Pancreatic cancer: associations of inflammatory potential of diet, cigarette smoking and long-standing diabetes

Triglyceride-glucose index and glycemic dynamics in pancreatic ductal adenocarcinoma: implications for disease progression and prognosis

BACKGROUND

To elucidate the relationship between the triglyceride-glycemic index (TyG) and clinical characteristics of pancreatic ductal adenocarcinoma (PDAC).

METHODS

A total of 1,594 individuals diagnosed with pancreatic and periampullary neoplasms were categorized into four groups: PDAC-early (n = 403), locally advanced PDAC (LAPC, n = 315), PDAC-late with distant metastasis (n = 371), and other tumor types (n = 505). TyG-high was defined as a TyG index greater than 8.81 in males and 8.73 in females.

RESULTS

The prevalence of TyG-high status was highest in PDAC-early (68.48%), followed by LAPC (53.33%), and lowest in PDAC-late (44.47%). TyG-high status significantly predicted worse PDAC prognosis (P = 0.0166), particularly in PDAC-late (P = 0.0420). Despite similar blood glucose levels across PDAC groups (P = 0.897), PDAC-early patients showed significantly higher rates of glycemic disturbances (56.33% vs. 32.28%) and TyG-high status (68.48% vs. 47.13%) compared to those with other tumors. Progressive increases in glycemic disturbances and TyG-high status were observed from benign to pre-malignant lesions and PDAC-early. PDAC-early patients at the pancreatic head exhibited higher rates of glycemic disturbances (58.12% vs. 33.33%, P < 0.0001), larger pancreatic duct diameters (0.4056 cm vs. 0.3398 cm, P = 0.0043), and poorer prognosis compared to periampullary cancers, although the TyG-high rate and body mass index were similar.

CONCLUSION

The TyG index exhibits a complex association with PDAC stages, profoundly shaping glycemic profiles. At the initial stages of PDAC, a notable elevation in TyG-high status and glycemic disturbances is observed. However, in advanced PDAC, while the TyG-high rate diminishes, abnormal glucose levels persist.

Associations between Diabetes Mellitus and Selected Cancers

Cancer is one of the major causes of mortality and is the second leading cause of death. Diabetes mellitus is a serious and growing problem worldwide, and its prevalence continues to grow; it is the 12th leading cause of death. An association between diabetes mellitus and cancer has been suggested for more than 100 years. Diabetes is a common disease diagnosed among patients with cancer, and evidence indicates that approximately 8-18% of patients with cancer have diabetes, with investigations suggesting an association between diabetes and some particular cancers, increasing the risk for developing cancers such as pancreatic, liver, colon, breast, stomach, and a few others. Breast and colorectal cancers have increased from 20% to 30% and there is a 97% increased risk of intrahepatic cholangiocarcinoma or endometrial cancer. On the other hand, a number of cancers and cancer therapies increase the risk of diabetes mellitus. Complications due to diabetes in patients with cancer may influence the choice of cancer therapy. Unfortunately, the mechanisms of the associations between diabetes mellitus and cancer are still unknown. The aim of this review is to summarize the association of diabetes mellitus with selected cancers and update the evidence on the underlying mechanisms of this association.

Hot topics in pancreatic cancer management

Pancreatic ductal adenocarcinoma (PDAC) is a sneaky and lethal disease burdened by poor prognosis. PDAC is often detected too late to be successfully cured, and it has been estimated that it will be a leading cause of cancer-related deaths in the near future. During the last decade, multimodal treatments involving surgery, chemotherapy and radiotherapy have contributed to improving the prognosis of this disease; however, long-term results are still not satisfactory. Postoperative morbidity and mortality rates remain high, and systemic treatments are burdened by toxicity in both neoadjuvant and adjuvant settings. Advancements in technologies, targeted therapies, immunotherapy and PDAC microenvironment modulation strategies may represent useful potential weapons in the future. Nevertheless, in the fight against this dreadful disease, there is an urgent need for new, cheap and user-friendly tools for early detection. In this field, promising results have been found in nanotechnologies and “omics” analyses that search for new biomarkers to be used in primary and secondary prevention. However, there are many issues that need to be solved before considering these tools in daily clinical practice. This editorial reported the state of the art of pancreatic cancer management.

Smoking Cessation after Cancer Diagnosis and Enhanced Therapy Response: Mechanisms and Significance

The adverse effects of smoking on human health have been recognized for several decades, especially in the context of cancer. The ability of tobacco smoke components, including tobacco-specific carcinogens and additive compounds such as nicotine, to initiate or promote tumor growth have been described in hundreds of studies. These investigations have revealed the tumor-promoting activities of nicotine and other tobacco smoke components and have also recognized the ability of these agents to suppress the efficacy of cancer therapy; it is now clear that smoking can reduce the efficacy of most of the widely used therapeutic modalities, including immunotherapy, radiation therapy, and chemotherapy. Several studies examined if continued smoking after cancer diagnosis affected therapy response; it was found that while never smokers or non-smokers had the best response to therapy, those who quit smoking at the time of diagnosis had higher overall survival and reduced side-effects than those who continued to smoke. These studies also revealed the multiple mechanisms via which smoking enhances the growth and survival of tumors while suppressing therapy-induced cell death. In conclusion, smoking cessation during the course of cancer therapy markedly increases the chances of survival and the quality of life.

Inflammatory potential of diet and pancreatic cancer risk in the EPIC study

PURPOSE

There is existing evidence on the potential role of chronic inflammation in the pathogenesis of pancreatic cancer (PC) and on how risk may be modulated by dietary factors. Pro-inflammatory diets are suggested to be associated with increased risk of PC but, so far, evidence remains not conclusive. We examined the association between the dietary inflammatory potential and PC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which includes 450,112 participants.

METHODS

After a 14-year follow-up, a total of 1239 incident PC cases were included in this study. The inflammatory potential of the diet was estimated using an Inflammatory Score of the Diet (ISD). Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the ISD and PC were estimated using multivariable Cox regression models, adjusted for known risk factors for PC.

RESULTS

Participants with higher ISDs had a higher risk of developing PCs. In the fully adjusted multivariate model, the risk of PC increased by 11% (HR 1.11, 95% CI 1.02-1.22) for 1 point each standard deviation increase in the ISD score. Neither obesity nor any other known risk factor for PC showed statistically significant interactions.

CONCLUSION

To the best of our knowledge, this is the first prospective study reporting a positive relationship between the inflammatory potential of diet and PC. Since early diagnosis and treatment of pancreatic cancer might be challenging, prevention remains the major hope for reducing the burden of this disease.

Influence of Cancer Susceptibility Gene Mutations and ABO Blood Group of Pancreatic Cancer Probands on Concomitant Risk to First-Degree Relatives

BACKGROUND

ABO blood group is associated with pancreatic cancer risk. Whether ABO blood group alone or when combined with inherited mutation status of index pancreatic cancer cases (probands) can enhance pancreatic cancer risk estimation in first-degree relatives (FDR) is unclear. We examined FDRs' risk for pancreatic cancer based on probands' ABO blood group and probands' cancer susceptibility gene mutation status.

METHODS

Data on 23,739 FDRs, identified through 3,268 pancreatic cancer probands, were analyzed. Probands' ABO blood groups were determined serologically or genetically, and 20 cancer susceptibility genes were used to classify probands as "mutation-positive" or "mutation-negative." SIRs and 95% confidence intervals (CI) were calculated, comparing observed pancreatic cancer cases in the FDRs with the number expected in SEER-21 (reference population).

