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

Anti-Inflammatory Diet Index and risk of renal cell carcinoma

INTRODUCTION

A diet rich in fruits, vegetables, coffee, and tea, limited red meat, and moderate alcohol intake may reduce the risk of renal cell carcinoma (RCC). The anti-inflammatory potential of diet has been proposed as a mechanism influencing cancer risk. This study assessed the association between an anti-inflammatory diet and RCC risk.

METHODOLOGY

Data from two Swedish cohorts, the Swedish-Mammography-Cohort and the Cohort-of-Swedish-Men, were analysed. Dietary habits were assessed using a 96-item food frequency questionnaire. The Anti-Inflammatory Diet Index (AIDI), composed of 16 food groups (11 anti-inflammatory and 5 pro-inflammatory), was used to score dietary patterns. RCC cases were identified from the Swedish Cancer Register using ICD-10 codes, and Cox proportional hazards models were used to estimate hazard ratios based on AIDI quartiles.

RESULTS

Among 71,421 participants, 431 RCC cases were identified during a 19.7-year follow-up. Higher AIDI scores were associated with a lower RCC risk (HR for Q4 vs. Q1: 0.68, CI: 0.52-0.89). In sex-stratified analyses (p-for heterogeneity = 0.006), the association was stronger in among women (HR: 0.47, CI: 0.30-0.75) but less clear in among men (HR: 0.83, CI: 0.63-1.24).

CONCLUSION

These data suggest that adherence to an anti-inflammatory diet may confer a reduced risk for RCC, especially among women.

The association between the dietary inflammatory index during pregnancy and risk of gestational diabetes: a prospective cohort study and a meta-analysis

INTRODUCTION

To examine the association between dietary inflammatory index (DII) and risk of gestational diabetes mellitus (GDM).

METHODS

A prospective birth cohort study was conducted in Iran. During the first trimester of pregnancy, food intake was measured using a food frequency questionnaire. Each participant's DII score was calculated, and then, the Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% CI of GDM across the quartiles of DII. We systematically searched the literature to conduct a meta-analysis of observational studies (PROSPERO: CRD42022331703). To estimate the summary relative risk for the highest versus lowest category of DII, a random-effects meta-analysis was performed. The certainty of evidence was assessed using the GRADE approach.

RESULTS

In the prospective cohort study (n = 635 pregnant mothers), the multivariable HRs of GDM for the third and fourth quartiles of DII were 2.98 (95%CI: 1.98, 6.46) and 2.72 (95%CI: 1.11, 6.63), respectively. Based on a meta-analysis of six prospective cohorts and a case-control study (1014 cases of GDM in 7027 pregnant mothers), being in the highest category of the DII was associated with a 27% higher risk of GDM (relative risk: 1.27, 95%CI: 1.01, 1.59; I2 = 50%; low certainty of evidence). A dose-response meta-analysis suggested a positive monotonic association between DII and GDM risk.

CONCLUSIONS

Our prospective cohort demonstrated a positive correlation between GDM risk and the inflammatory potential of diet in the first trimester of pregnancy. The results need to be confirmed by larger cohort studies.

CLINICAL TRIAL NUMBER

Not applicable.

Dietary patterns and risk of multiple cancers: umbrella review of meta-analyses of prospective cohort studies

BACKGROUND

Numerous prospective cohort studies have investigated the influence of dietary patterns on the risks of various cancers, although the findings differed.

OBJECTIVES

To evaluate the associations of dietary patterns with risks of various cancers and assess the strength and validity of the evidence.

METHODS

Relevant articles were retrieved from the PubMed, EMBASE, Web of Science, and Cochrane library databases from inception to February 22, 2024. The included systematic reviews were meta-analyses of prospective cohort studies that reported an effect size to calculate the association between dietary patterns and cancer risk. The quality of the included studies was evaluated using a measurement tool to assess systematic reviews and the certainty of evidence was assessed using credibility assessment of evidence. Outcomes of interest included any incident cancers. This study was registered with PROSPERO (CRD42023425237).

RESULTS

Overall, 74 meta-analyses from 30 articles were identified. Three meta-analyses (4.1%) were graded as convincing evidence and included associations between adherence to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) dietary recommendations (per 1-unit score increase) and lower risk of all cancers (relative risk [RR] = 0.93, 95% confidence interval [CI]: 0.92, 0.95), whereas negative associations were found comparing the highest compared with lowest categories for a prudent diet (RR = 0.89, 95% CI: 0.85, 0.93) and vegetable-fruit-soybean diet (RR = 0.87, 95% CI: 0.83, 0.92) in relation to breast cancer. After credibility assessment of evidence by Grading of Recommendations, Assessment, Development, and Evaluation, 4 (5.4%) meta-analyses were classified as high, including adherence to the 2007 WCRF/AICR dietary recommendations and decreased risks of all cancers, breast cancer, colorectal cancer, and prostate cancer.

CONCLUSIONS

These findings suggest that adherence to certain healthy dietary patterns is associated with lower risk of all cancers and certain individual cancers. This study was registered at crd.york.ac.uk, PROSPERO as CRD42023425237 and /PROSPERO/display_record.php?RecordID=425237.

Plasma metabolomic signature of a proinflammatory diet in relation to breast cancer risk: a prospective cohort study

BACKGROUND

A proinflammatory diet has been linked to an increased risk of breast cancer. However, the underlying metabolic roles remain to be elucidated.

OBJECTIVES

This study aimed to investigate the metabolic mechanism between proinflammatory diet and breast cancer risk.

METHODS

This prospective study included 273,324 females from the UK Biobank. The dietary inflammatory potential was assessed via an energy-adjusted dietary inflammatory index (E-DII) based on a 24-h recall questionnaire. The plasma metabolome was profiled via high-throughput nuclear magnetic resonance spectroscopy. A metabolic signature was constructed by summing selected metabolite concentrations weighted by the coefficients via absolute shrinkage and selection operator analysis. Multivariate Cox regression was applied to assess the associations of the E-DII and metabolic signature with breast cancer risk.

RESULTS

We constructed a metabolic signature comprising 26 metabolites associated with a proinflammatory diet. These metabolites primarily included lipoproteins, amino acids, fatty acids, and ketone bodies. Both the E-DII and metabolic signature were positively associated with breast cancer risk [hazard ratio (HR) comparing the highest quintile with the lowest quintile: 1.17; 95% CI: 1.04, 1.32; and 1.21; 95% CI: 1.01, 1.46, respectively]. Furthermore, we found that saturated fatty acids to total fatty acids percentage and acetone concentration were positively associated (HR: 1.20; 95% CI: 1.04, 1.37; HR: 1.15; 95% CI: 1.01, 1.32, respectively), whereas the degree of unsaturation was inversely associated with breast cancer risk (HR: 0.86; 95% CI: 0.75, 0.99).

CONCLUSIONS

We identified a metabolic signature that reflects a proinflammatory diet and is associated with increased risk of breast cancer.

A prognostic nomogram for T3N0M0 esophageal squamous cell carcinoma patients undergoing radical surgery based on computed tomography radiomics and inflammatory nutritional biomarkers

BACKGROUND

This study explores the significance of computed tomography (CT) radiomic features, along with inflammation and nutrition biomarkers, in the prognosis of postoperative patients with T3N0M0 esophageal squamous cell carcinoma (ESCC). The study aims to construct a related nomogram.

METHODS

A total of 114 patients were enrolled and randomly assigned to training and validation cohorts in a 7:3 ratio. Radiomic features were extracted from their preoperative chest-enhanced CT arterial images of the primary tumor, and inflammatory and nutritional indices, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI), were calculated based on laboratory data from the 3 days before surgery. Intra-class correlations coefficient (ICC) and least absolute shrinkage and selection operator (Lasso) were applied to screen valuable radiomics features predicting overall survival (OS), and the Rad-score was calculated. In the training cohort, univariate and multivariate Cox regression analyses identified independent prognostic factors, which were adopted to establish the nomogram.

RESULTS

Eight radiomic features were selected for Rad-score calculation. Multivariate Cox regression revealed Rad-score, PNI, NLR, and PLR as independent prognostic factors for ESCC patients (p < 0.05). A nomogram was constructed based on these variables. The concordance index (C-index) for the nomogram was 0.797 (95% CI: 0.726-0.868) in the training cohort and 0.796 (95% CI: 0.702-0.890) in the validation cohort. Calibration curves indicated good calibration ability, and the receiver operating characteristic (ROC) analysis demonstrated superior discriminative ability for the nomogram in comparison to the Rad-score alone. Decision curve analysis (DCA) confirmed the clinical utility of the nomogram.

