Inflammatory and insulinemic dietary patterns and risk of endometrial cancer among US women

Abstract

Background Whilst unopposed estrogen exposure is considered a major driver of endometrial carcinogenesis, chronic inflammation and insulin resistance/hyperinsulinemia are also major endometrial cancer risk factors. However, it is unclear whether diets with inflammatory or insulinemic potential are associated with risk of endometrial cancer. Methods We followed 48,330 women from the Nurses’ Health Study (NHS, 1984-2016) and 85,426 women from the Nurses’ Health Study II (NHSII, 1989-2017). Using food frequency questionnaires, we calculated repeated measures of empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores, that characterize the potential of the whole diet to modulate circulating biomarkers of inflammation or C-peptide, respectively. We used multivariable-adjusted Cox regression to estimate hazard ratios (HRs) and 95% CIs for type I endometrial cancer risk. Results We documented 1,462 type I endometrial cancer cases over 2,823,221 person-years of follow-up. In the pooled multivariable-adjusted analyses, women in the highest, compared with lowest quintiles were at higher risk of type I endometrial cancer (EDIP HRQ5vs.Q1 =1.46; 95% CI, 1.24-1.73, p-trend<.001; EDIH HRQ5vs.Q1 =1.58; 95% CI, 1.34-1.87, p-trend<.001). Additional adjustment for body mass index (BMI) attenuated the associations (EDIP HR, 1.03; 95% CI, 0.87-1.22; EDIH HR, 1.01; 95% CI, 0.85-1.21), and mediation analyses showed that BMI may explain 60.4% (37.4% -79.6%; p<.001) and 71.8% (41.0% -90.4%; p<.001) of the association of endometrial cancer with EDIP and EDIH, respectively. Conclusions In this large cohort study, higher dietary inflammatory and insulinemic potential were each associated with increased endometrial cancer incidence, and this association may be almost entirely mediated by adiposity.

Hyperinsulinemic and Pro-Inflammatory Dietary Patterns and Metabolomic Profiles Are Associated with Increased Risk of Total and Site-Specific Cancers among Postmenopausal Women

“…In the current study, both EDIH and EDIP were strongly associated with endometrial cancer risk, which attenuated after adjusting for obesity as a mediator. Similarly, a study in NHS and NHS-II cohorts applied the EDIH and EDIP scores and found strong associations with endometrial cancer, and showed that BMI mediated 84% and 93% of the associations, respectively [ 9 ]. Obesity is linked to inflammation and insulin resistance [ 41 ], and a study that analyzed data on 1.2 million women, found that each 10-kg/m 2 increment in BMI was associated with a nearly 3-fold increase in endometrial cancer risk [ 42 ].…”

“…EDIH and EDIP scores have shown stronger associations with cancer risk [ 6 , 7 , 8 , 9 , 10 , 11 ] than traditional dietary patterns in both men and women [ 12 , 13 ]. For example, dietary patterns including the Mediterranean diet and alternative healthy eating index, and other patterns, have not been consistently associated with cancer risk among women [ 14 ].…”

Chinese Empirical Dietary Inflammatory Index Is Associated with High Risk of Systematic Inflammation and Aging in Rural China

“…Empirical dietary in ammatory pattern (EDIP) is devised to capture overall in ammatory potential of whole diets, as described in more detail previously 9,19 . Brie y, 39 prede ned food groups were added into reduced-rank regression(RRR) models followed by stepwise linear regression analyses to develop a dietary pattern most predictive of in ammatory indices (tumor necrosis factor-α receptor 2(TNFαR2), interleukin-6(IL-6) and C-reactive protein (CRP)).…”

Prognostic impact of metabolic syndrome in patients with primary endometrial cancer: a retrospective bicentric study

“…Although unopposed estrogen exposure is considered a major driver of endometrial carcinogenesis, other additional factors such as chronic inflammation, insulin resistance, and hyperinsulinemia are allied to substantial risk factors for EC (Perez-Martin et al 2022 ; Siegel et al 2021 ). Previous epidemiological studies revealed that obesity, DM, and metabolic syndrome (MetS) are each linked to an increase in EC incidence, but their separate and combined influence on survival remains unclear (Raglan et al 2019 ; Perez-Martin et al 2022 ; Romanos-Nanclares et al 2023 ; Morice et al 2016 ). Conversely, Tang et al described in a meta-analysis the perceived protective effects of metformin intake leading to a decrease in incidence rates and an improvement in OS in EC Patients.…”