RESULTS

Overall, FDRs had 2-fold risk of pancreatic cancer (SIR = 2.00; 95% CI = 1.79-2.22). Pancreatic cancer risk was higher in FDRs of mutation-positive (SIR = 3.80; 95% CI = 2.81-5.02) than mutation-negative (SIR = 1.79; 95% CI = 1.57-2.04) probands (P < 0.001). The magnitude of risk did not differ by ABO blood group alone (SIR_{blood-group-O} = 1.57; 95% CI = 1.20-2.03, SIR_non-O = 1.83; 95% CI = 1.53-2.17; P = 0.33). Among FDRs of probands with non-O blood group, pancreatic cancer risk was higher in FDRs of mutation-positive (SIR = 3.98; 95% CI = 2.62-5.80) than mutation-negative (SIR = 1.66; 95% CI = 1.35-2.03) probands (P < 0.001), but risk magnitudes were statistically similar when probands had blood group O (SIR_{mutation-positive} = 2.65; 95% CI = 1.09-5.47, SIR_{mutation-negative} = 1.48; 95% CI = 1.06-5.47; P = 0.16).

CONCLUSIONS

There is a range of pancreatic cancer risk to FDRs according to probands' germline mutation status and ABO blood group, ranging from 1.48 for FDRs of probands with blood group O and mutation-negative to 3.98 for FDRs of probands with non-O blood group and mutation-positive.

IMPACT

Combined ABO blood group and germline mutation status of probands can inform pancreatic cancer risk estimation in FDRs.

Dietary Inflammatory Index in relation to Type 2 Diabetes: A Meta-Analysis

BACKGROUND AND AIMS

Epidemiologic studies show a strong association between chronic inflammation and type 2 diabetes (T2D). Diet may also affect the risk of T2D by modulating inflammation. This meta-analysis aimed to assess the relation of dietary inflammatory index (DII) and risk of T2D.

METHODS

PubMed and Scopus were systematically searched from their inception to September 2020 to identify relevant studies. Relative risks, hazard ratios, or odds ratios (OR), with their corresponding 95% confidence intervals (95% CI), were calculated and pooled using a random-effects model.

RESULTS

A total of 48 different studies, with a total sample size of 1,687,424 participants, were eligible to be included in this meta-analysis. In the overall analysis, no significant association was observed between DII and risk of T2D (OR = 1.03, 95% CI: 0.91 to 1.15), with significant evidence for heterogeneity (I ²  = 96.5%, P < 0.001); however, higher DII was identified as being significantly related to increased risk of T2D in high quality studies (OR = 1.58, 95% CI: 1.15 to 2.17). In the stratified analysis by the dietary assessment tool, background disease, and sex of participants, DII showed no significant association with T2D.

CONCLUSIONS

Higher DII might be associated with an increased risk of T2D. Additional well-designed studies are required to confirm this finding.

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.

Type 2 diabetes prevention diet and the risk of pancreatic cancer: A large prospective multicenter study

BACKGROUND & AIMS

Type 2 diabetes prevention diet confers a lower risk of type 2 diabetes, which exhibits overlapping mechanisms with pancreatic cancer. We performed a prospective study to examine whether adherence to this dietary pattern is associated with a reduced risk of pancreatic cancer.

METHODS

A population-based cohort of 101,729 American adults was identified. A dietary diabetes risk reduction score was computed to reflect adherence to this dietary pattern, with higher scores representing greater adherence. Cox regression was used to compute hazard ratios (HRs) for pancreatic cancer incidence. Prespecified subgroup analyses were used to identify the potential effect modifiers.

RESULTS

After an average follow-up of 8.86 years (900,871.67 person-years), a total of 402 pancreatic cancer cases were observed. In the fully adjusted model, participants in the highest quartile of dietary diabetes risk reduction score were found to have a reduced risk of pancreatic cancer compared with those in the lowest quartile [HR_{quartiles 4versus1}: 0.62; 95% confidence interval (CI): 0.44, 0.86; P_trend = 0.004], which remained in a series of sensitivity analyses. Subgroup analyses further found that this favorable association was more pronounced in current or former smokers (HR_{quartiles 4versus1}: 0.48; 95% CI: 0.30, 0.77) than in never smokers (HR_{quartiles 4versus1}: 0.71; 95% CI: 0.44, 1.15), although the interaction test did not reach statistical significance (P_interaction = 0.095).

CONCLUSIONS

Greater adherence to type 2 diabetes prevention diet is associated with a lower risk of pancreatic cancer in this US population. More studies are needed to confirm our findings.

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.

Red and processed meat consumption and cancer outcomes: Umbrella review

The purpose of this umbrella review was to evaluate the quality of evidence, validity and biases of the associations between red and processed meat consumption and multiple cancer outcomes according to existing systematic reviews and meta-analyses. The umbrella review identified 72 meta-analyses with 20 unique outcomes for red meat and 19 unique outcomes for processed meat. Red meat consumption was associated with increased risk of overall cancer mortality, non-Hodgkin lymphoma (NHL), bladder, breast, colorectal, endometrial, esophageal, gastric, lung and nasopharyngeal cancer. Processed meat consumption might increase the risk of overall cancer mortality, NHL, bladder, breast, colorectal, esophageal, gastric, nasopharyngeal, oral cavity and oropharynx and prostate cancer. Dose-response analyses revealed that 100 g/d increment of red meat and 50 g/d increment of processed meat consumption were associated with 11%-51% and 8%-72% higher risk of multiple cancer outcomes, respectively, and seemed to be not correlated with any benefit.

Shorter Treatment-Naïve Leukocyte Telomere Length is Associated with Poorer Overall Survival of Patients with Pancreatic Ductal Adenocarcinoma

BACKGROUND

Critically shortened telomeres contribute to chromosomal instability and neoplastic transformation and are associated with early death of patients with certain cancer types. Shorter leukocyte telomere length (LTL) has been associated with higher risk for pancreatic ductal adenocarcinoma (PDAC) and might be associated also with survival of patients with PDAC. We investigated the association between treatment-naïve LTL and overall survival of patients with incident PDAC.

METHODS

The study included 642 consecutively enrolled PDAC patients in the Mayo Clinic Biospecimen Resource for Pancreas Research. Blood samples were obtained at the time of diagnosis, before the start of cancer treatment, from which LTL was assayed by qRT-PCR. LTL was first modeled as a continuous variable (per-interquartile range decrease in LTL) and then as a categorized variable (short, medium, long). Multivariable-adjusted HRs and 95% confidence intervals (CI) were calculated for overall mortality using Cox proportional hazard models.

RESULTS

Shorter treatment-naïve LTL was associated with higher mortality among patients with PDAC (HR_continuous = 1.13, 95% CI: 1.01-1.28, P = 0.03; HR_{shortest vs. longest LTL} = 1.29, 95% CI: 1.05-1.59, P _trend = 0.01). There was a difference in the association between LTL and overall mortality by tumor stage at diagnosis; resectable tumors (HR_continuous = 0.91; 95% CI: 0.73-1.12), locally advanced tumors (HR_continuous = 1.29; 95% CI: 1.07-1.56), and metastatic tumors (HR_continuous = 1.17; 95% CI: 0.96-1.42), P _interaction = 0.04.

CONCLUSION

Shorter treatment-naïve LTL is associated with poorer overall survival of patients with incident PDAC.

IMPACT

Peripheral blood LTL might be a prognostic marker for PDAC.

