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Epidemiology

Inflammatory potential of diet and colorectal carcinogenesis: a prospective longitudinal cohort

British Journal of Cancer volume 126, pages 1735–1743 (2022)Cite this article

Subjects

Abstract

Background

Acknowledging the role of inflammation in colorectal carcinogenesis, this study aimed to evaluate the associations between diet-associated inflammation, as measured by the energy-adjusted dietary inflammatory index (E-DIITM), and distinct stages of colorectal carcinogenesis.

Methods

The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial enrolled participants without a colorectal cancer history, who were asked to complete baseline questionnaires and food frequency questionnaires. To estimate the associations between the E-DII and risks of newly incident colorectal adenoma, recurrent adenoma, and colorectal cancer, multivariable-adjusted Cox proportional hazards regression models were employed.

Results

Among 101,680 participants, with an average age of 65 years, a total of 1177 incident colorectal adenoma cases, 895 recurrent adenoma cases and 1100 colorectal cancer cases were identified. Higher E-DII scores from food and supplement (HRQ5 vs Q1: 0.86 [0.69–1.06], Ptrend: 0.27) or from food only (HRQ5 vs Q1: 0.82 [0.64–1.05], Ptrend: 0.06) were not associated with higher risks of incident adenoma. However, the elevated risk of recurrent adenoma was found in the highest category of E-DII from food plus supplement (HRQ5 vs Q1: 1.63 [1.28–2.03], Ptrend: < 0.001) when compared with the lowest category. A significant association between colorectal cancer risk and E-DII from food plus supplement (HRQ5 vs Q1: 1.34 [1.09–1.65], Ptrend: 0.009) was found, where this association was only pronounced in distal colorectal cancer.

Conclusion

Higher E-DII scores from diet plus supplement but not from diet only were associated with a higher risk of recurrent adenoma and distal colorectal cancer. The role of nutrient supplements on cancer risk, especially when combined with diet, needs to be elucidated in future studies.

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Data availability

Clinical and supplemental data that support the findings of this study have been deposited at https://biometry.nci.nih.gov/cdas/plco/. The PLCO trial has the following five registration numbers: NCT00002540 (Prostate), NCT01696968 (Lung), NCT01696981 (Colorectal), NCT01696994 (Ovarian) and NCT00339495 (EEMS) on ClinicalTrials.gov. This study had registered in Cancer Data Access System and had been approved.

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Acknowledgements

Thanks to the National Cancer Institute for providing access to data collected by the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Cancer Screening Trial. The statements contained herein are solely those of the authors and do not represent or imply concurrence or endorsement by the National Cancer Institute.

Funding

No financial support was received.

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Authors and Affiliations

  1. West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China

    Zhuyue Li, Hong Chen & Xiaolian Jiang

  2. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden

    Kang Wang

  3. Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Nitin Shivappa & James R. Hébert

  4. Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA

    Nitin Shivappa & James R. Hébert

  5. West China Second Hospital, Sichuan University, Chengdu, China

    Hui Liu

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Contributions

ZYL and XLJ conceived and designed the analysis. ZYL, HC and HL collected and processed the data. NS and JRH calculated E-DII scores. ZYL and KW performed the analysis. ZYL wrote the paper. ZYL, KW, JRH and XL.J revised the manuscript. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Xiaolian Jiang.

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Competing interests

Dr. JRH owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smartphone applications for patient counselling and dietary intervention in clinical settings. Dr. NS is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project. The remaining authors declare no competing interests.

Ethics approval and consent to participate

Institutional Review Board of the National Cancer Institute approved the study protocol of PLCO Cancer Screening Trial, and all participants provided a written informed consent.

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Li, Z., Wang, K., Shivappa, N. et al. Inflammatory potential of diet and colorectal carcinogenesis: a prospective longitudinal cohort. Br J Cancer 126, 1735–1743 (2022). https://doi.org/10.1038/s41416-022-01731-8

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