Development of Dietary Inflammatory Index in Cancer Prevention
This content discusses the development and validation of a literature-derived population-based index to evaluate the inflammatory potential of diets in cancer prevention. It explores the associations between various dietary factors and inflammatory biomarkers, aiming to assess the impact of diet on inflammation levels. The content also highlights the importance of adherence to specific dietary patterns in reducing colorectal cancer risk and the influence of inflammation on cancer development, particularly in conditions like ulcerative colitis and Crohn's disease.
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Fred Tabung, PhD(c), MSPH Department of Epidemiology and Biostatistics Cancer Prevention and Control Program Arnold School of Public Health, USC 4thAnnual USC Center for Research in Nutrition and Health Disparities, Annual Symposium March 21, 2014
Literature-derived population-based index to assess the inflammatory potential of diet Developed from published associations of 45 dietary factors (macronutrients, micronutrients and foods) and six inflammatory biomarkers Assesses the inflammatory potential of an individual s diet on a continuum from maximally anti- inflammatory to maximally pro-inflammatory Validated using data on hsCRP and 24-hour dietary recall interviews (24HR) and 7-day dietary recalls (7DDR) CANCER PREVENTION & CONTROL PROGRAM
Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR. Designing and Developing a Literature-derived, Population- based Dietary Inflammatory Index. Public Health Nutr 2013; S1368980013002115 [pii]; 10.1017/S1368980013002115 [doi]:1-8. Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Tabung FK, Hebert JR. A Population-based Dietary Inflammatory Index Predicts Levels of C-Reactive Protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr 2013; S1368980013002565 [pii]; 10.1017/S1368980013002565 [doi]:1-9. CANCER PREVENTION & CONTROL PROGRAM
Q1 (-7.055, <- 3.136) (healthiest) 2.71 3.15 5.86 0.07 0.63 0.44 0.08 0.26 0.34 5.89 1.73 0.97 2.30 Q5 (1.953, 5.636) (least healthy) 1.73 2.00 3.73 0.07 0.76 0.38 0.02 0.17 0.18 4.47 1.12 0.71 1.76 Food group (medium servings/day) Q2 (-3.136, <-1.995) Q3 (-1.995, <- 0.300) Q4 (-0.300, <1.953) 2.04 2.30 4.34 0.07 0.73 0.40 0.02 0.20 0.22 4.69 1.24 0.88 2.06 1.85 2.12 3.97 0.07 0.74 0.38 0.02 0.18 0.20 4.55 1.17 0.80 1.92 1.73 2.00 3.73 0.07 0.76 0.38 0.02 0.17 0.18 4.47 1.12 0.71 1.76 Fruits Vegetables Combo Fruit/Veg Fish Red meat Poultry Soy Nuts Combo Nut/soy Grains Whole Grain Milk Dairy Actual intake data in the WHI CT-OS CANCER PREVENTION & CONTROL PROGRAM
About 65,000 American women are projected to be diagnosed with colorectal cancer (CRC) in 2014 3rd most commonly diagnosed cancer in women after breast and lung cancers Adherence to dietary patterns such as DASH, HEI and Med diet, has been shown to be associated with reduced CRC risk Evidence of an influence of inflammation on CRC: Patients with ulcerative colitis and Crohn's disease have an increased risk of developing CRC Reduced risk of colon cancer with use of aspirin or other NSAIDs CANCER PREVENTION & CONTROL PROGRAM
To utilize the DII to evaluate the association of the inflammatory potential of diet with risk of colorectal cancer in postmenopausal women CANCER PREVENTION & CONTROL PROGRAM
DII calculated from baseline FFQs (1993-1998) Both OS and CT data used Categorized into quintiles Participants followed until incident colorectal cancer or September 30, 2010 Colorectal cancer cases ascertained through a centralized physician adjudication process (n=1,922) CANCER PREVENTION & CONTROL PROGRAM
Excluded from analysis: Women who reported previous CRC at baseline or missing previous CRC status at baseline Women with implausible reported total energy intake values ( 600 kcal/d or 5000 kcal/d) or extreme body mass index (BMI) values ( 15kg/m2or 50kg/m2) Multiple covariate-adjusted Cox proportional hazards (PH) regression models used to calculate hazard ratios (HR) for: colorectal cancer colon cancer proximal colon cancer distal colon cancer rectal cancer CANCER PREVENTION & CONTROL PROGRAM
