Dietary inflammatory index and non-Hodgkin lymphoma risk in an Italian case–control study

Abstract

Background While dietary factors have been shown to play an important etiologic role in non-Hodgkin lymphoma (NHL), little is known about the association between inflammatory properties of diet and NHL risk. Methods We explored the association between the dietary inflammatory index (DII) and NHL risk in a multicentric Italian case-control study conducted between 1999 and 2014. Cases were 536 subjects with incident, histologically confirmed NHL from 3 areas in Italy. Controls were 984 subjects admitted to the same network of hospitals as the cases for acute, non-malignant conditions, unrelated to diet. DII scores were computed based on 30 nutrients and food items assessed using a reproducible and validated 78-item food frequency questionnaire. Odds ratios (ORs) were estimated through logistic regression models adjusting for age, total energy intake and other recognised or likely confounding factors. Results Subjects in the highest quartile of DII scores (i.e., with the most pro-inflammatory diets) had a higher risk of NHL compared to subjects in the lowest quartile (i.e., with the most anti-inflammatory diets) (ORQuartile4vs1= 1.61, 95% confidence interval, CI, 1.07, 2.43; p-trend=0.01). Stratified analyses produced stronger associations between DII and NHL among males (ORQuartile4vs1= 2.14; 95%CI=1.25, 3.67) with significant heterogeneity (p-value=0.02); when analysed by histological subtype, a significant association was observed with diffuse large B-cell lymphoma (ORQuartile4vs1= 1.84; 95%CI=1.09, 3.10). Conclusion A pro-inflammatory diet, as indicated by higher DII scores, is associated with elevated odds of NHL, especially among males.

Adherence to the mediterranean diet and lymphoma risk in the european prospective investigation into cancer and nutrition

“…In addition, several studies have consistently linked chronic inflammation or autoimmune conditions with lymphomagenesis and reported associations between plasma levels of cytokines, or other inflammatory markers, and lymphoma . Recent studies are supporting the inflammatory potential of diet; in particular, for lymphoid neoplasms, positive associations have been recently reported between a proinflammatory dietary score and NHL . Thus, the MD's favorable fatty acid profile, as well as a high intake of fiber, vitamins and flavonoids, may be relevant owing its properties.…”

“…[40][41][42] Recent studies are supporting the inflammatory potential of diet 43 ; in particular, for lymphoid neoplasms, positive associations have been recently reported between a proinflammatory dietary score and NHL. 44 Thus, the MD's favorable fatty acid profile, as well as a high intake of fiber, vitamins and flavonoids, may be relevant owing its properties.…”

Ageing: from inflammation to cancer

“…The “dietary inflammatory index” (DII) weights each major macronutrient and multiple micronutrients on the basis of their general proinflammatory effects, as measured, for example, by assessment of C-reactive protein in serum [ 63 ]. This index significantly correlates with the risk of developing postmenopausal breast cancer, colorectal cancer, lung cancer in smokers, non-Hodgkin lymphoma, bladder cancer, and nasopharyngeal carcinoma [ 70 – 75 ].…”

The Dietary Inflammatory Index and Chronic Lymphocytic Leukaemia in the MCC Spain Study

“…Clear associations have been reported for colorectal cancers [51,52] and gastric cancers [53], whereas the association with breast cancer is still inconclusive [54][55][56]. Regarding haematological cancers, other case-control studies looking into the association of DII (and DII-like tools) and other types of haematological cancers have been carried out [37,38], reporting positive associations between a pro-inflammatory diet and NHL and B-cell lymphoma subtypes. These findings were supported by the European Prospective Investigation into Cancer and Nutrition (EPIC) study for NHL and all mature B-cell subtypes [36].…”

“…This study, including 2606 non-Hodgkin lymphoma (NHL) cases and 537 CLL cases, used a modified version of the DII and showed no association between the inflammatory score of the diet and overall lymphoma as well as CLL risk [36]. In a couple of Italian case-control studies, DII has been shown to be associated with Non-Hodgkin's Lymphoma but not with Hodgkin's Lymphoma [37,38].…”