Pancreatic cancer treatment: better, but a long way to go

Remarkable progress has been made in treating pancreatic cancer over the past century, including refinement of our surgical techniques and improvements in adjuvant and neoadjuvant therapies. Despite these advances, the incidence of pancreatic cancer is rising globally, and it remains a deadly disease. In this review, we highlight the historical perspectives of pancreatic cancer treatment and outline the areas of future advancement that will assist progression towards better outcomes. Areas of future advancement include improving prevention strategies and early detection, refining our molecular understanding of pancreatic cancer, identifying more effective systemic therapies, and improving quality of life and surgical outcomes. Furthermore, systems need to be put in place to ensure all patients with pancreatic cancer receive high quality care and are given the appropriate options and sequence of therapy. This is best achieved through multidisciplinary care.

Diabetes and cancer: Epidemiological and biological links

The incidence of diabetes and cancer has increased significantly in recent years. Furthermore, there are many common risk factors for both diabetes and cancer, such as obesity, sedentary lifestyle, smoking, and ageing. A large body of epidemiological evidence has indicated that diabetes is considered as an independent risk factor for increased rates of heterogeneous types of cancer occurrence and death. The incidence and mortality of various types of cancer, such as pancreas, liver, colorectal, breast, endometrial, and bladder cancers, have a modest growth in diabetics. However, diabetes may work as a protective factor for prostate cancer. Although the underlying biological mechanisms have not been totally understood, studies have validated that insulin/insulin-like growth factor (IGF) axis (including insulin resistance, hyperinsulinemia, and IGF), hyperglycemia, inflammatory cytokines, and sex hormones provide good circumstances for cancer cell proliferation and metastasis. Insulin/IGF axis activates several metabolic and mitogenic signaling pathways; hyperglycemia provides energy for cancer cell growth; inflammatory cytokines influence cancer cell apoptosis. Thus, these three factors affect all types of cancer, while sex hormones only play important roles in breast cancer, endometrial cancer, and prostate cancer. This minireview consolidates and discusses the epidemiological and biological links between diabetes and various types of cancer.

The Impact of obesity and diabetes mellitus on pancreatic cancer: Molecular mechanisms and clinical perspectives

The incidence of obesity and type 2 diabetes (T2DM) in the Western world has increased dramatically during the recent decades. According to the American Cancer Society, pancreatic cancer (PC) is the fourth leading cause of cancer‐related death in the United States. The relationship among obesity, T2DM and PC is complex. Due to increase in obesity, diabetes, alcohol consumption and sedentary lifestyle, the mortality due to PC is expected to rise significantly by year 2040. The underlying mechanisms by which diabetes and obesity contribute to pancreatic tumorigenesis are not well understood. Furthermore, metabolism and microenvironment within the pancreas can also modulate pancreatic carcinogenesis. The risk of PC on a population level may be reduced by modifiable lifestyle risk factors. In this review, the interactions of diabetes and obesity to PC development were summarized, and novel strategies for the prevention and treatment of diabetes and PC were discussed.

Leukocyte Telomere Length and Its Interaction with Germline Variation in Telomere-Related Genes in Relation to Pancreatic Adenocarcinoma Risk

BACKGROUND

Leukocyte telomere length (LTL) has been associated with risk of multiple cancers, but its association with pancreatic ductal adenocarcinoma (PDAC) is unclear. We therefore investigated the association between peripheral blood LTL and PDAC risk, and examined effect modification by candidate SNPs previously reported to be associated with variation in LTL.

METHODS

A case-control study of 1,460 PDAC cases and 1,459 frequency-matched controls was performed using biospecimens and data from the Mayo Clinic Biospecimen Resource for Pancreas Research. Quantitative PCR was used to measure LTL and categorized into tertiles based on sex-specific control distribution. Eleven telomere-related SNPs also were genotyped. Logistic regression was used to calculate ORs and 95% confidence intervals (CI).

RESULTS

Shorter peripheral blood LTL was associated with a higher risk of PDAC (OR_T1vsT3 = 1.26, 95% CI = 1.03-1.54, P _trend = 0.02; OR_continuous = 1.14, 95% CI = 1.02-1.28), but the association was restricted to cases with treatment-naïve blood samples (OR_T1vsT3 = 1.51, 95% CI = 1.16-1.96, P _trend = 0.002; OR_continuous = 1.25, 95% CI = 1.08-1.45) and not cases whose blood samples were collected after initiation of cancer therapy (OR_T1vsT3 = 1.10, 95% CI = 0.87-1.39, P _trend = 0.42; OR_continuous = 1.08, 95% CI = 0.94-1.23). Three SNPs (TERC-rs10936599, ACYP2-rs11125529, and TERC-rs1317082) were each associated with interindividual variation in LTL among controls, but there was no evidence of effect modification by these SNPs.

CONCLUSIONS

Treatment-naïve short LTL is associated with a higher risk of PDAC, and the association does not differ by germline variation in the candidate telomere-related SNPs examined.

IMPACT

Peripheral blood LTL might serve as a molecular marker for risk modeling to identify persons at high risk of PDAC.

Plasma extracellular vesicle long RNA profiling identifies a diagnostic signature for the detection of pancreatic ductal adenocarcinoma

OBJECTIVE

Pancreatic ductal adenocarcinoma (PDAC) is difficult to diagnose at resectable stage. Recent studies have suggested that extracellular vesicles (EVs) contain long RNAs. The aim of this study was to develop a diagnostic (d-)signature for the detection of PDAC based on EV long RNA (exLR) profiling.

DESIGN

We conducted a case-control study with 501 participants, including 284 patients with PDAC, 100 patients with chronic pancreatitis (CP) and 117 healthy subjects. The exLR profile of plasma samples was analysed by exLR sequencing. The d-signature was identified using a support vector machine algorithm and a training cohort (n=188) and was validated using an internal validation cohort (n=135) and an external validation cohort (n=178).

RESULTS

We developed a d-signature that comprised eight exLRs, including FGA, KRT19, HIST1H2BK, ITIH2, MARCH2, CLDN1, MAL2 and TIMP1, for PDAC detection. The d-signature showed high accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.960, 0.950 and 0.936 in the training, internal validation and external validation cohort, respectively. The d-signature was able to identify resectable stage I/II cancer with an AUC of 0.949 in the combined three cohorts. In addition, the d-signature showed superior performance to carbohydrate antigen 19-9 in distinguishing PDAC from CP (AUC 0.931 vs 0.873, p=0.028).

CONCLUSION

This study is the first to characterise the plasma exLR profile in PDAC and to report an exLR signature for the detection of pancreatic cancer. This signature may improve the prognosis of patients who would have otherwise missed the curative treatment window.

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.

Emerging incidence trends and application of curative treatments of pancreatic cancer in the USA

Annual pancreatic tumor incidence rates have been increasing. We explored pancreatic tumor incidence trends by treatment and clinicopathologic features.Data from the Surveillance, Epidemiology and End Results (SEER) was retrieved to evaluate temporal trends and pancreatic cancer rates from 2000 to 2015. Joinpoint regression analyses were carried out to examine trend differences.Overall, the incidence of pancreatic cancer was on the increase. The initial APC increased at a rate of 2.22% from 2000 to 2012, and increased from 2012 to 2015 at a rate of 9.05%. Joinpoint analyses revealed that trends within different demographics of pancreatic cancer showed different characteristics. The rate of pancreatic cancer also varied with histologic types. In addition, the trends by cancer stage showed significant increase incidences of stage I and II pancreatic cancer from 2000 to 2013 (stage I: APC: 2.71%; stage II: APC: 4.87%). Incidences of patients receiving surgery increased from 2000 to 2008 (APC: 7.55%), 2008 to 2011 (APC: 2.17%) and then there was a significant acceleration from 2011 to 2015 (APC: 10.51%). The incidence of cases in stage II receiving surgery increased significantly from 2004 to 2009 (APC: 9.28%) and 2009 to 2013 (APC: 2.57%). However, for cases in stage I, the incidence of cases with surgery decreased significantly since 2009 (APC: -4.14%). Patients undergoing surgical treatment without chemotherapy and radiotherapy had the higher rates compared with those who received other combined treatments.Pancreatic cancer has been increasing overall, but patterns differ by demographics and clinicopathologic features. Efforts to identify and treat more eligible candidates for curative therapy could be beneficial.