CONCLUSION

We developed and validated a nomogram for predicting the OS of postoperative T3N0M0 ESCC patients, integrating nutritional, inflammatory markers, and radiomic signature. The combined nomogram can serve as a robust tool for risk stratification and clinical management.

Higher dietary inflammatory index linked to increased risk of hypertension: a systematic review and dose-response meta-analysis

The relationship between dietary inflammation index (DII) and the risk of hypertension is inconsistent across published epidemiological studies. This meta-analysis aimed to investigate the dose-response relationship between DII score and the risk of hypertension. A systematic search for relevant studies was conducted in PubMed, Web of Science, and Embase databases until January 9, 2024. After data extraction, the summarized relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated using the Der Simonian and Laird random effect model, and dose-response analyses were performed using restricted cubic splines. A total of six studies with 120,294 participants and 36,725 cases of hypertension were included. The pooled relative risk (RR) for hypertension risk was 1.15 (95% CI: 1.06, 1.26) for the highest DII score compared with the lowest, and 1.10 (95% CI: 1.03, 1.18) for higher DII score compared with the lower. The dose-response meta-analysis further demonstrated a positive association between elevated DII scores and hypertension risk. For each one-unit increase in the DII score, the incidence of hypertension increased by 4% (RR = 1.04, 95% CI: 1.00, 1.07). Pro-inflammation dietary increases the risk of hypertension. Therefore, reducing pro-inflammatory components in the diet may be beneficial for the prevention and control of hypertension.

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

Background/aim

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

Methods

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

Results

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

Conclusion

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

Systematic review registration

PROSPERO registration no. CRD42024496912.

Association between dietary inflammatory index and all-cause mortality in US adults with dermatitis: a population-based cohort study

Background

While dermatitis management is primarily symptomatic, the role of diet in symptom exacerbation and improvement is increasingly recognized. The dietary inflammatory index (DII), a quantitative assessment tool for dietary inflammatory potential, has been associated with various chronic diseases but remains understudied in dermatitis. This cohort study investigated the association between DII scores and all-cause mortality among patients with dermatitis.

Methods

The study included 1,074 patients with dermatitis and complete dietary intake records from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. The DII scores were calculated using two 24-h dietary recalls and dietary supplement intakes and the consumption of 28 foods with known pro- or anti-inflammatory properties. All-cause mortality information was from the National Death Index, censored on December 31, 2019. Multivariable Cox hazards regression models, restricted cubic spline (RCS) models, and subgroup analyses were employed to evaluate the association of DII with all-cause mortality, adjusting for potential confounders.

Results

The 1,074 patients were divided into DII tertiles (T1: n = 358, median age 40 years, DII -3.91, 0.06; T2: n = 296, median age 40 years, DII 0.06, 1.88; T3: n = 237, median age 39 years, DII 1.88, 4.39). The study revealed a positive correlation between higher DII scores and increased all-cause mortality risk among patients with dermatitis (fully-adjusted model, HR = 1.13, 95% CI 1.02, 1.27, p = 0.026). This association was more pronounced in adults over 45 years, with the highest DII tertile indicating a 2.42-fold increased mortality risk (95% CI 1.15, 5.07, p = 0.019) compared with the lowest tertile. The RCS model confirmed a linear dose-response trend (p for non-linear = 0.183), validating the relationship.

Conclusion

Elevated DII scores are associated with an increased risk of all-cause mortality in patients with dermatitis, suggesting that the dietary inflammatory potential may impact health outcomes in this population. The findings underscore the importance of dietary interventions in dermatitis management, especially for middle-aged and older adults. Future research with larger cohorts and a longer follow-up is warranted to validate the findings.

Dietary inflammatory index after liver transplantation: Associated effects and long-term outcomes

BACKGROUND & AIMS

We examined the dietary inflammatory potential in patients who underwent liver transplantation (LTx), associated factors and its relationship with clinical outcomes ten years after the initial evaluation.

METHODS

Dietary Inflammatory Index (DII®) scores were generated from data derived from the 24-h recall in 108 patients.

RESULTS

Patients with higher DII scores (highest tertile), indicating a pro-inflammatory diet, had significantly higher serum LDL cholesterol (108.0 vs 78.2 mg/dL, p = <0.01) at the initial evaluation. However, DII scores did not significantly predict the occurrence of clinical outcomes after ten years of follow-up. Patient age was predictive of neoplasia (OR:1.05 95% CI:1.00-1.11; p = 0.03). Higher BMI at the initial evaluation was associated with steatosis (OR:1.51; 95% CI:1.29-1.77; p < 0.01), and smoking history was associated with the occurrence of cardiovascular events (OR:7.71; 95% CI:1.53-38.79; p = 0.01).

CONCLUSIONS

A pro-inflammatory diet was associated with higher serum LDL cholesterol in the initial evaluation but may not be strongly related to clinical outcomes during long-term follow-up.

Dietary Inflammatory Index and Magnetic Resonance Imaging-Detected Knee Structural Change and Pain: A 10.7-Year Follow-up Study

OBJECTIVE

To determine whether the dietary inflammatory index (DII) scores were associated with knee structural changes and pain over a 10.7-year follow-up.

METHODS

This study used data from a prospective population-based cohort study (mean age 63 years, 51% female) in which 1,099, 875, 768, and 566 participants completed assessments at baseline, 2.6, 5.1, and 10.7 years, respectively. T1-weighted and T2-weighted magnetic resonance imaging was performed to measure cartilage volume (CV) and bone marrow lesions (BMLs) at baseline and 10.7 years. The Western Ontario and McMaster Universities Osteoarthritis Index pain questionnaire was used to measure knee pain at each visit. Pain trajectories ("minimal pain," "mild pain," and "moderate pain") were previously identified. Baseline energy-adjusted DII (E-DII) scores were calculated. Linear, log-binomial regression, linear mixed-effects modeling, and multi-nominal logistic regression were used for analyses.

RESULTS

The mean ± SD E-DII score at baseline was -0.48 ± 1.39. In multivariable analyses, higher E-DII scores were not associated with tibial CV loss or BML size increase except for medial tibial BML size increase. Higher E-DII scores were associated with a higher pain score (β = 0.21; 95% confidence interval [CI] 0.004-0.43) and an increased risk of belonging to the "moderate pain" compared to the "minimal pain" trajectory group (relative risk ratio 1.19; 95% CI 1.02-1.39).

CONCLUSION

A proinflammatory diet, as indicated by a higher DII score, may be associated with a greater pain score and higher risk of more severe pain trajectory over 10 years. However, inconsistent findings related to structural changes suggest a discordance between the potential impact of diet on structural damage and pain in knee OA.

Inflammation and cancer: friend or foe?

Chronic inflammation plays a crucial role in the onset and progression of pathologies like neurodegenerative and cardiovascular diseases, diabetes, and cancer, since tumor development and chronic inflammation are linked, sharing common signaling pathways. At least 20% of breast and colorectal cancers are associated with chronic inflammation triggered by infections, irritants, or autoimmune diseases. Obesity, chronic inflammation, and cancer interconnection underscore the importance of population-based interventions in maintaining healthy body weight, to disrupt this axis. Given that the dietary inflammatory index is correlated with an increased risk of cancer, adopting an anti-inflammatory diet supplemented with nutraceuticals may be useful for cancer prevention. Natural products and their derivatives offer promising antitumor activity with favorable adverse effect profiles; however, the development of natural bioactive drugs is challenging due to their variability and complexity, requiring rigorous research processes. It has been shown that combining anti-inflammatory products, such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and statins, with plant-derived products demonstrate clinical utility as accessible adjuvants to traditional therapeutic approaches, with known safety profiles. Pharmacological approaches targeting multiple proteins involved in inflammation and cancer pathogenesis emerge as a particularly promising option. Given the systemic and multifactorial nature of inflammation, comprehensive strategies are essential for long term success in cancer therapy. To gain insights into carcinogenic phenomena and discover diagnostic or clinically relevant biomarkers, is pivotal to understand genetic variability, environmental exposure, dietary habits, and TME composition, to establish therapeutic approaches based on molecular and genetic analysis. Furthermore, the use of endocannabinoid, cannabinoid, and prostamide-type compounds as potential therapeutic targets or biomarkers requires further investigation. This review aims to elucidate the role of specific etiological agents and mediators contributing to persistent inflammatory reactions in tumor development. It explores potential therapeutic strategies for cancer treatment, emphasizing the urgent need for cost-effective approaches to address cancer-associated inflammation.

