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Clinical nutrition

Dietary inflammatory index and bladder cancer risk: a prospective study



Dietary factors may play a role in bladder cancer etiology through modulation of inflammation. The purpose of this study was to examine the relationship between the inflammatory potential of diet, as estimated by the Dietary Inflammatory Index (DII®), and bladder cancer risk.


Energy-adjusted DII (E-DIITM) scores were computed among 101,721 participants in the Prostate, Lung, Colorectal, and Ovarian (PLCO) study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression analysis stratified by sex, with adjustment for smoking status and other confounding.


Over a median of 12.5 years of follow-up, 776 bladder cancer cases were diagnosed. E-DII scores were not associated with bladder cancer risk in the multivariable models. The HRs (95% CIs) in the highest compared with the lowest E-DII quintile were 0.90 (0.70–1.17) and 1.22 (0.72–2.06) for men and women, respectively. The associations did not differ when DII score was set as a continuous variable. The HRs (95% CIs) of one-unit increment in the E-DII for bladder cancer risk were 0.99 (0.96–1.02) and 1.01 (0.94–1.10) for men and women, respectively.


Our study does not support an association between inflammatory potential of diet, as estimated by the E-DII, and bladder cancer risk.

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Fig. 1: Dose-response analysis using restricted cubic spline model for the association between E-DII and bladder cancer risk in men and women, respectively.
Fig. 2: Subgroup analyses by potential effect modifiers including race (white, non-Hispanic vs. other), body mass index at the time of enrollment (<25 kg/m2 vs. ≥25 kg/m2), education (≤high school vs. ≥some college), smoking status (never vs. former vs. current), randomization arm (intervention vs. control), and marital status (married vs. not married).


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

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Authors and Affiliations



All the authors contributed to the work and approved the final version of the manuscript. Particularly, contributions were: study design: JL and XX; Data collection: XX; Data analyses and interpretation: XX, NS, JH; Manuscript drafting: JL and XX; Critical revision of the manuscript: XX, NS, JH.

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Correspondence to Xin Xu.

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Conflict of interest

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 smart phone applications for patient counseling and dietary intervention in clinical settings. NS is an employee of CHI. This study received no external sponsorship from industry. In addition, the subject matter of this paper will not have any direct bearing on the work of CHI, nor has any CHI activity exerted any influence on this project. The authors declare that they have no conflict of interest.

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Luo, J., Shivappa, N., Hébert, J.R. et al. Dietary inflammatory index and bladder cancer risk: a prospective study. Eur J Clin Nutr 74, 1428–1433 (2020).

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