Pancreatic cancer risk is modulated by inflammatory potential of diet and ABO genotype: a consortia-based evaluation and replication study

Diets with high inflammatory potential are suspected to increase risk for pancreatic cancer (PC). Using pooled analyses, we examined whether this association applies to populations from different geographic regions and population subgroups with varying risks for PC, including variation in ABO blood type. Data from six case-control studies (cases, n = 2414; controls, n = 4528) in the Pancreatic Cancer Case-Control Consortium (PanC4) were analyzed, followed by replication in five nested case-control studies (cases, n = 1268; controls, n = 4215) from the Pancreatic Cancer Cohort Consortium (PanScan). Two polymorphisms in the ABO locus (rs505922 and rs8176746) were used to infer participants' blood types. Dietary questionnaire-derived nutrient/food intake was used to compute energy-adjusted dietary inflammatory index (E-DII®) scores to assess inflammatory potential of diet. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable-adjusted logistic regression. Higher E-DII scores, reflecting greater inflammatory potential of diet, were associated with increased PC risk in PanC4 [ORQ5 versus Q1=2.20, 95% confidence interval (CI) = 1.85-2.61, Ptrend < 0.0001; ORcontinuous = 1.20, 95% CI = 1.17-1.24], and PanScan (ORQ5 versus Q1 = 1.23, 95% CI = 0.92-1.66, Ptrend = 0.008; ORcontinuous = 1.09, 95% CI = 1.02-1.15). As expected, genotype-derived non-O blood type was associated with increased PC risk in both the PanC4 and PanScan studies. Stratified analyses of associations between E-DII quintiles and PC by genotype-derived ABO blood type did not show interaction by blood type (Pinteraction = 0.10 in PanC4 and Pinteraction=0.13 in PanScan). The results show that consuming a pro-inflammatory diet and carrying non-O blood type are each individually, but not interactively, associated with increased PC risk.

The relationship between pancreatic cancer and type 2 diabetes: cause and consequence

Pancreatic cancer (PC) is a devastating and lethal malignant disease and it is well known that there is a complex bidirectional relationship between PC and type 2 diabetes mellitus (T2DM). In order to more deeply summarize the relationship between them, this article summarizes the epidemiological data on the relationship between PC and T2DM in the past 5 years, and further explains the mechanism of interaction between them. Meanwhile, it also summed up the effects of drug therapy for T2DM on PC and the impact of T2DM on surgical resection of PC. Epidemiological studies clearly indicate that the risk of PC is increased in patients with T2DM. But increasing epidemiological data points out that PC also acts as a cause of T2DM and new-onset T2DM is sign and consequence of PC. Insulin resistance, hyperinsulinemia, hyperglycemia, and chronic inflammation are the mechanisms of T2DM-Associated PC. Metformin decreases the risk of PC, while insulin therapy increases the risk of PC. Besides, studies have shown that T2DM decreases the survival in patients with PC resection.

Association between leukocyte telomere length and the risk of pancreatic cancer: Findings from a prospective study

INTRODUCTION

Telomeres and telomerase play important role in maintaining chromosome integrity and genomic stability. Recent epidemiologic data showed inconsistent findings which suggested that both short and long leukocyte telomeres could be associated with increased risk of pancreatic cancer. We prospectively examined the association between telomere length and pancreatic cancer risk in a population-based cohort study.

METHODS

The Singapore Chinese Health Study recruited 63,257 Chinese aged 45 to 74 years from 1993 to 1998 in Singapore. Relative telomere length in peripheral blood leukocytes was quantified using a validated monochrome multiplex quantitative polymerase chain reaction method in 26,540 participants, including 116 participants who later developed pancreatic cancer after an average of 13 years of follow-up. Cox proportional hazard regression method was used to calculate hazard ratio (HR) and its 95% confidence interval (CI) of pancreatic cancer risk associated with telomere length, with adjustment for confounding factors.

RESULTS

Longer telomeres were significantly associated with higher risk of pancreatic cancer (Ptrend = 0.02). Compared with lowest quartile, subjects with highest quartile of telomere length had an HR of 2.18 (95% CI: 1.25-3.80) for developing pancreatic cancer. In stratified analysis, this association remained among pancreatic adenocarcinoma patients but not among pancreatic non-adenocarcinoma patients. In continuous scale, the HRs and 95% CIs were 3.08 (1.17-8.11) for adenocarcinoma patients and 1.47 (0.43-5.06) for non-adenocarcinoma patients. The HRs and 95% CIs of the highest quartile of telomere length, compared with the lowest quartile, for adenocarcinoma and non-adenocarcinoma were 2.50 (1.22-5.13) and 1.63 (0.66-4.03), respectively. The length of follow-up from the collection of blood for the measurement of telomere length to the diagnosis of cancer (median = 8.0, range: from 5.0 months to 16.2 years) had no significant impact on the association between telomere length and pancreatic cancer risk.

CONCLUSIONS

The present study demonstrates that longer telomeres are associated with increased risk of overall pancreatic cancer.

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.

Inflammatory Potential of Diet, Inflammation-Related Lifestyle Factors, and Risk of Pancreatic Cancer: Results from the NIH-AARP Diet and Health Study

BACKGROUND

Chronic inflammation is implicated in pancreatic cancer, and can be modulated by diet and other lifestyle factors. We examined the association between Dietary Inflammatory Index (DII) scores and pancreatic cancer risk in the NIH-AARP Diet and Health Study, and examined effect modification by inflammation-related lifestyle factors, including body mass index, cigarette smoking, diabetes, alcohol drinking, and use of non-steroidal anti-inflammatory drugs.

METHODS

Energy-adjusted DII scores (E-DII) were computed on the basis of food frequency questionnaire responses for foods and dietary supplements. Cox proportional hazards models were fitted and effect modification was examined by adding a cross-product of each effect modifier with E-DII quintile in the multivariable-adjusted model.

RESULTS

There were 2,824 primary incident pancreatic cancers diagnosed during a median of 13.4 years follow-up, and there was no association between E-DII scores and pancreatic cancer risk among either men [HR_Q5vsQ1, 1.00; 95% confidence interval (CI), 0.86-1.16] or women (HR_Q5vsQ1, 1.00; 95% CI, 0.82-1.21) in the multivariable-adjusted model, and no association was detected by any cancer stage. The E-DII and pancreatic cancer association was not modified by any of the inflammation-related lifestyle factors examined.

CONCLUSIONS

Results from this large prospective study did not support an association between inflammatory potential of diet and pancreatic cancer, or effect modification by other inflammation-related lifestyle factors.

IMPACT

Inflammatory potential of diet may not be related to pancreatic cancer risk. Future cohort studies with more frequent dietary measures could be useful in determining the appropriate timing of dietary intake in relation to pancreatic cancer etiology.