Association between dietary inflammation index and cataract: a population-based study from NHANES 2005-2008

Importance

Various studies have widely explored the association between index of dietary inflammation (DII) and occurrence of diseases. Accumulating evidence have revealed that a lower DII seems to be protective against a variety of diseases. Nevertheless, the association between DII and age-related cataract remains unclear.

Objective

To investigate the correlation between DII and age-related cataract in a representative sample of the American population.

Design setting and participants

This cross-sectional population-based study comprised 6,395 participants from the National Health and Nutrition Examination Survey (NHANES) conducted in cycles from 2005 to 2008. DII was calculated using dietary recall information, with higher scores indicating greater inflammatory potential of the diet. Age-related cataract was evaluated using cataract surgery as a surrogate measure. Covariates included sociodemographic factors, lifestyle factors, physical measures, and comorbidities. Logistic regression models were employed to assess the association between DII and cataract. The presence of a non-linear relationship was examined using restricted cubic spline analysis. Subgroup analysis was conducted to explore potential interaction effects. Data analysis was performed from September 1 to December 30, 2022.

Main outcomes and measures

Age-related cataract assessed through cataract surgery information obtained from a self-reported questionnaire.

Results

A total of 6,395 participants were included, with a mean (standard deviation, SD) age of 48.7 (15.3) years. Of these, 3,115 (48.7%) were male, 3,333 (52.1%) were non-Hispanic white, and 683 (10.7%) had cataract. The mean (SD) DII was -4.78 (1.74). After adjusting for all included covariates, DII showed a positive association with cataract, both as a continuous variable (odds ratio (OR): 1.054, 95% confidence interval (CI): 1.007-1.103, p = 0.023) and in quartiles, with the highest quartile compared to the lowest (OR: 1.555, 95% CI: 1.233-1.967, p < 0.001). Restricted cubic spline analysis revealed no evidence of a non-linear relationship (p for non-linearity 0.085). Subgroup analysis indicated no interaction effects among the studied covariates.

Conclusions and relevance

These findings suggest that a pro-inflammatory diet serves as a risk factor for the occurrence of cataracts.

Association between the dietary inflammatory index and all-cause mortality in the U.S. cancer survivors: A prospective cohort study using the National Health and Nutrition Examination Survey database

Background

Cancer remains one of the leading causes of mortality worldwide. Diet can impact inflammation and consequently affect cancer outcomes. The Dietary Inflammatory Index (DII) can serve as a tool to assess the inflammatory potential of cancer survivors' diets and further predict their survival.

Objectives

To investigate the relationship between the DII and the survival of cancer survivors in National Health and Nutrition Examination Survey (NHANES).

Methods

An overall sample of 2359 U.S. cancer survivors from the 2005-2014 cohorts of the NHANES were studied. The DII scores were calculated using 28 dietary components and the mortality status was ascertained until December 31, 2015. Based on the multiple analyses, the relationship between DII and all-cause mortality was examined.

Results

The weighted mean age at baseline was 65.17 ± 14.46 years, 53.16 % were female and 71.30 % were non-Hispanic white. The average DII was 1.51 ± 1.97. After accounting for multiple covariates, positive associations were observed (P < 0.01). Based on Kaplan-Meier survival curves, their significant relationship remains same and the survival probability was decreased among the groups of anti-inflammatory diets (DII < 0) versus pro-inflammatory diets (DII ≥ 0) significantly (Log rank test; P = 0.03). Further analyses were conducted on subgroups and the results are still robust.

Conclusions

An elevated DII was associated with a rising mortality rate among cancer survivors. DII might serve as a potential inflammatory predictor of cancer mortality prognosis, as well as guide nutritional care and even clinical treatment of cancer survivors.

The association between dietary inflammation index and bone mineral density: results from the United States National Health and nutrition examination surveys

OBJECTIVE

To investigate the associations of dietary inflammation index (DII) with bone density and osteoporosis in different femoral areas.

METHODS

The study population was selected from the National Health and Nutrition Examination Survey (NHANES) with the exclusion criteria of age 18, pregnancy, or missing information on DII, femoral bone marrow density (BMD), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR), or had diseases which may influence systemic inflammation. DII was calculated based on the questionnaire interview of dietary recall within 24 h. Subjects' baseline characteristics were collected. The associations between DII and different femoral areas were analyzed.

RESULTS

After applying exclusion criteria, 10,312 participants were included in the study. Significant differences among DII tertiles were found in BMD or T scores (p < .001) of the femoral neck, the trochanter, the intertrochanter, and the total femur. High DII was associated with low BMDs and T scores in all the femoral areas (all p < .01). Compared to low DII (tertile1, DII < 0.380 as reference), in the femoral neck, the intertrochanter, and the total femur, increased DII is independently associated with increased the possibility of the presence of osteoporosis (OR, 95% CI: 1.88, 1.11-3.20; 2.10, 1.05-4.20; 1.94, 1.02-3.69, respectively). However, this positive association was only observed in the trochanteric area of the non-Hispanic White population after full adjustment (OR, 95% CI: 3.22 (1.18, 8.79)). No significant difference in the association of DII and the presence of osteoporosis were found in subjects with or without impaired kidney function (eGFR < 60 ml/min/1.73 m²).

CONCLUSION

High DII is independently related to declined femoral BMD of femoral areas.

Pancreatic Ductal Adenocarcinoma and Nutrition: Exploring the Role of Diet and Gut Health

The incidence of pancreatic cancer is increasing worldwide. The most common form is represented by pancreatic ductal adenocarcinoma (PDAC) which has been shown to be linked to chronic inflammation. Notably, the gut microbiota has emerged as a critical player in regulating immune responses and inflammation. Indeed, intestinal dysbiosis, characterized by an imbalance in the gut microbiota composition, can contribute to the initiation of chronic inflammation. Sterile chronic inflammation can occur, probably activated by the translocation of bacterial components, such as lipopolysaccharide (LPS), the major component of Gram-negative microbiota, with the consequent induction of innate mucosal immunity, through the activation of Toll-like receptors (TLRs). Furthermore, the interaction between LPS and TLRs could enhance cancer progression. Recent research has shed light on the pivotal role of nutrition, as a modifiable risk factor, in PDAC immunological processes, particularly focusing on the immuno-modulatory effects of the gut microbiota. Different dietary regimens, fiber intake, immunonutrients, and antioxidants have the potential to either exacerbate or mitigate chronic inflammation, thereby influencing the pathogenesis and natural history of PDAC. These dietary components may affect the gut microbiota composition and, consequently, the level of inflammation, either promoting or protecting against PDAC. In this review of reviews, we discuss the modulatory role of nutrition and the gut microbiota in PDAC's immunological processes to explore a translational therapeutic approach that could improve the survival and quality of life of these patients.

Dose-Response Associations of Dietary Inflammatory Potential With Health Outcomes: A Prospective Cohort Study of 198,265 UK Biobank Participants

To investigate the dose-response associations of dietary inflammatory potential with all-cause mortality and incident cardiovascular disease (CVD) and cancer.

METHODS

This was a prospective cohort study of 198,265 UK Biobank participants who completed at least 1 dietary assessment. A web based 24 hours recall questionnaire was used to derive the energy-adjusted dietary inflammatory index (E-DII). All-cause mortality and incident CVD and cancer ascertained from linked records.

RESULTS

After adjusting for socio-demographic and lifestyle factors, there were J-shaped associations of E-DII with all-cause mortality and CVD, and a relatively linear association with cancer. When E-DII was <0, E-DII was not associated with any of the outcomes. When E-DII was ≥0, the linear associations were strongest in all-cause mortality (HR 1.09, 95% CI, 1.05-1.13), followed by CVD (HR 1.06, 95% CI, 1.03-1.09), and cancer (HR 1.03, 95%,CI, 1.01-1.05).

CONCLUSION

Dietary inflammatory potential was associated with mortality and CVD primarily when the diet is proinflammatory.

2022 Update on Prostate Cancer Epidemiology and Risk Factors-A Systematic Review

CONTEXT

Prostate cancer (PCa) is one of the most common cancers worldwide. Understanding the epidemiology and risk factors of the disease is paramount to improve primary and secondary prevention strategies.

OBJECTIVE

To systematically review and summarize the current evidence on the descriptive epidemiology, large screening studies, diagnostic techniques, and risk factors of PCa.

EVIDENCE ACQUISITION

PCa incidence and mortality rates for 2020 were obtained from the GLOBOCAN database of the International Agency for Research on Cancer. A systematic search was performed in July 2022 using PubMed/MEDLINE and EMBASE biomedical databases. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in PROSPERO (CRD42022359728).