Lowest DII quintile (most anti-inflammatory diet) was the referent for all models Potential effect modification by waist-to-hip ratio, waist circumference, BMI, and NSAID use, investigated by stratifying on these covariates in the Cox PH models Tests of linear trend adjusted for covariates, computed by assigning the median value of each quintile to each participant in the quintile Sensitivity analyses- exclusion of CRC cases that occurred within 3 years from baseline Analyses by stage of CRC at diagnosis (localized, regional and distant) CANCER PREVENTION & CONTROL PROGRAM
Total energy intake Age BMI Race/ethnicity Educational level Physical activity Family history of colorectal cancer Diabetes Hypertension Arthritis History of colonoscopy History of occult blood tests NSAID use Category & duration of estrogen use Category & duration of combined estrogen & progesterone use DM arm, HRT arm, and CaD arm CANCER PREVENTION & CONTROL PROGRAM
Risk of colorectal cancer across quintiles of the DII Q1 (-7.055, <- 3.136) (healthiest) Referent Q5 (1.953, 5.636) (least healthy) HR (95%CI) Q3 (-1.995, <- 0.300) HR (95%CI) Ptrend 1.00 0.98 (0.84, 1.14) 0.02 Colorectal cancer 1.22 (1.05, 1.43) Colorectal cancer cases, 1922 365 (19.0%) 360 (18.7%) 435 (22.6%) 1.00 0.98 (0.83, 1.15) 0.02 Colon cancer 1.23 (1.03, 1.47) 299 (19.2%) 289 (18.5%) 346 (22.2%) Colon cancer cases, 1560 1.00 0.98 (0.79, 1.20) 0.01 Proximal colon 1.35 (1.09, 1.67) Proximal colon cancer cases, 1034 193 (18.7%) 181 (17.5%) 229 (22.2%) CANCER PREVENTION & CONTROL PROGRAM
HRs were strengthened when CRC cases that developed within 3 years from baseline were excluded, e.g. HR Q5vsQ1 for colon cancer: 1.36 (1.11, 1.66), Ptrend=0.003 HRs for CRC differed by category of NSAID use: Pinteraction=0.26 Non-NSAID users: 1.31 (1.05, 1.65)Q5vsQ1, Ptrend=0.03 NSAID users: 1.11 (0.89, 1.38) Q5vsQ1, Ptrend=0.61 No significant association with: Distal colon cancer Rectal cancer CRC stage at diagnosis CANCER PREVENTION & CONTROL PROGRAM
Study limited to postmenopausal women FFQ measurement error Diet assessment at only one time point CANCER PREVENTION & CONTROL PROGRAM
Consumption of pro-inflammatory diets increases the risk of colorectal cancer in older women, especially colon cancer located in the proximal colon Consumption of pro-inflammatory diets increases the risk of colorectal cancer in older women not regularly taking NSAIDs CANCER PREVENTION & CONTROL PROGRAM
Longitudinal Changes in Diet-related Inflammation and Risk of Cancer in Women An assessment of the inflammatory potential of diet over time in the Women s Health Initiative Changes in the DII over time and risk of colorectal cancer in women CANCER PREVENTION & CONTROL PROGRAM
Chair: Susan E. Steck USC Dept. of EPID/BIOS and Cancer Prevention and Control Program Members: Yunsheng Ma Angela D. Liese USC Dept. of EPID/BIOS and Center for Nutrition & Health Disparities Jiajia Zhang USC Dept. of Epidemiology & Biostatistics James R. Hebert USC Dept. of EPID/BIOS and Cancer Prevention and Control Program UMass Medical School CANCER PREVENTION & CONTROL PROGRAM
Lifang Hou Bette Caan Karen K. Johnson Yasmin Mossavar-Rahmani Albert Einstein College of Jean Wactawski-Wende Judith K. Ockene Nitin Shivappa Northwestern Univ. Feinberg School of Medicine Kaiser Permanente Division of Research Univ. of Tennessee Health Science Center Medicine SUNY Dept. of Social and Preventive Medicine UMass Medical School USC Dept. of EPID/BIOS and Cancer Prevention and Control Program CANCER PREVENTION & CONTROL PROGRAM
Mr. Tabung was supported by an NIH F31 National Research Service Predoctoral Award, a USC SPARC grant and a fellowship from the USC Center for Colon Cancer Research Drs. Steck and Zhang were supported by the Prevent Cancer Foundation - Living in Pink grant Dr. H bert was supported by an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the National Cancer Institute (K05 CA136975). Funding for DII development was provided by the CPCP The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. CANCER PREVENTION & CONTROL PROGRAM