High dietary inflammatory index scores are associated with an elevated risk of hepatocellular carcinoma in a case-control study

Chronic inflammation and diet play crucial roles in the development of hepatocellular carcinoma (HCC); yet the association between dietary inflammatory potential and risk of HCC has rarely been investigated. This study aimed to examine whether a higher dietary inflammatory index (DII®) score (indicating a pro-inflammatory diet) is associated with an increased risk of HCC in a matched case-control study conducted between September 2013 and October 2017 in South China. A total of 659 cases with newly diagnosed, previously untreated HCC and 659 controls individually matched on age (±3 years) and sex were included in this study. DII scores were computed based on dietary intake information collected via a validated 79-item food frequency questionnaire (FFQ) during the one year prior to diagnosis (for the cases) or interview (for the controls). Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) between the DII score and the risk of HCC, adjusted for age, energy intake, body mass index, physical activity, marital status, education, household income, smoking status, and hepatitis B virus (HBV) infection status. Compared with subjects in the lowest DII tertile, subjects in the highest tertile had an elevated risk of HCC (fully adjusted OR: 3.22, 95% CI: 1.30-7.98, P-trend = 0.009). In stratified analyses, a significantly positive association was observed only in men, individuals with lower education level, smokers and non-alcohol drinkers. In conclusion, a higher DII score, representing a more inflammatory diet, was associated with an increased risk of HCC, in men, individuals with lower education level, smokers and non-alcohol drinkers.

Risk of Different Cancers Among First-degree Relatives of Pancreatic Cancer Patients: Influence of Probands' Susceptibility Gene Mutation Status

BACKGROUND

Increased risk of malignancies other than pancreatic cancer (PC) has been reported among first-degree relatives (FDRs) of PC patients; however, the roles of susceptibility gene mutations are unclear. We assessed risk for 15 cancers among FDRs of unselected PC probands.

METHODS

Data on 17 162 FDRs, with more than 336 000 person-years at risk, identified through 2305 sequential PC probands enrolled at Mayo Clinic (2000-2016) were analyzed. Family history data were provided by the probands. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated, comparing malignancies observed among the FDRs with that expected using Surveillance, Epidemiology, and End Results (SEER) data. Genetic testing was performed among a subset of probands (n = 2094), enabling stratified analyses among FDRs based on whether the related proband tested positive or negative for inherited mutation in 22 sequenced cancer susceptibility genes. All statistical tests were two-sided.

RESULTS

Compared with SEER, PC risk was twofold higher among FDRs of PC probands (SIR = 2.04, 95% CI = 1.78 to 2.31, P < .001). Primary liver cancer risk was elevated among female FDRs (SIR = 2.10, 95% CI = 1.34 to 3.12, P < .001). PC risk was more elevated among FDRs of mutation-positive probands (SIR = 4.32, 95% CI = 3.10 to 5.86) than FDRs of mutation-negative probands (SIR = 1.77, 95% CI = 1.51 to 2.05, between-group P < .001). FDR PC risk was higher when the related proband was younger than age 60 years at diagnosis and mutation-positive (SIR = 5.24, 95% CI = 2.93 to 8.64) than when the proband was younger than age 60 years but mutation-negative (SIR = 1.76, 95% CI = 1.21 to 2.47, between-group P < .001). Breast (SIR = 1.29, 95% CI = 1.01 to 1.63) and ovarian (SIR = 2.38, 95% CI = 1.30 to 4.00) cancers were elevated among FDRs of mutation-positive probands.

CONCLUSIONS

Our study substantiates twofold risk of PC among FDRs of PC patients and suggests increased risk for primary liver cancer among female FDRs. FDRs of susceptibility mutation carriers had substantially increased risk for PC and increased risk for breast and ovarian cancers.

Perspective: The Dietary Inflammatory Index (DII)-Lessons Learned, Improvements Made, and Future Directions

The literature on the role of inflammation in health has grown exponentially over the past several decades. Paralleling this growth has been an equally intense focus on the role of diet in modulating inflammation, with a doubling in the size of the literature approximately every 4 y. The Dietary Inflammatory Index (DII) was developed to provide a quantitative means for assessing the role of diet in relation to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. Based on literature from a variety of different study designs ranging from cell culture to observational and experimental studies in humans, the DII was designed to be universally applicable across all human studies with adequate dietary assessment. Over the past 4 y, the DII has been used in >200 studies and forms the basis for 12 meta-analyses. In the process of conducting this work, lessons were learned with regard to methodologic issues related to total energy and nutrient intake and energy and nutrient densities. Accordingly, refinements to the original algorithm have been made. In this article we discuss these improvements and observations that we made with regard to misuse and misinterpretation of the DII and provide suggestions for future developments.

Total Serum Cholesterol and Pancreatic Cancer: A Nested Case-Control Study

BACKGROUND

Pancreatic cancer is the third leading cause of cancer-related death in the United States. Total serum cholesterol (TSC) may predict cancer risk, although its role independent of statins remains elusive. We examined the association between TSC and pancreatic cancer risk independent of statins.

METHODS

A nested case-control analysis was conducted among statin-naïve patients within The Health Improvement Network (THIN), a United Kingdom-based general practice database. Cases were >40 years old and diagnosed with pancreatic cancer after at least 6 months of follow-up. Controls were selected by incidence density sampling and matched by age, sex, practice site, and follow-up. Primary exposure was TSC (mmol/L) prior to index date. Conditional logistic regression estimated ORs for pancreatic cancer risk associated with TSC. Sensitivity analyses were conducted among nondiabetics.

RESULTS

Among 1,241 cases and 3,307 matched controls, an average 8% reduction was observed in pancreatic cancer risk per mmol/L increase in TSC [OR 0.92, 95% confidence interval (CI): 0.85-1.00; nondiabetics: OR 0.91, 95% CI: 0.83-0.99]. When TSC was measured at 12-month intervals prior to diagnosis, the OR between TSC and pancreatic cancer was 0.88 at 0 to 12 months (95% CI: 0.77-1.00; nondiabetics: OR 0.81, 95% CI: 0.68-0.96). No significant association was seen at subsequent discrete intervals before index date.

CONCLUSIONS

TSC is a significant predictor of short-term risk for pancreatic cancer. This risk increase associated with lower TSC was independent of statins.

IMPACT

TSC could serve as a biomarker for risk stratification, screening, and early diagnosis of pancreatic cancer in future clinical prediction models.

Influence of anti-inflammatory diet and smoking on mortality and survival in men and women: two prospective cohort studies

BACKGROUND

The associations between an anti-inflammatory diet and both all-cause and cause-specific mortality have been studied previously; however, the influence of an anti-inflammatory diet on survival time has not been investigated. Moreover, the potential modification of these associations by smoking status remains unclear.

OBJECTIVE

The aims of this study were to examine the associations between an anti-inflammatory diet index (AIDI) and all-cause and cause-specific mortality, to determine the association between the AIDI and differences in survival time and to assess effect modification by smoking status.

METHODS

The study population included 68 273 Swedish men and women (aged 45-83 years) at baseline. The anti-inflammatory potential of the diet was estimated using the validated AIDI, which includes 11 potential anti-inflammatory and five potential pro-inflammatory foods. Cox proportional hazards and Laplace regression were used to estimate hazard ratios and differences in survival time.