EVIDENCE SYNTHESIS

Globally, PCa is the second most common cancer, with the highest incidence in North and South America, Europe, Australia, and the Caribbean. Risk factors include age, family history, and genetic predisposition. Additional factors may include smoking, diet, physical activity, specific medications, and occupational factors. As PCa screening has become more accepted, newer approaches such as magnetic resonance imaging (MRI) and biomarkers have been implemented to identify patients who are likely to harbor significant tumors. Limitations of this review include the evidence being derived from meta-analyses of mostly retrospective studies.

CONCLUSIONS

PCa remains the second most common cancer among men worldwide. PCa screening is gaining acceptance and will likely reduce PCa mortality at the cost of overdiagnosis and overtreatment. Increasing use of MRI and biomarkers for the detection of PCa may mitigate some of the negative consequences of screening.

PATIENT SUMMARY

Prostate cancer (PCa) remains the second most common cancer among men, and screening for PCa is likely to increase in the future. Improved diagnostic techniques can help reduce the number of men who need to be diagnosed and treated to save one life. Avoidable risk factors for PCa may include factors such as smoking, diet, physical activity, specific medications, and certain occupations.

Association between inflammatory potential of diet and periodontitis disease risks: Results from a Korean population-based cohort study

AIM

To examine the association between a pro-inflammatory diet, estimated using the energy-adjusted dietary inflammatory index (E-DII), and the risk of periodontitis.

MATERIALS AND METHODS

Study subjects from the Korean Genome and Epidemiology Study Health Examinee (KoGES_HEXA) cohort were included for cross-sectional analysis (n = 168,378) using multivariate logistic regression and prospective analysis (n = 160,397) using Cox proportional hazard models respectively. DII and E-DII scores were calculated based on the intake reported on a validated semi-quantitative food frequency questionnaire (SQ-FFQ).

RESULTS

Cox proportional hazard models revealed a significantly increased risk of incident periodontitis in individuals consuming high E-DII (more pro-inflammatory) diets in the total population (HRquartile4vs1  = 1.29; 95% CI: 1.13-1.48; ptrend <.001) and in both men (HRquartile4vs1  = 1.36; 95% CI: 1.07-1.73; ptrend  = 0.02) and women (HRquartile4vs1  = 1.27; 95% CI: 1.08-1.50; ptrend  = .002). The association remained significant even after excluding cases diagnosed early in the follow-up. In the cross-sectional analysis, a significant association was observed between the E-DII score and the prevalence of periodontitis among all study subjects (ORquartile4vs1  = 1.17; 95% CI: 1.03-1.34; ptrend  = 0.01) and men (ORquartile4vs1  = 1.28; 95%CI: 1.01-1.63; ptrend <.001); however, the association did not reach statistical significance in women (ORquartile4vs1  = 1.13; 95% CI: 0.96-1.33; ptrend <.001).

CONCLUSIONS

Findings from the current study support the hypothesis that diets with high pro-inflammatory potential increase the risk of periodontitis.

The Association between Dietary Inflammatory Index and Aging Biomarkers/Conditions: A Systematic Review and Dose-response Meta-analysis

OBJECTIVES

We performed a current study to examine the association between dietary inflammatory index (DII) score and older age-related muscle conditions, including sarcopenia, low muscle mass, low muscle strength, frailty, and/or disability.

DESIGN

Systematic review and dose-response meta-analysis.

SETTING

A systematic literature search was performed using Scopus, PubMed/MEDLINE, and ISI Web of Science without limitation until October 04, 2022. Relative risk (RR) and 95% confidence interval (CI) were pooled by applying a random-effects model, while validated methods examined assess quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests respectively. A dose-response meta-analysis was conducted to estimate the RRs per 1-unit increment in DII scores.

PARTICIPANTS

Adults (≥18 years).

MEASURES

The risk of older age-related muscle conditions (sarcopenia, low muscle mass, low muscle strength, frailty, and/or disability).

RESULTS

Data were available from 19 studies with 68079 participants. Results revealed that a higher DII score was significantly related to an increased risk of sarcopenia (RR=1.50; 95% CI: 1.26, 1.79; I2=53.3%; p<0.001; n=10; sample size =43097), low muscle strength (RR=1.47; 95% CI: 1.24, 1.74; I2=6.6%; p<0.001; n=4; sample size =9339), frailty (RR=1.61; 95% CI: 1.41, 1.84; I2=0.0%; p<0.001; study=5; participant=3882) and disability (RR=1.41; 95% CI: 1.16, 1.72; I2=58.4%; p=0.001; n=5; sample size =13760), but not low muscle mass (RR=1.24; 95% CI: 0.98, 1.56; I2=49.3%; p=0.069; n=4; sample size =11222). Additionally, results of the linear dose-response indicated that an increase of one point in the DII score was related to a 14% higher risk of sarcopenia, 6% higher risk of low muscle mass, 7% higher risk of low muscle strength, and a 7% higher risk of disability in adults. Non-linear dose-response relationships also revealed a positive linear association between the DII score and the risk of sarcopenia (Pnonlinearity = 0.097, Pdose-response<0.001), frailty (Pnonlinearity = 0.844, Pdose-response=0.010) and disability (Pnonlinearity = 0.596, Pdose-response=0.007).

CONCLUSION

Adherence to a pro-inflammatory diet was significantly associated with a higher risk of sarcopenia and other age-associated adverse effects such as low muscle strength, disability, and frailty. These results indicate a necessity to prioritize the reduction of pro-inflammatory diets to help promote overall older age-related muscle conditions.

Diets, Dietary Patterns, Single Foods and Pancreatic Cancer Risk: An Umbrella Review of Meta-Analyses

Pancreatic cancer (PC) represents the third leading cause of cancer death in 2020. Despite the fact that, in 2018, the World Cancer Research Fund report concluded that there is still a lack of evidence on the role of foods or diets and risk for PC, a flourishing body of evidence has been published and needs to be analyzed. For this reason, we conducted an umbrella review on the association between different dietary patterns/food components and PC. Data sources PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and the Cochrane Collaboration were searched. The Joanna Briggs Institute Umbrella Review Methodology was used. The protocol was registered in PROSPERO. A total of 23 articles were included, covering a wide range of dietary patterns/food components: healthy/prudent dietary patterns (n = 4), Mediterranean diets (MedDiet) (n = 1), plant-based diets (n = 2), the Dietary Inflammatory Index (DII) (n = 2), western diets (n = 2), and, lastly, unhealthy diets (n = 2). Regarding dietary components, the following were assessed: total fruit (n = 2), citrus fruit (n = 1), total vegetables (n = 2), cruciferous vegetables (n = 1), red meat (n = 6), processed meat (n = 4), poultry (n = 2), eggs (n = 1), fish (n = 5), whole grain (n = 2), potato (n = 1), and nuts (n = 2). The methodological quality of the included meta-analyses was generally low or critically low. Although the strength of evidence was generally weak, convincing or suggestive evidence was found for a healthy/prudent, plant-based diet, fruit and vegetables, and lower risk of PC, whereas a high intake of red meat was associated with a higher risk of PC at a convincing level of evidence. Further studies are needed to confirm the role of the other dietary patterns/food components and the risk of PC.

Association between dietary inflammatory index and oral cancer risk: A systematic review and dose–response meta-analysis

Background

Dietary inflammatory index (DII) has been suggested to be associated with oral cancer risk. However, a quantitative comprehensive assessment of the dose–response relationship has not been reported. We performed a meta-analysis to clarify the risk of oral cancer with DII.

Methods

We searched PubMed, Embase, Cochrane Library, and Web of Science databases for relevant articles published up to 1 March 2022. Fixed- or random-effects models were utilized to estimate the pooled odds ratio (OR) of oral cancer with DII, as appropriate. Restricted cubic splines were used to model the dose–response relationship.

Results

We included five case–control studies involving 1,278 cases and 5,137 controls in the meta-analysis. Risk of oral cancer was increased by 135% with the highest versus lowest DII level [OR: 2.35, 95% confidence interval (CI): 1.88–2.94], and 79% with higher versus lower DII level (OR: 1.79, 95% CI: 1.49–2.15). We found no evidence of a nonlinear dose–response association of DII with oral cancer (p_{non-linearity} = 0.752), and the risk was increased by 17% (OR: 1.17, 95% CI: 1.05–1.30) with 1 unit increment in DII score.

Conclusion

This meta-analysis suggested that a higher DII score was associated with increased risk of oral cancer. Therefore, reducing pro-inflammatory components and promoting anti-inflammatory components of diet may be effective in the prevention of oral cancer.

