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Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women.
JAMA Oncol. 2018 Mar 01; 4(3):366-373.JO

Abstract

Importance

Inflammation is important in colorectal cancer development. Diet modulates inflammation and may thus be a crucial modifiable factor in colorectal cancer prevention.

Objective

To examine whether proinflammatory diets are associated with increased colorectal cancer risk by using an empirical dietary inflammatory pattern (EDIP) score based on a weighted sum of 18 food groups that characterizes dietary inflammatory potential based on circulating levels of inflammation biomarkers.

Design, Settings, and Participants

Cohort study of 46 804 men (Health Professionals Follow-up Study: 1986-2012) and 74 246 women (Nurses' Health Study: 1984-2012) followed for 26 years to examine associations between EDIP scores and colorectal cancer risk using Cox regression. We also examined associations in categories of alcohol intake and body weight. Data analysis began January 17, 2017, and was completed August 9, 2017.

Exposures

EDIP scores calculated from food frequency questionnaires administered every 4 years.

Main Outcomes and Measures

Incident colorectal cancer.

Results

We documented 2699 incident colorectal cancer cases over 2 571 831 person-years of follow-up. Compared with participants in the lowest EDIP quintile (Q) who had a colorectal cancer incidence rate (per 100 000 person-years) of 113 (men) and 80 (women), those in the highest Q had an incidence rate of 151 (men) and 92 (women), leading to an unadjusted rate difference of 38 and 12 more colorectal cancer cases, respectively, among those consuming highly proinflammatory diets. Comparing participants in the highest vs lowest EDIP Qs in multivariable-adjusted analyses, higher EDIP scores were associated with 44% (men: hazard ratio [HR], 1.44; 95% CI, 1.19-1.74; P < .001 for trend), 22% (women: HR, 1.22; 95% CI, 1.02-1.45; P = .007 for trend), and 32% (men and women: pooled HR, 1.32; 95% CI, 1.12-1.55; P < .001 for trend) higher risk of developing colorectal cancer. In both men and women, associations were observed in all anatomic subsites except for the rectum in women. In subgroups (P ≤ .02 for all interactions), associations differed by alcohol intake level, with stronger associations among men (Q5 vs Q1 HR, 1.62; 95% CI, 1.05-2.49; P = .002 for trend) and women (Q5 vs Q1 HR, 1.33; 95% CI, 0.97-1.81; P = .03 for trend) not consuming alcohol; and by body weight, with stronger associations among overweight/obese men (Q5 vs Q1 HR, 1.48; 95% CI, 1.12-1.94; P = .008 for trend) and lean women (Q5 vs Q1 HR, 1.31; 95% CI, 0.99-1.74; P = .01 for trend).

Conclusions and Relevance

Findings suggest that inflammation is a potential mechanism linking dietary patterns and colorectal cancer development. Interventions to reduce the adverse role of proinflammatory diets may be more effective among overweight/obese men and lean women or men and women who do not consume alcohol.

Authors+Show Affiliations

Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, P.R. China.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Nutrition, Simmons College, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Massachusetts.Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Massachusetts.Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Massachusetts. Smilow Cancer Hospital at Yale University Cancer Center, New Haven, Connecticut.Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29346484

Citation

Tabung, Fred K., et al. "Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women." JAMA Oncology, vol. 4, no. 3, 2018, pp. 366-373.
Tabung FK, Liu L, Wang W, et al. Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women. JAMA Oncol. 2018;4(3):366-373.
Tabung, F. K., Liu, L., Wang, W., Fung, T. T., Wu, K., Smith-Warner, S. A., Cao, Y., Hu, F. B., Ogino, S., Fuchs, C. S., & Giovannucci, E. L. (2018). Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women. JAMA Oncology, 4(3), 366-373. https://doi.org/10.1001/jamaoncol.2017.4844
Tabung FK, et al. Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women. JAMA Oncol. 2018 Mar 1;4(3):366-373. PubMed PMID: 29346484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women. AU - Tabung,Fred K, AU - Liu,Li, AU - Wang,Weike, AU - Fung,Teresa T, AU - Wu,Kana, AU - Smith-Warner,Stephanie A, AU - Cao,Yin, AU - Hu,Frank B, AU - Ogino,Shuji, AU - Fuchs,Charles S, AU - Giovannucci,Edward L, PY - 2018/1/19/pubmed PY - 2019/9/12/medline PY - 2018/1/19/entrez SP - 366 EP - 373 JF - JAMA oncology JO - JAMA Oncol VL - 4 IS - 3 N2 - Importance: Inflammation is important in colorectal cancer development. Diet modulates inflammation and may thus be a crucial modifiable factor in colorectal cancer prevention. Objective: To examine whether proinflammatory diets are associated with increased colorectal cancer risk by using an empirical dietary inflammatory pattern (EDIP) score based on a weighted sum of 18 food groups that characterizes dietary inflammatory potential based on circulating levels of inflammation biomarkers. Design, Settings, and Participants: Cohort study of 46 804 men (Health Professionals Follow-up Study: 1986-2012) and 74 246 women (Nurses' Health Study: 1984-2012) followed for 26 years to examine associations between EDIP scores and colorectal cancer risk using Cox regression. We also examined associations in categories of alcohol intake and body weight. Data analysis began January 17, 2017, and was completed August 9, 2017. Exposures: EDIP scores calculated from food frequency questionnaires administered every 4 years. Main Outcomes and Measures: Incident colorectal cancer. Results: We documented 2699 incident colorectal cancer cases over 2 571 831 person-years of follow-up. Compared with participants in the lowest EDIP quintile (Q) who had a colorectal cancer incidence rate (per 100 000 person-years) of 113 (men) and 80 (women), those in the highest Q had an incidence rate of 151 (men) and 92 (women), leading to an unadjusted rate difference of 38 and 12 more colorectal cancer cases, respectively, among those consuming highly proinflammatory diets. Comparing participants in the highest vs lowest EDIP Qs in multivariable-adjusted analyses, higher EDIP scores were associated with 44% (men: hazard ratio [HR], 1.44; 95% CI, 1.19-1.74; P < .001 for trend), 22% (women: HR, 1.22; 95% CI, 1.02-1.45; P = .007 for trend), and 32% (men and women: pooled HR, 1.32; 95% CI, 1.12-1.55; P < .001 for trend) higher risk of developing colorectal cancer. In both men and women, associations were observed in all anatomic subsites except for the rectum in women. In subgroups (P ≤ .02 for all interactions), associations differed by alcohol intake level, with stronger associations among men (Q5 vs Q1 HR, 1.62; 95% CI, 1.05-2.49; P = .002 for trend) and women (Q5 vs Q1 HR, 1.33; 95% CI, 0.97-1.81; P = .03 for trend) not consuming alcohol; and by body weight, with stronger associations among overweight/obese men (Q5 vs Q1 HR, 1.48; 95% CI, 1.12-1.94; P = .008 for trend) and lean women (Q5 vs Q1 HR, 1.31; 95% CI, 0.99-1.74; P = .01 for trend). Conclusions and Relevance: Findings suggest that inflammation is a potential mechanism linking dietary patterns and colorectal cancer development. Interventions to reduce the adverse role of proinflammatory diets may be more effective among overweight/obese men and lean women or men and women who do not consume alcohol. SN - 2374-2445 UR - https://www.unboundmedicine.com/medline/citation/29346484/Association_of_Dietary_Inflammatory_Potential_With_Colorectal_Cancer_Risk_in_Men_and_Women_ L2 - https://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2017.4844 DB - PRIME DP - Unbound Medicine ER -