RESULTS

During 16 years of follow-up (1 057 959 person-years), 16 088 deaths [5980 due to cardiovascular disease (CVD) and 5252 due to cancer] were recorded. Participants in the highest versus lowest quartile of the AIDI had lower risks of all-cause (18% reduction, 95% CI: 14-22%), CVD (20%, 95% CI: 14-26%) and cancer (13%, 95% CI: 5-20%) mortality. The strongest inverse associations between the highest and lowest quartiles of AIDI and risk of mortality were observed in current smokers: 31%, 36% and 22% lower risks of all-cause, CVD and cancer mortality, respectively. The difference in survival time between current smokers in the lowest AIDI quartile and never smokers in the highest quartile was 4.6 years.

CONCLUSION

Adherence to a diet with high anti-inflammatory potential may reduce all-cause, CVD and cancer mortality and prolong survival time especially amongst smokers.

Diet-related inflammation and risk of prostate cancer in the California Men's Health Study

PURPOSE

The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk.

METHODS

Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials.

RESULTS

Time to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04-1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74-1.32, Ptrend = .74), suggesting a nonlinear dose-response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease.

CONCLUSIONS

Relationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.

CDKN2A Germline Rare Coding Variants and Risk of Pancreatic Cancer in Minority Populations

Background: Pathogenic germline mutations in the CDKN2A tumor suppressor gene are rare and associated with highly penetrant familial melanoma and pancreatic cancer in non-Hispanic whites (NHW). To date, the prevalence and impact of CDKN2A rare coding variants (RCV) in racial minority groups remain poorly characterized. We examined the role of CDKN2A RCVs on the risk of pancreatic cancer among minority subjects.Methods: We sequenced CDKN2A in 220 African American (AA) pancreatic cancer cases, 900 noncancer AA controls, and 183 Nigerian controls. RCV frequencies were determined for each group and compared with that of 1,537 NHW patients with pancreatic cancer. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for both a case-case comparison of RCV frequencies in AAs versus NHWs, and case-control comparison between AA cases versus noncancer AA controls plus Nigerian controls. Smaller sets of Hispanic and Native American cases and controls also were sequenced.Results: One novel missense RCV and one novel frameshift RCV were found among AA patients: 400G>A and 258_278del. RCV carrier status was associated with increased risk of pancreatic cancer among AA cases (11/220; OR, 3.3; 95% CI, 1.5-7.1; P = 0.004) compared with AA and Nigerian controls (17/1,083). Further, AA cases had higher frequency of RCVs: 5.0% (OR, 13.4; 95% CI, 4.9-36.7; P < 0.001) compared with NHW cases (0.4%).Conclusions: CDKN2A RCVs are more common in AA than in NHW patients with pancreatic cancer and associated with moderately increased pancreatic cancer risk among AAs.Impact: RCVs in CDKN2A are frequent in AAs and are associated with risk for pancreatic cancer. Cancer Epidemiol Biomarkers Prev; 27(11); 1364-70. ©2018 AACR.

Dietary inflammatory index in relation to obesity and body mass index: a meta-analysis

Purpose

Studies investigating the association between dietary inflammatory index (DII) and body mass index (BMI) have led to inconsistent findings. Therefore, to decisively conclude, this paper aims to clarify the relationship between DII and obesity by performing meta-analysis.

Design/methodology/approach

PubMed, Scopus and Google Scholar were searched up to July 2017 using key words selected from Medical Subject Headings and other related keywords to identify all relevant articles. In total, 22 articles were entered into the meta-analysis; 22 studies compared the mean of BMI among subjects with highest versus the lowest DII and 4 studies had data on the hazard risk (HR) or odds ratio (OR) for obesity.

Findings

A meta-analysis on included studies indicated a significant association on either mean differences (MD) in BMI (MD = 0.811; 95 per cent CI: 0.365-1.256; p: 0.0001) or obesity OR (OR: 1.310; 95 per cent CI: 1.144-1.500; p = 0.000) by comparing the highest and lowest DII categories. Between-study heterogeneity was high (Cochrane Q test, p < 0.001, I2 = 98.1 per cent, df = 21, τ2 = 0.9273), and only dietary assessment methods could explain the source of heterogeneity in which 24-h dietary recalls were homogeny (I2 = 8.4 per cent, df = 2, p = 0.335).

Originality/value

The results of the present meta-analysis suggest that adherence to high DII score increased BMI and obesity. More prospective studies in different populations are needed to better clarify this relation.

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 Inherited Germline Mutations in Cancer Predisposition Genes and Risk of Pancreatic Cancer

IMPORTANCE

Individuals genetically predisposed to pancreatic cancer may benefit from early detection. Genes that predispose to pancreatic cancer and the risks of pancreatic cancer associated with mutations in these genes are not well defined.

OBJECTIVE

To determine whether inherited germline mutations in cancer predisposition genes are associated with increased risks of pancreatic cancer.

DESIGN, SETTING, AND PARTICIPANTS

Case-control analysis to identify pancreatic cancer predisposition genes; longitudinal analysis of patients with pancreatic cancer for prognosis. The study included 3030 adults diagnosed as having pancreatic cancer and enrolled in a Mayo Clinic registry between October 12, 2000, and March 31, 2016, with last follow-up on June 22, 2017. Reference controls were 123 136 individuals with exome sequence data in the public Genome Aggregation Database and 53 105 in the Exome Aggregation Consortium database.

EXPOSURES

Individuals were classified based on carrying a deleterious mutation in cancer predisposition genes and having a personal or family history of cancer.

MAIN OUTCOMES AND MEASURES

Germline mutations in coding regions of 21 cancer predisposition genes were identified by sequencing of products from a custom multiplex polymerase chain reaction-based panel; associations of genes with pancreatic cancer were assessed by comparing frequency of mutations in genes of pancreatic cancer patients with those of reference controls.

RESULTS

Comparing 3030 case patients with pancreatic cancer (43.2% female; 95.6% non-Hispanic white; mean age at diagnosis, 65.3 [SD, 10.7] years) with reference controls, significant associations were observed between pancreatic cancer and mutations in CDKN2A (0.3% of cases and 0.02% of controls; odds ratio [OR], 12.33; 95% CI, 5.43-25.61); TP53 (0.2% of cases and 0.02% of controls; OR, 6.70; 95% CI, 2.52-14.95); MLH1 (0.13% of cases and 0.02% of controls; OR, 6.66; 95% CI, 1.94-17.53); BRCA2 (1.9% of cases and 0.3% of controls; OR, 6.20; 95% CI, 4.62-8.17); ATM (2.3% of cases and 0.37% of controls; OR, 5.71; 95% CI, 4.38-7.33); and BRCA1 (0.6% of cases and 0.2% of controls; OR, 2.58; 95% CI, 1.54-4.05).

CONCLUSIONS AND RELEVANCE

In this case-control study, mutations in 6 genes associated with pancreatic cancer were found in 5.5% of all pancreatic cancer patients, including 7.9% of patients with a family history of pancreatic cancer and 5.2% of patients without a family history of pancreatic cancer. Further research is needed for replication in other populations.

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.

Association between the Dietary Inflammatory Index (DII) and urinary enterolignans and C-reactive protein from the National Health and Nutrition Examination Survey-2003-2008

BACKGROUND

Enterolignans are important biomarkers of microbiota diversity, with higher levels indicating greater diversity. Diet and inflammation have been shown to play a role in maintaining microbiota diversity. This study examined whether inflammatory potential of diet, as measured by the Dietary Inflammatory Index (DII^®) has an impact on levels of urinary enterolignans in the National Health and Nutrition Examination Survey (NHANES) 2003-2008. We also carried out construct validation of the DII with C-reactive protein (CRP).