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 Neutrophil-To-Lymphocyte Ratio and Diabetes Secondary to Exocrine Pancreatic Disorders

Background

Diabetes mellitus among patients with exocrine pancreatic disorders is commonly known to be associated with chronic inflammation, including chronic pancreatitis and pancreatic ductal adenocarcinoma (PDAC). The neutrophil-to-lymphocyte ratio (NLR) is a novel marker that indicates the presence of various chronic inflammatory diseases, including type 2 diabetes (T2DM). However, no studies have examined the relationship between the NLR value and diabetes secondary to exocrine pancreatic disorders.

Aim

To determine whether the NLR value is associated with diabetes secondary to exocrine pancreatic disorders.

Methods

The medical data of subjects with confirmed pancreatic disease who were admitted to the Department of Pancreatic Surgery of our institution from August 2017 to October 2021 were obtained from the database and retrospectively analyzed. Anthropometric measures, laboratory data, including HbA1c, fasting insulin, and fasting C-peptide levels and the inflammatory index (white blood cell count, NLR, platelet-to-lymphocyte ration, monocyte-to-lymphocyte ratio) were recorded. The NLR is the ratio of neutrophils to lymphocytes. A homeostasis model (HOMA-B and HOMA-IR) was used to measure beta-cell dysfunction and insulin resistance.

Results

The NLR values of the diabetes secondary to exocrine pancreatic disorders group were significantly higher than those of the nondiabetic group (P=0.001). In multivariate logistic regression, after adjusting for covariates, high NLR values were found to be an independent risk factor for diabetes secondary to exocrine pancreatic disorders (OR: 1.37, 95% CI: 1.138-1.649, P=0.001). According to Spearman correlation analysis, the NLR was significantly correlated with fasting plasma glucose levels (P<0.0001) and HOMA2-IR values (P=0.02).

Conclusion

The NLR inflammation marker was significantly higher in subjects with diabetes secondary to exocrine pancreatic disorders and was associated with insulin resistance. NLR values may be reliable predictive markers for diabetes among patients with exocrine pancreatic disorders.

The Association Between Dietary Inflammatory Index and Cognitive Performance in Older Adults Aged 60 Years and Older

Background

Neuroinflammation has been linked to the development of cognitive performance. Epidemiological evidence on dietary inflammatory potential and cognitive performance is scarce. We evaluated the association between dietary inflammatory index (DII) and cognitive performance in older adults.

Methods

This study included adults aged 60 years or older from the 2011–2014 National Health and Nutrition Examination Survey. The DII scores were calculated based on 27 nutritional parameters. Cognitive performance was assessed with four cognitive tests: the Digit Symbol Substitution Test (DSST, n = 2,780), the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning (CERAD-WL, n = 2,859) and Delayed Recall (CERAD-DR, n = 2,857), and the Animal Fluency (AF, n = 2,844) tests. Restricted cubic splines and logistic regression were adopted to assess the associations.

Results

Comparing the highest to lowest tertile of DII scores, the odds ratio (95% CI) of lower cognitive functioning was 1.97 (1.08–3.58) [P-trend = 0.02, per 1 unit increment: 1.17 (1.01–1.38)] on DSST, 1.24 (0.87–1.76) [P-trend = 0.24, per 1 unit increment: 1.09 (0.96–1.23)] on CERAD-WL, 0.93 (0.57–1.51) [P-trend = 0.74, per 1 unit increment: 1.02 (0.87–1.20)] on CERAD-DR, and 1.76 (1.30–2.37) [P-trend < 0.01, per 1 unit increment: 1.17 (1.05–1.29)] on AF. The above-mentioned associations were observed in both men and women. In non-linear dose–response analysis, the association between DII and lower cognitive functioning was not significant at lower DII scores up to 3.0, after which the association was significant and the curve rose steeply.

Conclusion

Higher DII is associated with lower scores on DSST and AF tests in older adults.

The role of diet in renal cell carcinoma incidence: an umbrella review of meta-analyses of observational studies

BACKGROUND

Evidence associating diet with the incidence of renal cell carcinoma (RCC) is inconclusive. We aimed to summarize evidence associating dietary factors with RCC incidence and assess the strength and validity of this evidence.

METHODS

We conducted an umbrella review of systematic reviews or meta-analyses (SRoMAs) that assessed the association between diet and RCC incidence. Through April 2021, PubMed, Web of Science, Embase, The Cochrane Library, Scopus, and WCRF were searched. Two independent reviewers selected studies, extracted data, and appraised the quality of SRoMAs. According to credibility assessment criteria, evidence can be divided into five categories: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV), and nonsignificant (class V).

RESULTS

Twenty-nine meta-analyses were obtained after screening. After excluding 7 overlapping meta-analyses, 22 meta-analyses including 502 individual studies and 64 summary hazard ratios for RCC incidence were included: dietary patterns or dietary quality indices (n = 6), foods (n = 13), beverages (n = 4), alcohol (n = 7), macronutrients (n =15), and micronutrients (n =19). No meta-analyses had high methodological quality. Five meta-analyses exhibited small study effects; one meta-analysis showed evidence of excess significance bias. No dietary factors showed convincing or highly suggestive evidence of association with RCC in the overall analysis. Two protective factors had suggestive evidence (vegetables (0.74, 95% confidence interval 0.63 to 0.86) and vitamin C (0.77, 0.66 to 0.90)) in overall analysis. One protective factor had convincing evidence (moderate drinking (0.77, 0.70 to 0.84)) in Europe and North America and one protective factor had highly suggestive evidence (cruciferous vegetables (0.78, 0.70 to 0.86)) in North America.

CONCLUSIONS

Although many meta-analyses have assessed associations between dietary factors and RCC, no high-quality evidence exists (classes I and II) in the overall analysis. Increased intake of vegetables and vitamin C is negatively associated with RCC risk. Moderate drinking might be beneficial for Europeans and North Americans, and cruciferous vegetables might be beneficial to North Americans, but the results should be interpreted with caution. More researches are needed in the future.

TRIAL REGISTRATION

PROSPERO CRD42021246619.

Associations of Evolutionary-Concordance Diet and Lifestyle Pattern Scores with Incident, Sporadic Colorectal Adenoma in a Pooled Case-Control Study

Differences in diet and lifestyle relative to those of our Paleolithic-era ancestors may explain current high incidences of chronic diseases, including colorectal cancer (CRC), in Westernized countries. Previously reported evolutionary-concordance diet and lifestyle pattern scores, reflecting closeness of diet and lifestyle patterns to those of Paleolithic-era humans, were associated with lower CRC incidence. Separate and joint associations of the scores with colorectal adenoma among men and women are unknown. To address this, we pooled data from three case-control studies of incident, sporadic colorectal adenomas (n = 771 cases, 1,990 controls), used participants' responses to food frequency and lifestyle questionnaires to calculate evolutionary-concordance diet and lifestyle pattern scores, and estimated the scores' associations with adenomas using multivariable unconditional logistic regression. The multivariable-adjusted odds ratios comparing those in the highest relative to the lowest diet and lifestyle score quintiles were 0.84 (95% confidence interval [CI] 0.62, 1.12; P_trend:0.03) and 0.41 (95% CI 0.29, 0.59; P_trend:<0.0001), respectively. The inverse associations were stronger for high-risk adenomas, and among those with both high relative to those with both low diet and lifestyle scores. These results suggest that more evolutionary-concordant diet and lifestyle patterns, separately and jointly, may be associated with lower risk for incident, sporadic colorectal adenoma.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.2002919 .

Longitudinal and cross-sectional associations between the dietary inflammatory index and objectively and subjectively measured sleep among police officers

Police officers experience exposures associated with increased inflammation, such as the stress associated with shiftwork and poor-quality diet, both of which have been shown to affect sleep duration and quality. This study examined the longitudinal and cross-sectional effects of the Energy-density Dietary Inflammatory Index (E-DII™) on objectively and subjectively measured sleep among police officers. Data were derived from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort (n = 464 at baseline), with longitudinal data collected from 2004 to 2019. A food frequency questionnaire obtained estimated dietary intake from which E-DII scores were calculated. Dependent variables were objectively (Micro Motion Logger Sleep Watch™) and subjectively (Pittsburgh Sleep Quality Index) measured sleep quality and quantity. The analyses included a series of linear mixed-effects models used to examine cross-sectional and longitudinal associations between the E-DII and sleep quantity and quality. Cross-sectionally, more pro-inflammatory diets were associated with higher wake-after-sleep-onset but improved subjective sleep quality. In models accounting for both longitudinal and cross-sectional effects, for every 1-unit increase in the E-DII scores over time (representing a pro-inflammatory change), wake-after-sleep-onset increased by nearly 1.4 min (p = 0.07). This result was driven by officers who primarily worked day shifts (β = 3.33, p = 0.01). Conversely, for every 1-unit increase in E-DII score, the Pittsburgh Sleep Quality Index global score improved. More pro-inflammatory diets were associated with increased wake-after-sleep-onset, an objective measure of sleep quality. Intervention studies to reduce dietary inflammatory potential may provide greater magnitude of effect for changes in sleep quality.

