Dietary Inflammatory Index, Obesity, and the Incidence of Colorectal Cancer: Findings from a Hospital-Based Case-Control Study in Malaysia

Abstract

Obesity-mediated inflammation represents a key connection between the intake of foods with high inflammatory potential and colorectal cancer (CRC) risk. We aimed to explore the association between energy-adjusted dietary inflammatory index (E-DII) in relation to CRC risk in both obese and non-obese subjects. This study included 99 histopathologically confirmed CRC cases, 73 colonic polyps cases, and 141 healthy controls from tertiary medical centres in both urban and suburban areas in Peninsular Malaysia. The subjects were categorised into body mass index (BMI) < 25 kg/m2 and BMI ≥ 25 kg/m2 groups. E-DII scores were computed based on dietary intake assessed using a validated food frequency questionnaire (FFQ). Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential cofounders. The mean dietary energy intake and mean BMI values of the subjects tended to increase as the E-DII scores increased (p for trend < 0.001). E-DII was significantly related to CRC risk only in obese subjects (OR = 1.45; 95% CI = 1.30–1.77; p < 0.001 for trend). Stratified analyses of risk factors showed significant associations between E-DII and CRC risk by age group (p for interaction = 0.030), smoking status (p for interaction = 0.043), and anthropometric indices for both males and females (p for interaction < 0.001) in the most pro-inflammatory E-DII quartile vs. the lowest E-DII quartile. Overall, pro-inflammatory diets were associated with an increased incidence of CRC in the Malaysian population, particularly in obese subjects.

Association between Dietary Inflammatory Index and Risk of Colorectal Adenomatous Polyps in Kashgar Prefecture of Xinjiang, China

“…The mean of E-DII scores in the present study was −0.29, and the scores ranged from −4.33 to +3.48, where −4.33 and +3.48 represented the most anti- and pro-inflammatory scores, respectively. These results are similar to previous research findings [ 19 , 21 ]. Table 1 presents the descriptive characteristics of the 52 patients with CAP and the 194 controls.…”

“…This led to a relatively small sample size in the CAP group. As CAP are an important precursor to CRC, there is substantial evidence showing a positive correlation between DII and CRC [ 17 , 18 , 19 , 20 , 21 ]. Further research is needed to explore the association between E-DII and CAP.…”

“…Recent studies have explored the relationship between DII and the occurrence and development of CRC. In addition, dietary patterns with high levels of inflammation are positively associated with CRC [ 17 , 18 , 19 ]. Although CAP are an important precursor to CRC, scholars have different views on the association between E-DII and CAP.…”

“…However, some studies did not find a significant correlation between the DII and CAP. Consequently, more evidence is needed to clarify their relationship further [ 19 , 22 , 23 ]. Therefore, this study aimed to analyze the correlation between E-DII and the risk of CAP, providing a theoretical basis for conducting dietary intervention guidance and performing early screening for the high-risk population of patients with CAP in Kashgar while offering new perspectives for cancer prevention.…”

Understanding exposomes and its relation with cancer risk in Malaysia based on epidemiological evidence: a narrative review

“…Limited data representing Malaysia in this field of research making this review very short. In one of the recently published case-control study, pro-inflammatory diets which contains foods that may potentially promote inflammation within the body, such as food high in sugar, refined flour, saturated fats, and red and processed meats, were reported to be associated with an increased incidence of colorectal cancer in the Malaysian population, particularly in obese subjects [ 53 ]. From the same cohort of subjects, four main dietary patterns were identified: the allergenic diet, plant-based diet, processed diet, and energy-dense diet pattern.…”