METHODS

Data came from NHANES 2003-2008. Enterolignans [enterodiol (END) and enterolactone (ENL)] and CRP were assayed from urine and serum specimens, respectively. Energy-adjusted DII (E-DII) scores were calculated from food intakes assessed using 24-h dietary recalls and expressed per 1000 calories consumed. Associations were examined using survey-based multivariable linear and logistic regression for enterolignans, and logistic regression for CRP.

RESULTS

After multivariable adjustment, higher E-DII scores (i.e., indicating a relatively more pro-inflammatory diet) were associated with lower levels of creatinine-normalized END [beta coefficient (b)_{DIIquartile4vs1} = - 1.22; 95% CI = - 0.69, - 1.74; P_trend ≤ 0.001] and ENL (b_{DIIquartile4vs1} = - 7.80; 95% CI = - 5.33, - 10.26; P_trend ≤ 0.001). A positive association was also observed when enterolignans were dichotomized based on the cut-off of the 75th percentile value. In this same sample, the E-DII also was associated with CRP ≥ 3 mg/l (OR_{DIIcontinuous} = 1.12; 95% CI 1.05, 1.19).

CONCLUSION

In these NHANES data, there was an association between E-DII score and enterolignans. This study also provided construct validation of the E-DII using CRP in a nationally representative sample. The results indicate that dietary inflammatory potential is associated with urinary enterolignans, a potential marker for microbiota diversity. However, studies are required to understand the direct association between DII and microbiota.

Leukocyte Telomere Length and Pancreatic Cancer Risk: Updated Epidemiologic Review

Many risk factors have been firmly established for pancreatic cancer (PC), but the molecular processes by which known risk factors influence susceptibility to PC are not clear. There has been a recent upsurge of interest in the role of telomere length (TL), the protective DNA sequence repeats at chromosome ends, in pancreatic carcinogenesis. Given this heightened interest, we performed an in-depth, focused, and up-to-date review of the epidemiological evidence linking leukocyte TL (LTL) with PC risk. We searched MEDLINE, Embase, and the Cochrane Library databases for all published studies on LTL and PC risk, up to May 2017. Five studies were identified for review: 4 nested case-control studies and 1 retrospective case-control study. Two studies found opposite associations between LTL and PC risk: 1 found a dose-response positive association and the other found a dose-response inverse association. Two studies also found a "U-shaped" association, whereas another reported a weak nonlinear relationship. We offer potential reasons for the conflicting findings including variation in study design, biospecimen characteristics, and differences in interlaboratory measurements of TL. Future studies should carefully control for risk factors of PC that are associated also with telomere attrition and investigate the role of genetic variation in TL maintenance.

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.

Survival and glycemic control outcomes among patients with coexisting pancreatic cancer and diabetes mellitus

Aim:

We aimed to determine the effect of diabetes mellitus (DM) on survival in pancreatic cancer and effects of pancreatic cancer on glycemic control in DM.

Materials & methods:

Patients with pancreatic cancer from 2007 to 2015, with and without DM, were matched 1:1. We compared characteristics between the groups and assessed 2-year survival with Kaplan–Meier analysis.

Results:

In patients with DM, hemoglobin A_1c decreased significantly over time (p = 0.01). In survival analysis, 2-year overall survival estimates were 15% (95% CI: 8–24%) for DM patients versus 26% (95% CI: 17–36%) for non-DM patients (p = 0.55). The hazard ratio for matched pairs was 1.15 (95% CI: 0.75–1.77; p = 0.51).

Conclusion:

DM did not decrease survival in pancreatic cancer. Pancreatic cancer did not affect glycemic control.

The objective of this study was to identify the effect of diabetes mellitus (DM) on survival of patients with pancreatic cancer and to determine whether pancreatic cancer and its treatment affect glycemic control. From an institutional cancer registry, 226 patients with pancreatic cancer were identified and grouped by the presence of DM (n = 113) or absence of DM (n = 113). The groups were matched by age and year of pancreatic cancer diagnosis. Results indicated that DM does not decrease survival and that pancreatic cancer and its treatment do not affect the control of DM.

Dietary Inflammatory Index and Cardiovascular Risk and Mortality-A Meta-Analysis

Diet and chronic inflammation have been suggested to be risk factors in the development of cardiovascular disease (CVD) and related mortality. The possible link between the inflammatory potential of diet measured through the Dietary Inflammatory Index (DII^®) and CVD has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from 14 studies were eligible, of which two were case-control, eleven were cohort, and one was cross-sectional. Results from the random-effects meta-analysis showed a positive association between increasing DII, indicating a pro-inflammatory diet, and CVD. Individuals in the highest versus the lowest (reference) DII category showed a 36% increased risk of CVD incidence and mortality, with moderate evidence of heterogeneity (relative risk (RR) = 1.36, 95% confidence interval (CI): 1.19, 1.57; heterogeneity index I² = 69%, p < 0.001). When analyzed as a continuous variable, results showed an increased risk of CVD risk and mortality of 8% for each one-point increase in the DII score. Results remained unchanged when analyses were restricted to the prospective studies. Results of our meta-analysis support the importance of adopting a healthier anti-inflammatory diet for preventing CVD incidence and related mortality. In conclusion, a pro-inflammatory diet is associated with increased risk of CVD and CVD mortality. These results further substantiate the utility of DII as tool to characterize the inflammatory potential of diet and to predict CVD incidence and mortality.

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.

Inflammatory potential of diet and risk of pancreatic cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial

Inflammation plays a central role in pancreatic cancer etiology and can be modulated by diet. We aimed to examine the association between the inflammatory potential of diet, assessed with the Dietary Inflammatory Index (DII®), and pancreatic cancer risk in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial prospective cohort. Our study included 101,449 participants aged 52-78 years at baseline who completed both baseline questionnaire and a diet history questionnaire. Energy-adjusted DII (E-DII) scores were computed based on food and supplement intake. Cox proportional hazards models and time dependent Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with participants in the lowest E-DII quintile (most anti-inflammatory scores) as referent. After a median 8.5 years of follow-up, 328 pancreatic cancer cases were identified. E-DII scores were not associated with pancreatic cancer risk in the multivariable model (HR_Q5vsQ1  = 0.94; 95% CI = 0.66-1.35; p-trend = 0.43). Time significantly modified the association (p-interaction = 0.01). During follow up <4 years, there was suggestive evidence of an inverse association between E-DII and pancreatic cancer (HR_Q5vsQ1  = 0.60; 95% CI = 0.35-1.02; p-trend = 0.20) while there was a significant positive trend in the follow up ≥4 years (HR_Q5vsQ1  = 1.31; 95% CI = 0.83-2.08; p-trend = 0.03). Similar results were observed for E-DII from food only. Our study does not support an association between inflammatory potential of diet and pancreatic cancer risk; however, heterogeneous results were obtained with different follow-up times. These divergent associations may result from the influences of undetected disease in the short-term.

Dietary patterns and risk of pancreatic cancer: a systematic review

Context

Pancreatic cancer has the highest case fatality rate of all major cancers.

Objective

A systematic review using PRISMA guidelines was conducted to summarize the associations between dietary patterns and risk of pancreatic cancer.

Data Sources

PubMed and Web of Science databases were searched for case-control and cohort studies published up to June 15, 2016.

Study Selection

Eligible studies included a dietary pattern as exposure and pancreatic cancer incidence or mortality as outcome and reported odds ratios, hazard ratios, or relative risks, along with corresponding 95%CIs.