Dietary inflammatory index and pancreatic cancer risk: a systematic review and dose-response meta-analysis

OBJECTIVE

The meta-analysis was conducted to test the link between pancreatic cancer (PC) risk and dietary inflammatory index (DII®) score.

DESIGN

Systematic review and meta-analysis.

SETTING

We searched PubMed, Embase, Web of Science and the Cochrane Library up to 22 November 2020 to identify the relevant studies. Studies that reported the risk estimates and the corresponding 95 % CI for the DII category and PC risk were included. The effect sizes were pooled using the random-effects model. Dose-response analysis was conducted where possible.

PARTICIPANTS

Two prospective cohort studies of 634 705 participants (3152 incident cases), and four case-control studies of 2737 cases and 4861 controls.

RESULTS

Overall, the pooled risk ratio (RR) indicated that individuals in the highest category compared with the lowest category had an increased PC risk (RR = 1·45; 95 % CI 1·11, 1·90; P = 0·006). Meanwhile, significant heterogeneity was also revealed. The dose-response meta-analysis indicated that a 1-unit increase in the DII score was associated with the PC risk (RR = 1·08; 95 % CI 1·002, 1·166; P = 0·045; I2 = 94·1 %, P < 0·001). Nonlinear result showed an increased risk of moving from fewer to more inflammatory borders with increasing DII score (Pnonlinearity = 0·003; I2 = 76·5 %, P < 0·001). Subgroup analyses found that significant positive association between PC risk and DII score appeared to be in case-control studies (RR = 1·70; 95 % CI 1·16, 2·50; P = 0·007) and studies with ≤ 31 DII components (RR = 1·76; 95 % CI 1·14, 2·72; P = 0·011).

CONCLUSION

These findings suggested dietary habits with high inflammatory features (high DII score) might increase PC risk.

Adapted dietary inflammatory index and differentiated thyroid carcinoma risk in two French population-based case-control studies

PURPOSE

Thyroid cancer is the most common endocrine cancer and its etiology is still not well understood. The aim of the present study was to assess the association between an adapted dietary inflammatory index and differentiated thyroid cancer (DTC) risk in two population-based case-control studies (CATHY and YOUNG-THYR) conducted in France.

METHODS

These studies included a total of 1321 DTC cases and 1502 controls, for which an adapted dietary inflammatory index (ADII) was computed based on food frequency questionnaires in each study separately. The association between ADII and thyroid cancer risk was assessed using logistic regression models controlling for potential confounders.

RESULTS

Higher ADII scores, corresponding to a higher pro-inflammatory potential of the diet, were associated with higher DTC risk (odds ratio (OR) for 1 standard deviation (SD) increase: 1.09, 95% confidence interval (CI): 1.01, 1.18, P: 0.03). Associations were stronger in analyses restricted to women (OR for 1-SD increase: 1.14, 95% CI 1.04, 1.25, P: 0.005), as well as in women with lower education level, current smoking, or high body mass index.

CONCLUSION

Our study suggests that a pro-inflammatory diet is associated with an increased risk of DTC, especially when combined with other inflammatory conditions such as tobacco smoking or overweight. Our findings will help better understand the role of diet-induced inflammation in DTC etiology.

The Dietary Inflammatory Index and Human Health: An Umbrella Review of Meta-Analyses of Observational Studies

Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size.

Impact of lifestyle in prostate cancer patients. What should we do?

Objective:

This review aimed to analyze interventions raised within primary and tertiary prevention concerning the disease's incidence, progression, and recurrence of Prostate Cancer (PCa). Priority was given to the multidisciplinary approach of PCa patients with an emphasis on modifiable risk factors.

Materials and Methods:

We conducted a comprehensive literature review in the following databases: Embase, Central, and Medline. We included the most recent evidence assessing cohort studies, case-control studies, clinical trials, and systematic reviews published in the last five years. We only included studies in adults and in vitro or cell culture studies. The review was limited to English and Spanish articles.

Results:

Preventive interventions at all levels are the cornerstone of adherence to disease treatment and progression avoidance. The relationship in terms of healthy lifestyles is related to greater survival. The risk of developing cancer is associated to different eating habits, determined by geographic variations, possibly related to different genetic susceptibilities.

Discussion:

PCa is the second most common cancer in men, representing a leading cause of death among men in Latin America. Prevention strategies and healthy lifestyles are associated with higher survival rates in PCa patients. Also, screening for anxiety and the presence of symptoms related to mood disorders is essential in the patient's follow-up concerning their perception of the condition.

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.

Assessing the (anti)-inflammatory potential of diets

PURPOSE OF REVIEW

It is accepted that several chronic diseases are associated with inflammation. Dietary habits and the consumption of certain nutrients have been shown to influence inflammation, reflected by inflammatory cytokines. In this narrative review, we discuss currently developed tools to assess the inflammatory potential of diets and compare them with established tools.

RECENT FINDINGS

Four new indices were recently developed. The Inflammatory Score of the Diet is a modified version of the established Dietary Inflammatory Index. The novel Empirical Dietary Inflammatory Index works without previous dietary intake assessment and the Anti-Inflammatory Diet Index was specifically developed in a northern European population. The Dietary and Lifestyle Inflammation Scores addresses additional confounders. The informative value of dietary indices relies on the accuracy and completeness of dietary intake assessment.

SUMMARY

Dietary inflammatory indices are important tools to assess, compare and validate the inflammatory potential of diets across populations without the need for biomarker assessments. They allow to investigate associations between an (anti)-inflammatory diet with disease risk and course. Although the Dietary Inflammatory Index remains the most used index worldwide, currently developed indices allow more flexibility, have a different focus or simplify assessment. Additional foods, that were recently shown to modulate inflammation, but are not (fully) considered yet, may deserve more attention in the future.

Dietary inflammatory index and the risk of non-communicable chronic disease and mortality: an umbrella review of meta-analyses of observational studies

We aimed to perform an umbrella review of systematic reviews and meta-analyses (SRMAs) of observational studies of the association of the dietary inflammatory index (DII) with the risk of non-communicable chronic disease and mortality in the general population. We searched PubMed, Scopus, and ISI Web of Science to November 2020. For each outcome, the summary effect sizes with the corresponding 95%CIs were recalculated using a random-effects model. The certainty of the evidence and the quality of conduct of published SRMAs were rated using the GRADE and ASMTAR 2 tools, respectively. A total of 11 SRMAs of observational studies, reporting pooled effect sizes for 29 outcomes obtain from 60 prospective cohort and 67 case-control studies, were included. Our results demonstrated evidence of moderate certainty for a positive relation between DII and the risk cardiovascular disease, all-cause mortality, and colorectal cancer. Higher DII was also associated with site-specific cancer risk, but for cancers at most sites, existing evidence is derived from case-control studies with the certainty of evidence being rated low or very low. Our findings suggested that adherence to a diet with high inflammatory features might be associated with a higher risk of colorectal cancer, cardiovascular disease, and all-cause mortality.

Dietary Inflammatory Index and Health Outcomes: An Umbrella Review of Systematic Review and Meta-Analyses of Observational Studies

Background and Aims: The dietary inflammatory index (DII) is associated with non-communicable disease. We conducted an umbrella review to systematically evaluate meta-analyses of observational studies on DII and diverse health outcomes.

Methods: We comprehensively searched the PubMed, Web of Science, and Embase databases to identify related systematic reviews and meta-analyses of observational studies. Those investigating the association between DII and a wide range of health outcomes in humans were eligible for inclusion. For each meta-analysis, we estimated the summary effect size by using fixed and random effects models, the 95% confidence interval, and the 95% prediction interval. We assessed heterogeneity, evidence of small-study effects, and excess significance bias.

Results: The umbrella review identified 35 meta-analyses assessing associations between DII and various health outcomes: cancer (n = 24), mortality (n = 4), metabolic (n = 4), and other (n = 3). The methodological quality was high or moderate. Of the 35 meta-analyses, we observed highly suggestive evidence for harmful associations between digestive tract cancer, colorectal cancer, overall cancer, pharyngeal cancer, UADT cancer, and CVD mortality. Moreover, 11 harmful associations showed suggestive evidence: hormone-dependent cancer, rectal cancer, colon cancer, breast and prostate cancer, gynecological cancer, breast cancer, ovarian cancer, colorectal cancer, prostate cancer, all-cause mortality, and depression.

