assessed after surgery (5.4 ± 5.2 months after diagnosis) was significantly higher in patients with recurrence than those without recurrence, and Cox proportional hazards regression analysis showed that it was positively associated with the risk for cancer recurrence (hazard ratio (HR) 2.347, confidence interval (CI) 1.17⁻4.71) and overall mortality (HR 3.049, CI 1.08⁻8.83) after adjusting for confounding factors. Disease-free survival and overall survival rates were significantly lower in patients with higher DII scores. In addition, the DII was positively associated with the risk for cancer recurrence according to prognostic factors, such as age (<50 years), premenopausal status, body mass index (≥25 kg/m²), HR+, tumor size (>2 cm), and presence of lymph node metastasis. The present study showed that anti-inflammatory diets may decrease the risk of cancer recurrence and overall mortality in patients with breast cancer, particularly those with prognostic factors, such as younger age, premenopausal status, obesity, HR+ breast cancer, tumor size >2 cm, and presence of lymph node metastasis.

Dietary Inflammatory Index and Site-Specific Cancer Risk: A Systematic Review and Dose-Response Meta-Analysis

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.

Association between Dietary Inflammatory Index (DII) and Risk of Breast Cancer: a Case-Control Study

Background:

Breast cancer (BrCa) is the most common cancer among women worldwide and is the second leading cause of cancer-related death in women, in developed countries. This cancer is among the top five most common cancers in Iran. Studies have shown that dietary components are implicated in the etiology of BrCa. The existence of molecular connections between inflammation and BrCa has been demonstrated via different bimolecular events.

Methods:

We examined the ability of the dietary inflammatory index (DIITM) to predict the risk of BrCa. This included 145 cases and 148 controls, who attended the specialized centers. DII scores were computed based on dietary intake assessed using a 168-item FFQ. Logistic regression models were used to estimate multivariable ORs.

Results:

Modeling DII as a continuous variable in relation to risk of BrCa showed a positive association after adjustment for age and energy (OR=1.76; 95% CI=1.43-2.18); and were nearly identical in the multivariable analyses (OR=1.80; 95% CI=1.42-2.28). DII as tertiles, and adjusting for age and energy, subjects in tertile 3 had an OR of 6.94 (95% CI= 3.26-14.79; P-trend ≤0.0001) in comparison to subjects in tertile 1. After multivariable adjustment, results were essentially identical as in the model adjusting for age and energy (OR tertile 3vs1=7.24; 95% CI=3.14-16.68; P-trend ≤0.001). Sub group analyses revealed similar positive associations with HER 2 receptor +ve, progesterone receptor +ve, estrogen receptor +ve and lymph node invasive cases.

Conclusion:

Subjects who consumed a more pro-inflammatory diet were at increased risk of BrCa compared to those who consumed a more anti-inflammatory diet.

Associations between dietary inflammatory index and incidence of breast and prostate cancer: a systematic review and meta-analysis

OBJECTIVES

Dietary inflammatory index (DII) scores have been inconsistently linked to cancer risks. Therefore, a systematic review and meta-analysis was performed to examine the associations between the DII and the risks of breast and prostate cancer among men and women.

METHODS

Relevant studies were identified by searching PubMed and EMBASE databases up to March 2018. Data were available from 13 studies; of these, four studies used a prospective cohort design and nine studies were case-control studies. A total of 231 947 individuals from nine countries were included in these studies for the meta-analysis. The results were pooled using a random-effects model.

RESULTS

A pooled, adjusted odds ratio (OR) analysis indicated that there was a direct relationship between the highest versus lowest DII scores and prostate cancer risk in men (OR: 1.31; 95% CI: 1.04-1.57) but not the breast cancer risk (BCR) in women (OR: 1.65; 95% CI: 0.96-2.33). In the subgroup analyses, a more significant association between DII score and increased BCR was noted in premenopausal (OR: 2.03; 95% CI: 1.06-3.00) than in postmenopausal women (OR: 1.52; 95% CI: 0.89-2.16). When the results were stratified by body mass index, a positive association was observed between DII score and increased BCR in women (OR: 1.83; 95% CI: 1.48-2.18). Furthermore, there was no significant association between the highest versus lowest DII score and BCR among women who received hormone therapy (OR: 1.29; 95% CI: 0.93-1.64).

CONCLUSIONS

Men and premenopausal women who exhibit higher DII scores have increased prostate and breast cancer incidence risks, respectively. Moreover, body mass index had positive associations with the relationship between DII score and BCR in women. Further prospective cohort studies with longer follow-up periods are needed to support this possible association between DII score and cancer incidence.

Meta-analysis of the association between the dietary inflammatory index (DII) and breast cancer risk

BACKGROUND

Recent studies have reported mixed results on the association between the pro-inflammatory dietary index and risk of breast cancer. We perform this comprehensive meta-analysis to figure out whether high dietary inflammatory index (DII) score is a risk factor for the occurrence of breast cancer.

METHODS

We comprehensively searched the PubMed, EMBASE and Cochrane databases to identify included studies updated to September 12, 2017. All studies that reported risk estimates by comparing the highest DII score to the lowest were assessed.