Data Extraction

Important characteristics of each study, along with the dietary assessment instrument, the component foods or nutrients included in each dietary pattern or the scoring algorithm of a priori dietary patterns, were presented. For each dietary pattern identified, the estimate of association and the 95%CI comparing the highest versus the lowest category from the model with the most covariate adjustment were reported.

Results

A total of 16 studies were identified. Among the 8 studies that examined data-driven dietary patterns, significant positive associations were found between pancreatic cancer risk and the Animal Products, Starch Rich, and Western dietary patterns, with effect estimates ranging from 1.69 to 2.40. Significant inverse relationships were found between risk of pancreatic cancer and dietary patterns designated as Fruits and Vegetables, Vitamins and Fiber, and Prudent, with effect estimates ranging from 0.51 to 0.55. Eight studies of a priori dietary patterns consistently suggested that improved dietary quality was associated with reduced risk of pancreatic cancer.

Conclusions

Better diet quality is associated with reduced risk of pancreatic cancer. The associations between dietary patterns and pancreatic cancer were stronger in case-control studies than in cohort studies and were stronger among men than among women.

Dietary inflammatory index and ovarian cancer risk in a New Jersey case-control study

OBJECTIVE

Diet may influence the development of ovarian cancer. Although it has been shown that inflammation plays an important etiologic role in ovarian carcinogenesis, little is known about the influence of the inflammatory potential of food consumption. The aim of this study was to evaluate the effect of a proinflammatory diet, as indicated by a high dietary inflammatory index (DII^®) score, on ovarian cancer risk, in a New Jersey population.

METHODS

Data from a case-control study conducted in New Jersey were used to estimate the relation between DII score and the risk for ovarian cancer. The study consisted of 205 cases with incident, histologically confirmed ovarian cancer, and 390 controls identified by random-digit dialing, based on Centers for Medicare & Medicaid Service lists, and area sampling. Computation of the DII was based on the intake of selected dietary factors assessed by a validated food frequency questionnaire (FFQ). Logistic regression models were fit to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potential covariates.

RESULTS

Although there was no significant association observed in pre- and perimenopausal women, a significant association was observed between the most proinflammatory DII scores and ovarian cancer among postmenopausal women (OR_{Quartile4 vs1}, 1.89; 95% CI, 1.02-3.52; P_trend = 0.03).

CONCLUSION

Findings from the present study suggested that a proinflammatory diet may increase risk for ovarian cancer among postmenopausal women, and warrants further study to confirm this association.

Association Between Consumption of Red and Processed Meat and Pancreatic Cancer Risk: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

The relationship between consumption of red and processed meat and pancreatic cancer risk is inconclusive. We conducted a systematic review and meta-analysis to analyze this relationship.

METHODS

We performed a systematic search of PubMed, EMBASE, and the Web of Science to identify studies that examined associations between consumption of different kinds of meat with pancreatic cancer and were published through February 2016. By using data from these articles, we associated level of consumption with cancer risk and performed subgroup, meta-regression, and publication bias analyses.

RESULTS

We collected and analyzed data from a total of 28 studies that involved 3,143,777 participants (11,325 consumers of red meat) and 2,904,866 participants (9955 consumers of processed meat). We observed statistically significant differences between consumers and non-consumers of these meats in case-control studies (red meat, P = .02; processed meat, P < .01) but not in cohort studies (red meat, P = .09; processed meat, P = .18). In cohort studies, a 100 g/day increase in red meat consumption was associated with significant increase in risk of pancreatic cancer (P = .01); a 50 g/day increase in processed meat consumption was not associated with significant increase in risk of pancreatic cancer (P = .90). In cohort studies, we observed associations in consumption of red meat by men and pancreatic cancer (P < .01) and consumption of processed meat by men and pancreatic cancer (P < .01) but no associations for women (red meat, P = .61; processed meat, P = .88).

CONCLUSIONS

In a systematic review and meta-analysis, we found case-control but not cohort studies to associate consumption of red and processed meat with risk of pancreatic cancer. However, in cohort studies, consumption of red and processed meat appeared to increase risk of pancreatic cancer in men but not in women.

The Inflammatory Potential of the Diet Is Associated with Depressive Symptoms in Different Subgroups of the General Population

Background: Low-grade chronic inflammation, which can be modulated by diet, has been suggested as an important risk factor for depression, but few studies have investigated the association between the inflammatory potential of the diet and depression.Objective: We investigated the prospective association between the inflammatory potential of the diet, measured by the Dietary Inflammatory Index (DII), and incident depressive symptoms and tested the potential modulating effect of sex, age, physical activity, and smoking status.Methods: This study included 3523 participants (aged 35-60 y) from the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) cohort, who were initially free of depressive symptoms. Baseline DII (1994-1996) was computed by using repeated 24-h dietary records. Incident depressive symptoms were defined by a Center for Epidemiologic Studies-Depression Scale score ≥17 for men and ≥23 for women in 2007-2009. We used multivariable logistic regression models to estimate ORs and 95% CIs, and modeled the DII as a continuous variable and as sex-specific quartiles.Results: A total of 172 cases of incident depressive symptoms were identified over a mean follow-up of 12.6 y. The DII was not associated with incident depressive symptoms in the full sample. In sex-specific models, men with a higher DII had a higher risk of incident depressive symptoms (quartile 4 compared with quartile 1-OR: 2.32; 95% CI: 1.01, 5.35), but the association was only marginally significant (P-trend = 0.06). When analyses were performed across smoking status, current and former smokers with a higher DII had a higher risk of incident depressive symptoms (quartile 4 compared with quartile 1-OR: 2.21; 95% CI: 1.08, 4.52). A positive association was also observed among less physically active participants (quartile 4 compared with quartile 1-OR: 2.07; 95% CI: 1.05, 4.07).Conclusion: The promotion of a healthy diet with anti-inflammatory properties may help to prevent depressive symptoms, particularly among men, smokers, or physically inactive individuals. This trial was registered at clinicaltrials.gov as NCT0027242.

Metformin Improves Survival in Patients with Pancreatic Ductal Adenocarcinoma and Pre-Existing Diabetes: A Propensity Score Analysis

OBJECTIVES

Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal disease. Diabetes mellitus (DM) is both a risk factor for and a sequela of PDAC. Metformin is a commonly prescribed biguanide oral hypoglycemic used for the treatment of type II DM. We investigated whether metformin use before PDAC diagnosis affected survival of patients with DM, controlling confounders such as diabetic severity.

METHODS

We used the Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database to identify patients with PDAC diagnosed between 2007 and 2011. The diabetic TO comorbidity severity index (DCSI) controlled for DM severity. Inverse propensity weighted Cox Proportional-Hazard Models assessed the association between metformin use and overall survival adjusting for relevant confounders.

RESULTS

We identified 1,916 patients with PDAC and pre-existing DM on hypoglycemic medications at least 1 year before cancer diagnosis. Of these, 1,098 (57.3%) were treated with metformin and 818 (42.7%) with other DM medications. Mean survival for those on metformin was 5.5 months compared with 4.2 months for those not on metformin (P<0.01). After adjusting for confounders including DCSI, Charlson score, and chronic kidney disease (CKD), patients on metformin had a 12% decreased risk of mortality compared with patients on other medications (hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.81-0.96, P<0.01). In stratified analysis, differences persisted regardless of the Charlson score, the DCSI score, the presence of kidney disease, or the use of insulin/other hypoglycemic medications (P<0.01 for all).

CONCLUSIONS

Metformin is associated with increased survival among diabetics with PDAC. If confirmed in a prospective study, then these results suggest a possible role for metformin as an adjunct to chemotherapy among diabetics with PDAC.