Conclusion: DII is likely to be associated with harmful effects in multiple health outcomes. Robust randomized controlled trials are warranted to understand whether the observed results are causal.

Systematic Review Registration: CRD42021218361

Prospective Analyses of Lifestyle Factors Related to Energy Balance and Ovarian Cancer Risk by Infiltration of Tumor-Associated Macrophages

BACKGROUND

Lifestyle factors related to energy balance have been associated with ovarian cancer risk and influence the tumor immune microenvironment, including tumor-associated macrophages (TAM). However, no studies have assessed whether these factors differentially impact ovarian cancer risk by TAM densities.

METHODS

We conducted a prospective analysis in the Nurses' Health Studies to examine the associations of physical activity, sitting time, and a food-based empirical dietary inflammatory pattern (EDIP) score with invasive epithelial ovarian cancer risk by TAM density assessed by immunohistochemistry. We considered density of CD68 (marker of total TAMs) and CD163 (marker of pro-carcinogenic M2-type TAMs), and their ratios. We used multivariable Cox proportional hazards regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) of exposures with risk of ovarian tumors with high versus low TAMs, including analyses stratified by body mass index.

RESULTS

Analyses included 312 incident ovarian cancer cases with TAM measurements. Physical activity, sitting time, and EDIP score were not differentially associated with ovarian cancer risk by TAM densities (P heterogeneity > 0.05). Among overweight and obese women, higher EDIP score was associated with increased risk of CD163 low-density tumors (HR comparing extreme tertiles, 1.57; 95% CI, 0.88-2.80; P trend = 0.01), but not CD163 high-density tumors (comparable HR, 1.16; 95% CI, 0.73-1.86; P trend = 0.24), though this difference was not statistically significant (P heterogeneity = 0.22).

CONCLUSIONS

We did not observe differential associations between lifestyle factors and ovarian cancer risk by TAM densities.

IMPACT

Future investigations examining the interplay between other ovarian cancer risk factors and the tumor immune microenvironment may help provide insight into ovarian cancer etiology.

Associations of interleukin-4 and interleukin-4 receptor loci with esophageal squamous cell carcinoma susceptibility

Some functional polymorphisms in immune-regulating genes could affect the development of esophageal squamous cell carcinoma (ESCC). We enrolled 721 patients with ESCC and 1,208 healthy controls to explore the roles of rs2227282 (C > G) and rs2243283 (C > G) loci in the interleukin-4 (IL4) gene and rs1801275 loci in the interleukin-4 receptor (IL4R) gene for the occurrence of ESCC. As for IL4, the single nucleotide polymorphism rs2227282 (C > G) conferred an overall decreased risk for ESCC (adjusted P = 0.005, power = 0.816 in GG vs. CC genetic models). A stratification analysis of IL4 rs2227282 (C > G) and rs2243283 (C > G) and IL4R rs1801275 (A > G) loci with the ESCC risk revealed that the IL4 rs2243283 (C > G) polymorphism was a protective factor for the susceptibility to ESCC in some subgroups (women: power = 0.932 in CG vs. CC and 0.956 in CG/GG vs. CC; subjects aged ≥63 years: power = 0.844 in CG/GG vs. CC; never-smokers: power = 0.893 in CG vs. CC and 0.882 in CG/GG vs. CC; never-drinkers: power = 0.904 in CG vs. CC and 0.862 in CG/GG vs. CC). We also investigated the association of IL4 rs2227282 and rs2243283 and IL4R rs1801275 loci with the lymph node status. However, a null relationship was found. In conclusion, the present study highlighted that IL4 rs2227282 (C > G) and rs2243283 (C > G) loci are protective factors for the occurrence of ESCC.

Pancreatic Cancer Exposome Profile to Aid Early Detection and Inform Prevention Strategies

Pancreatic cancer (PCa) is associated with a poor prognosis and high mortality rate. The causes of PCa are not fully elucidated yet, although certain exposome factors have been identified. The exposome is defined as the sum of all environmental factors influencing the occurrence of a disease during a life span. The development of an exposome approach for PCa has the potential to discover new disease-associated factors to better understand the carcinogenesis of PCa and help with early detection strategies. Our systematic review of the literature identified several exposome factors that have been associated with PCa alone and in combination with other exposures. A potential inflammatory signature has been observed among the interaction of several exposures (i.e., smoking, alcohol consumption, diabetes mellitus, obesity, and inflammatory markers) that further increases the incidence and progression of PCa. A large number of exposures have been identified such as genetic, hormonal, microorganism infections and immune responses that warrant further investigation. Future early detection strategies should utilize this information to assess individuals' risk for PCa.

Dietary Inflammatory Index in relation to bone mineral density, osteoporosis risk and fracture risk: a systematic review and meta-analysis

Our systematic review and meta-analysis indicated that pro-inflammatory diets, as measured by higher Dietary Inflammatory Index scores, are significantly associated with lower BMD of lumbar spine and total hip as well as elevated risk of osteoporosis and fractures. These findings may contribute to the development of public health strategies.

INTRODUCTION

Inflammatory Index (DII) is a method to assess the inflammatory potential of diets; it has been reported to be associated with several diseases. However, the relation between DII and bone health remains controversial for the inconsistent findings from previous studies. This systematic review and meta-analysis aimed to ascertain the underlying relationships between DII and bone mineral density (BMD), osteoporosis risk, and fracture risk.

METHODS

We systematically searched PubMed and Web of Science for all relevant epidemiological studies published up to May 1, 2020. Fixed-effects model or random-effects model was employed to pool the study-specific effect sizes (ESs) and 95% confidence intervals (CIs).

RESULTS

Eleven studies with a total of 127,769 participants were included. We found that continuous DII was negatively associated with BMD of lumbar spine (odds ratios [OR]: 0.990; 95% CI: 0.984, 0.995) and total hip (OR: 0.995; 95% CI: 0.990, 0.999), but not femoral neck (OR: 0.998; 95% CI: 0.994, 1.002). Moreover, the highest category of DII displayed significantly associations to increased risk of osteoporosis (ES: 1.31; 95% CI: 1.16, 1.48) and fractures (ES: 1.28; 95% CI: 1.03, 1.59) compared with the lowest category of DII, respectively.

CONCLUSION

Our analysis indicated that diets with high pro-inflammatory components might increase the risk of osteoporosis and fractures and lower BMD of lumbar spine and total hip. More prospective studies involving populations of diverse ages and genders are expected to further verify the universality of the results.

Neutrophil-lymphocyte ratio (NLR) was associated with prognosis and immunomodulatory in patients with pancreatic ductal adenocarcinoma (PDAC)

Although the oncological outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) have markedly improved over the past decade, the survival prediction is still challenging. The aim of this study was to investigate the prognostic value of neutrophil–lymphocyte ratio (NLR) and analyze the relationship of between the NLR and immune cells phenotypes in patients with PDAC. Sixty-seven consecutive patients with PDAC were recruited in this study. Life-table estimates of survival time were calculated according to the Kaplan and Meier methodology. The phenotypic T cells subclasses were evaluated by flow cytometry. All the 67 patients in this study were treated with surgical resection and among them, 46 patients received adjuvant chemotherapy. Receiver operating characteristic (ROC) curves analysis was performed to compare prognostic value of NLR with CA199. We found that the Harrell's area under ROC (AUROC) for the NLR to predict overall survival (OS) (0.840; 95% CI, 0.766–0.898) was significantly higher than that of the CA199 levels. After that we stratified all patients into NLR > 2.5 (n = 42) and NLR ≤ 2.5 (n = 25) groups according to the OS of patients with PDAC. Survival analysis showed that patients with NLR ≤ 2.5 had significantly favorable OS and progressive free survival (PFS) compared with patients with NLR > 2.5. The CD3+ and CD8+/CD28+ T cell subsets were significantly increased in patients with NLR ≤ 2.5 (P<0.05), while the CD8+/CD28- and CD4+/CD25+ cell subsets were significantly decreased in patients with NLR ≤ 2.5 (P<0.05). In conclusion, a high NLR value independently predicts poor survival in patients with PDAC after surgical resection. The NLR was closely related with immune cells phenotypes The NLR may help oncologists evaluate outcomes of patients received surgical resection and chemotherapy to choose alternative therapies for patients with high NLR value.