RESULTS

A total of seven observational studies were identified: three case controls and four cohorts, involving 319,993 participants. Overall, the meta-analysis reported that individuals with the highest DII score were associated with a 25% increased risk of breast cancer versus those with the lowest DII score (relative risk [RR] = 1.25; 95% confidence interval [CI] 1.09-1.44; I² = 82.7%, p = 0.000). Upon stratified analysis, significant positive associations remained for postmenopausal women (RR = 1.15; 95% CI 1.02-1.30; p = 0.020), case-control studies (RR = 1.68; 95% CI 1.13-2.49; p = 0.010), Asia (RR = 2.30; 95% CI 1.7-3.12; p = 0.0031) and Europe (RR = 1.26; 95% CI 1.01-1.58; p = 0.0477). When analysed on hormonal receptor status, 36% increased risk was explored for hormone-receptor negative.

CONCLUSION

This meta-analysis suggested that more pro-inflammatory diets (higher DII scores) are associated with increased breast cancer incidence. However, the research is not about significant associations but about moderate effect sizes.

A dietary pattern based on estrogen metabolism is associated with breast cancer risk in a prospective cohort of postmenopausal women

Increased exposure to estrogen is a risk factor for postmenopausal breast cancer, and dietary factors can influence estrogen metabolism. However, studies of diet and breast cancer have been inconclusive. We developed a dietary pattern associated with levels of unconjugated estradiol and the ratio of 2- and 16-hydroxylated estrogen metabolites in a subsample of Prostate, Lung, Colorectal and Ovarian Screening Trial (PLCO) participants (n = 653) using reduced rank regression, and examined its association with postmenopausal breast cancer prospectively in the larger PLCO cohort (n = 27,488). The estrogen-related dietary pattern (ERDP) was comprised of foods with positively-weighted intakes (non-whole/refined grains, tomatoes, cruciferous vegetables, cheese, fish/shellfish high in ω-3 fatty acids, franks/luncheon meats) and negatively-weighted intakes (nuts/seeds, other vegetables, fish/shellfish low in ω-3 fatty acids, yogurt, coffee). A 1-unit increase in the ERDP score was associated with an increase in total (HR: 1.09, 95% CI: 1.01-1.18), invasive (HR: 1.13; 95% CI: 1.04-1.24) and estrogen receptor (ER)-positive (HR: 1.13, 95% CI: 1.02-1.24) breast cancer risk after adjustment for confounders. Associations were observed for the fourth quartile of ERDP compared with the first quartile for overall breast cancer (HR: 1.14; 95% CI: 0.98-1.32), invasive cases (HR: 1.20, 95% CI: 1.02-1.42) and ER-positive cases (HR: 1.19; 95% CI: 0.99-1.41). The increased risk associated with increasing ERDP score was more apparent in strata of some effect modifiers (postmenopausal hormone therapy non-users and non-obese participants) where the relative estrogen exposure due to that factor was lowest, although the p values for interaction were not statistically significant. Results suggest a dietary pattern based on estrogen metabolism is positively associated with postmenopausal breast cancer risk, possibly through an estrogenic influence.

Dose-response relation between dietary inflammatory index and human cancer risk: evidence from 44 epidemiologic studies involving 1,082,092 participants

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.

Dietary Inflammatory Potential Score and Risk of Breast Cancer: Systematic Review and Meta-analysis

Several studies have been conducted on the relationship between dietary inflammatory potential (DIP) and breast cancer. However, the findings are conflicting. This systematic review and meta-analysis summarizes the findings on the association between DIP and the risk of breast cancer. We used relevant keywords and searched online international electronic databases, including PubMed and NLM Gateway (for Medline), Institute for Scientific Information (ISI), and Scopus for articles published through February 2017. All cross-sectional, case-control, and cohort studies were included in this meta-analysis. Meta-analysis was performed using the random effects meta-analysis method to address heterogeneity among studies. Findings were analyzed statistically. Nine studies were included in the present systematic review and meta-analysis. The total sample size of these studies was 296,102, and the number of participants varied from 1453 to 122,788. The random effects meta-analysis showed a positive and significant association between DIP and the risk of breast cancer (pooled odds ratio, 1.14; 95% confidence interval, 1.01-1.27). The pooled effect size was not statistically significant because of the type of studies, including cohort (pooled relative risk, 1.04; 95% confidence interval, 0.98-1.10) and case-control (pooled odds ratio, 1.63; 95% confidence interval, 0.89-2.37) studies. We found a significant and positive association between higher DIP score and risk of breast cancer. Modifying inflammatory characteristics of diet can substantially reduce the risk of breast cancer.

Ageing: from inflammation to cancer

Ageing is the major risk factor for cancer development. Hallmark of the ageing process is represented by inflammaging, which is a chronic and systemic low-grade inflammatory process. Inflammation is also a hallmark of cancer and is widely recognized to influence all cancer stages from cell transformation to metastasis. Therefore, inflammaging may represent the biological phenomena able to couple ageing process with cancer development. Here we review the molecular and cellular pathway involved in age-related chronic inflammation along with its potential triggers and their connection with cancer development.

Nutrition, inflammation and cancer

Quantitative and qualitative aspects of nutrition have a profound effect on leukocytes and thereby affect proinflammatory carcinogenic effects or anticancer immune responses. As a result, nutrition affects the incidence, natural progression and therapeutic response of malignant diseases, both in humans and in preclinical animal models. Here we discuss the molecular mechanisms through which alimentary cues modulate metabolic, microbial and neuroendocrine circuitries and thus affect the probability of developing premalignant lesions that progress to clinically manifested disease and the response to therapeutic intervention. We examine each of the connections that compose the triangle of nutrition, immunological and inflammatory reactions and cancer while focusing on the mechanistic aspects of these relationships.