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Meta-analysis of the association between the dietary inflammatory index (DII) and breast cancer risk

European Journal of Clinical Nutrition (2018) | Download Citation



Recent studies have reported mixed results on the association between the pro-inflammatory dietary index and risk of breast cancer. We perform this comprehensive meta-analysis to figure out whether high dietary inflammatory index (DII) score is a risk factor for the occurrence of breast cancer.


We comprehensively searched the PubMed, EMBASE and Cochrane databases to identify included studies updated to September 12, 2017. All studies that reported risk estimates by comparing the highest DII score to the lowest were assessed.


A total of seven observational studies were identified: three case controls and four cohorts, involving 319,993 participants. Overall, the meta-analysis reported that individuals with the highest DII score were associated with a 25% increased risk of breast cancer versus those with the lowest DII score (relative risk [RR] = 1.25; 95% confidence interval [CI] 1.09–1.44; I2 = 82.7%, p = 0.000). Upon stratified analysis, significant positive associations remained for postmenopausal women (RR = 1.15; 95% CI 1.02–1.30; p = 0.020), case-control studies (RR = 1.68; 95% CI 1.13–2.49; p = 0.010), Asia (RR = 2.30; 95% CI 1.7–3.12; p = 0.0031) and Europe (RR = 1.26; 95% CI 1.01–1.58; p = 0.0477). When analysed on hormonal receptor status, 36% increased risk was explored for hormone-receptor negative.


This meta-analysis suggested that more pro-inflammatory diets (higher DII scores) are associated with increased breast cancer incidence. However, the research is not about significant associations but about moderate effect sizes.

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This research was supported by National Natural Science Foundation of China (No. 81473513).

Author contributions

LW and CL contributed equally to this paper and are co-first authors. LW, CL and CS designed the research; FF, LL and TZ searched databases and collected full-text papers; LW, CL and CZ interpreted and extracted the data; LW, CL and LZ wrote the manuscript; CS and JT secured funds, supervised the study and made critical revision of the manuscript. All authors have read and approved the final manuscript.

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Author notes

  1. These author contributed equally: Lu Wang, Cun Liu.


  1. College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, 250014, Jinan, Shandong Province, China

    • Lu Wang
    • , Cun Liu
    •  & Tingting Zhang
  2. Department of Oncology, Weifang Traditional Chinese Hospital, 261041, Weifang, Shandong Province, China

    • Chao Zhou
    • , Jing Zhuang
    • , Shifeng Tang
    • , Fubin Feng
    •  & Lijuan Liu
  3. University of California, San Francisco, CA, 94158, USA

    • Jintai Yu
  4. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 730000, Lanzhou, Gansu Province, China

    • Jinhui Tian
  5. Department of Oncology, Affilited Hospital of Weifang Medical University, 261031, Weifang, Shandong Province, China

    • Changgang Sun


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Correspondence to Changgang Sun.

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