Dietary Inflammatory Index and Risk of Colorectal Cancer in the Iowa Women's Health Study

Abstract

Background: Colorectal cancer, the third most common cancer in the United States, has a natural history that usually encompasses several decades. Dietary components have been implicated in the etiology of colorectal cancer, perhaps through their effect on inflammation.Methods: We examined the ability of the dietary inflammatory index (DII) to predict colorectal cancer in the Iowa Women's Health Study. The DII was computed based on dietary intake assessed by a 121-item food frequency questionnaire in this cohort of 34,703 women, ages 55 to 69 years, free of any self-reported prior malignancy at enrollment in 1986. Incident colorectal cancer cases were identified through linkage with the State Health Registry of Iowa (a Surveillance, Epidemiology, and End Results program member). Cox proportional hazards regression was used to estimate HRs. Through the end of 2010, 1,636 incident colorectal cancers were identified, including 1,329 colon and 325 rectal cancers.Results: Multivariable analysis, adjusting for body mass index, smoking status, pack-years of smoking, hormone replacement therapy, education, diabetes, and total energy intake, revealed positive associations between higher DII and colorectal cancer risk [HR for DII continuous : 1.07 per unit increase in DII (corresponding to 0.5 SD unit increase); 95% confidence interval (CI), 1.01-1.13; HR for DII quintiles : Q5 vs. Q1 ¼ 1.20; 95% CI, 1.01-1.43]. HRs for DII were similar for colon cancer and rectal cancer, though not statistically significant for rectal cancer.Conclusions: These results indicate that a proinflammatory diet, as indicated by higher DII scores, was associated with higher risk of developing colorectal cancer.Impact: Proinflammatory diets are associated with increased risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev; 23(11); 2383-92. Ó2014 AACR.

Dietary inflammatory index and inflammatory gene interactions in relation to colorectal cancer risk in the Bellvitge colorectal cancer case–control study

“…CRC risk was increased by 51 and 65 % when participants in the third and the fourth DII quartile, respectively, were compared with those in the first quartile. Similar results were previously observed in the Iowa Women's Health Study, although the CRC risk, in this cohort, was only increased by 20 % (Shivappa et al 2014a). Despite the limited evidence on the relationship between overall inflammatory effects of diet and CRC risk, other epidemiological studies have reported comparable associations between CRC risk and antiinflammatory foods (e.g., fruits and vegetables) (World Research Cancer Fund and American Institute for Cancer Research 2007), nutrients (e.g., fiber, selenium, and folate) (van Duijnhoven et al 2009), and other bioactive compounds (e.g., flavonoids) (Zamora-Ros et al 2013b).…”

“…In addition, higher circulating CRP and cytokine levels (inflammatory markers) have been associated with increased CRC risk in case-control studies, but in cohort studies, these associations have been less conclusive Our results suggest that the association of DII score with colon cancer risk could be stronger than with rectal cancer risk, but the interaction was not statistically significant. In other epidemiological studies, similar associations were reported for colon and rectal cancer risks with DII score (Shivappa et al 2014a), and intakes of fruits and vegetables, fiber, and flavonoids (World Research Cancer Fund and American Institute for Cancer Research 2007; Zamora- Ros et al 2013b;Murphy et al 2012). However, for circulating CRP levels, significant associations were observed only for colon cancer risk (Aleksandrova et al 2010;Wu et al 2013).…”

“…The DII has been validated demonstrating its effectiveness in predicting serum CRP levels in a large longitudinal epidemiological study (Shivappa et al 2014c). Previously, we observed that women with a pro-inflammatory diet (higher DII scores) had a higher risk of developing CRC in a US-based cohort study (Shivappa et al 2014a). Furthermore, higher DII scores have been linked to asthma (Wood et al 2014), and using a modification of the previous DII version (Hebert et al 2014), a positive association was observed between the DII and higher concentrations of glucose metabolism markers (van Woudenbergh et al 2013).…”

“…Moreover, circulating inflammatory biomarkers, such as C-reactive protein (CRP) (Aleksandrova et al 2010), cytokines, chemokines, and cell adhesion molecules (McClellan et al 2012;Song et al 2013), and some genes related to pro-inflammation (Landi et al 2003(Landi et al , 2007 tended to be associated with a higher CRC risk. Diet plays a crucial role in the etiology of CRC (World Research Cancer Fund and American Institute for Cancer Research 2007), although there is little evidence of the proinflammatory and anti-inflammatory effects of the overall diet on CRC risk (Shivappa et al 2014a).…”

Association between Maternal Dietary Inflammatory Index (DII) and abortion in Iranian women and validation of DII with serum concentration of inflammatory factors: case-control study

“…Dietary Inflammatory Index (DII) is a dietary tool developed to measure the inflammatory potential of individual's diet (Cavicchia et al 2009;Shivappa et al 2014a). DII has been shown to be predictive of levels of various inflammatory markers (Cavicchia et al 2009;Shivappa et al 2014b;Shivappa et al 2015b).…”