Chronic inflammation towards cancer incidence: A systematic review and meta-analysis of epidemiological studies

This systematic review and meta-analysis provides epidemiological data on the relationship between chronic inflammation, as measured by inflammatory blood parameters, and cancer incidence. Two independent researchers searched PubMed, Web Of Science and Embase databases until October 2020. In vitro studies, animal studies, studies with chronically-ill subjects or cross-sectional studies were excluded. Quality was assessed with the Newcastle-Ottawa scale. The 59 nested case-control, 6 nested case-cohort and 42 prospective cohort studies considered 119 different inflammatory markers (top three: CRP, fibrinogen and IL6) and 26 cancer types (top five: colorectal, lung, breast, overall and prostate cancer). Nineteen meta-analyses resulted in ten significant positive associations: CRP-breast (OR = 1.23[1.05-1.43];HR = 1.14[1.01-1.28)), CRP-colorectal (OR = 1.34[1.11-1.60]), CRP-lung (HR = 2.03[1.59-2.60]), fibrinogen-lung (OR = 2.56[1.86-3.54]), IL6-lung (OR = 1.41[1.12-1.78]), CRP-ovarian (OR = 1.41[1.10-1.80]), CRP-prostate (HR = 1.09[1.03-1.15]), CRP-overall (HR = 1.35[1.16-1.57]) and fibrinogen-overall (OR = 1.22[1.07-1.39]). Study quality improvements can be done by better verification of inflammatory status (more than one baseline measurement of one parameter), adjusting for important confounders and ensuring long-term follow-up.

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.

Diet-Associated Inflammation Modulates Inflammation and WNT Signaling in the Rectal Mucosa, and the Response to Supplementation with Dietary Fiber

Inflammation drives colorectal cancer development, and colorectal cancer risk is influenced by dietary factors, including dietary fiber. Hyperactive WNT signaling occurs in colorectal cancer and may regulate inflammation. This study investigated (i) relationships between the inflammatory potential of diet, assessed using the Energy-adjusted Dietary Inflammatory Index (E-DII), and markers of WNT signaling, and (ii) whether DII status modulated the response to supplementation with two types of dietary fiber. Seventy-five healthy participants were supplemented with resistant starch and/or polydextrose (PD) or placebo for 50 days. Rectal biopsies were collected before and after intervention and used to assess WNT pathway gene expression and crypt cell proliferation. E-DII scores were calculated from food frequency questionnaire data. High-sensitivity C-reactive protein (hsCRP) and fecal calprotectin concentrations were quantified. hsCRP concentration was significantly greater in participants with higher E-DII scores [least square means (LSM) 4.7 vs. 2.4 mg/L, P = 0.03]. Baseline E-DII score correlated with FOSL1 (β = 0.503, P = 0.003) and WNT11 (β = 0.472, P = 0.006) expression, after adjusting for age, gender, body mass index, endoscopy procedure, and smoking status. WNT11 expression was more than 2-fold greater in individuals with higher E-DII scores (LSM 0.131 vs. 0.059, P = 0.002). Baseline E-DII modulated the effects of PD supplementation on FOSL1 expression (P = 0.04). More proinflammatory diets were associated with altered WNT signaling and appeared to modulate the effects of PD supplementation on expression of FOSL1 This is the first study to investigate relationships between the E-DII and molecular markers of WNT signaling in rectal tissue of healthy individuals.Prevention Relevance: Our finding that more inflammatory dietary components may impact large bowel health through effects on a well-recognized pathway involved in cancer development will strengthen the evidence base for dietary advice to help prevent bowel cancer.

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.

Associations of Novel Dietary and Lifestyle Inflammation Scores with Incident, Sporadic Colorectal Adenoma

BACKGROUND

Colorectal carcinogenesis is mechanistically linked to inflammation and is highly associated with diet and lifestyle factors that may affect chronic inflammation. We previously developed dietary (DIS) and lifestyle (LIS) inflammation scores, comprising inflammation biomarker-weighted components, to characterize the collective contributions of 19 food groups and four lifestyle exposures to systemic inflammation. Both scores were more strongly directly associated with circulating inflammation biomarkers in three validation populations, including a subset of the study population described below, than were the previously reported dietary inflammatory index and empirical dietary inflammatory pattern.

METHODS

We calculated the DIS and LIS in three pooled case-control studies of incident, sporadic colorectal adenoma (N = 765 cases and 1,986 controls) with extensive dietary and lifestyle data, and investigated their associations with adenoma using multivariable unconditional logistic regression.

RESULTS

For those in the highest (more proinflammatory) relative to the lowest (more anti-inflammatory) quintiles of the DIS and LIS, the multivariable-adjusted ORs were 1.31 [95% confidence interval (CI), 0.98-1.75; P _trend = 0.09] and 1.98 (95% CI, 1.48-2.66; P _trend < 0.001), respectively. These associations were strongest for adenomas with high-risk characteristics and among men. Those in the highest relative to the lowest joint DIS/LIS quintile had a 2.65-fold higher odds (95% CI, 1.77-3.95) of colorectal adenoma.

CONCLUSIONS

These results support that diets and lifestyles with higher balances of pro- to anti-inflammatory exposures may be associated with higher risk for incident, sporadic colorectal adenoma.

IMPACT

Our findings support further investigation of the DIS and LIS in relation to colorectal neoplasms.

Inflammatory potential of the diet and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study

Proinflammatory diets are associated with risk of developing colorectal cancer (CRC), however, inconsistencies exist in subsite- and sex-specific associations. The relationship between CRC and combined lifestyle-related factors that contribute toward a low-grade inflammatory profile has not yet been explored. We examined the association between the dietary inflammatory potential and an inflammatory profile and CRC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. This cohort included 476,160 participants followed-up of 14 years and 5,991 incident CRC cases (3,897 colon and 2,094 rectal tumors). Dietary inflammatory potential was estimated using an Inflammatory Score of the Diet (ISD). An Inflammatory Profile Score (IPS) was constructed, incorporating the ISD, physical activity level and abdominal obesity. The associations between the ISD and CRC and IPS and CRC were assessed using multivariable regression models. More proinflammatory diets were related to a higher CRC risk, particularly for colon cancer; hazard ratio (HR) for highest versus lowest ISD quartile was 1.15 (95% confidence interval [CI] 1.04-1.27) for CRC, 1.24 (95% CI 1.09-1.41) for colon cancer and 0.99 (95% CI 0.83-1.17) for rectal cancer. Associations were more pronounced in men and not significant in women. The IPS was associated with CRC risk, particularly colon cancer among men; HRs for the highest versus lowest IPS was 1.62 (95% CI 1.31-2.01) for colon cancer overall and 2.11 (95% CI 1.50-2.97) for colon cancer in men. Our study shows that more proinflammatory diets and a more inflammatory profile are associated with higher risk of CRC, principally colon cancer and in men.

Systematic review and meta-analysis of diet quality and colorectal cancer risk: is the evidence of sufficient quality to develop recommendations?

The quality of existing evidence about the impact of diet quality on colorectal cancer (CRC) risk has only rarely been assessed. In the current review, we searched PubMed, EMBASE, Web of Science, Cochrane, and the resulting references (up to January 2020) for studies that evaluated the role of high diet quality by extreme dietary index categorization and the risk of CRC. Two researchers independently performed the study selection, data extraction, and quality assessment. We then applied a random-effects meta-analysis to estimate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) for CRC at the extremes of each dietary index, and we assessed the quality of the pooled results using the Grading of Recommendations Assessment, Development and Evaluation approach. A high diet quality was significantly associated with reduced CRC risk when patients had a low Diet Inflammatory Index score (OR, 0.66; 95%CI, 0.56-0.78), a high Mediterranean Diet Score (OR, 0.84; 95%CI, 0.78-0.90), high Dietary Approaches to Stop Hypertension adherence (OR, 0.83; 95%CI, 0.78-0.89), and a high Healthy Eating Index score (OR, 0.72; 95%CI, 0.64-0.80). The pooled results for all dietary indices were rated as being of low quality due to concerns over inconsistency or imprecision. We conclude that, despite a high diet quality appearing to have a preventive role in CRC, the evidence is currently of insufficient quality to develop dietary recommendations.

Overview of the Associations Between Cancer and Rheumatic Disease

People living with rheumatic diseases frequently encounter cancer, either as a potential harm of antirheumatic therapies or as a comorbidity that alters the conversation about management. This article provides a general overview of the issues related to cancer and rheumatic disease and serves as a springboard for the remaining chapters in this issue. Several topics are reviewed, including epidemiology, bidirectional causal pathways, and issues related to medications. Although uncertainties remain, the issue of cancer is of great importance to patients with rheumatic diseases, and an individualized, person-centered approach to assessment and management is necessary.