Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis

doi:10.3390/nu9091043

Review

. 2017 Sep 20;9(9):1043.

doi: 10.3390/nu9091043.

Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis

Nitin Shivappa^{1

2

3}, Justyna Godos⁴, James R Hébert^{5

6

7}, Michael D Wirth^{8

9

10}, Gabriele Piuri¹¹, Attilio F Speciani¹², Giuseppe Grosso^{13

14}

Affiliations

¹ Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA. shivappa@mailbox.sc.edu.
² Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. shivappa@mailbox.sc.edu.
³ Connecting Health Innovations LLC, Columbia, SC 29201, USA. shivappa@mailbox.sc.edu.
⁴ Inflammation Society, Church Hill, Orpington, London BR6OHH, UK. justynagodos@gmail.com.
⁵ Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA. JHEBERT@mailbox.sc.edu.
⁶ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. JHEBERT@mailbox.sc.edu.
⁷ Connecting Health Innovations LLC, Columbia, SC 29201, USA. JHEBERT@mailbox.sc.edu.
⁸ Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA. wirthm@mailbox.sc.edu.
⁹ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. wirthm@mailbox.sc.edu.
¹⁰ Connecting Health Innovations LLC, Columbia, SC 29201, USA. wirthm@mailbox.sc.edu.
¹¹ Inflammation Society, Church Hill, Orpington, London BR6OHH, UK. gabriele.piuri@studiospeciani.it.
¹² Inflammation Society, Church Hill, Orpington, London BR6OHH, UK. attilio.speciani@me.com.
¹³ Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy. giuseppe.grosso@studium.unict.it.
¹⁴ NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK. giuseppe.grosso@studium.unict.it.

PMID: 28930191
PMCID: PMC5622803
DOI: 10.3390/nu9091043

Review

Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis

Nitin Shivappa et al. Nutrients. 2017.

. 2017 Sep 20;9(9):1043.

doi: 10.3390/nu9091043.

Authors

Nitin Shivappa^{1

2

3}, Justyna Godos⁴, James R Hébert^{5

6

7}, Michael D Wirth^{8

9

10}, Gabriele Piuri¹¹, Attilio F Speciani¹², Giuseppe Grosso^{13

14}

Affiliations

¹ Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA. shivappa@mailbox.sc.edu.
² Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. shivappa@mailbox.sc.edu.
³ Connecting Health Innovations LLC, Columbia, SC 29201, USA. shivappa@mailbox.sc.edu.
⁴ Inflammation Society, Church Hill, Orpington, London BR6OHH, UK. justynagodos@gmail.com.
⁵ Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA. JHEBERT@mailbox.sc.edu.
⁶ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. JHEBERT@mailbox.sc.edu.
⁷ Connecting Health Innovations LLC, Columbia, SC 29201, USA. JHEBERT@mailbox.sc.edu.
⁸ Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA. wirthm@mailbox.sc.edu.
⁹ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA. wirthm@mailbox.sc.edu.
¹⁰ Connecting Health Innovations LLC, Columbia, SC 29201, USA. wirthm@mailbox.sc.edu.
¹¹ Inflammation Society, Church Hill, Orpington, London BR6OHH, UK. gabriele.piuri@studiospeciani.it.
¹² Inflammation Society, Church Hill, Orpington, London BR6OHH, UK. attilio.speciani@me.com.
¹³ Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy. giuseppe.grosso@studium.unict.it.
¹⁴ NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge CB4 0WS, UK. giuseppe.grosso@studium.unict.it.

PMID: 28930191
PMCID: PMC5622803
DOI: 10.3390/nu9091043

Abstract

Diet and chronic inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet, measured through the Dietary Inflammatory Index (DII^®), and CRC has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from nine studies were eligible, of which five were case-control and four were cohort studies. Results from meta-analysis showed a positive association between increasing DII scores, indicating a pro-inflammatory diet, and CRC. Individuals in the highest versus the lowest (reference) DII category showed an overall 40% increased risk of CRC with moderate evidence of heterogeneity [relative risk (RR) = 1.40, 95% confidence interval (CI): 1.26, 1.55; I² = 69%, p < 0.001]. When analyzed as a continuous variable, results showed an increased risk of CRC of 7% for a 1-point increase in the DII score. Results remained unchanged when analyses were restricted to the four prospective studies. Results of our meta-analysis support the importance of adopting a healthier anti-inflammatory diet in preventing CRC. These results further substantiate the utility of DII as tool to characterize the inflammatory potential of diet and to predict CRC.

Keywords: colorectal cancer; cytokines; diet; dietary inflammatory index; epidemiology; inflammation; meta-analysis; nutrition.

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Conflict of interest statement

Disclosure: J.R.H. owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license 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. M.D.W. and N.S. are employees of CHI.

Figures

**Figure 1**
Flow chart and process selection of relevant studies exploring the association between Dietary Inflammatory Index (DII) and risk of colorectal, colon and rectal cancer.

**Figure 2**
Forest plot of summary relative risks (RRs) of colorectal cancer for the highest versus lowest (reference) category of Dietary Inflammatory Index (DII), for case-control, prospective and all studies.

**Figure 3**
Funnel plots for colorectal cancer risk of the highest versus lowest (reference) category of Dietary Inflammatory Index (DII): (a) case-control, (b) prospective, and (c) all studies.

**Figure 4**
Forest plot of summary relative risks (RRs) of colorectal cancer for a one-point increase of Dietary Inflammatory Index (DII), for case-control, prospective and all studies.

**Figure 5**
Funnel plots for colorectal cancer risk of a one-point increase of Dietary Inflammatory Index (DII): (a) case-control, (b) prospective, and (c) total studies.

**Figure 6**
Forest plot of summary relative risks (RRs) of colon and rectal cancer for the highest *versus* lowest (reference) category of Dietary Inflammatory Index (DII).

**Figure 7**
Funnel plots for colon and rectal cancer risk of the highest *versus* lowest (reference) category of Dietary Inflammatory Index (DII): (a) colon and (b) rectal.

See this image and copyright information in PMC

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References

1. IARC Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalance Worldwide 2012. [(accessed on 18 September 2017)]; Available online: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.
1. Vogel V.G., McPherson R.S. Dietary epidemiology of colon cancer. Hematol. Oncol. Clin. N. Am. 1989;3:35–63. - PubMed
1. Keibel A., Singh V., Sharma M.C. Inflammation, microenvironment, and the immune system in cancer progression. Curr. Pharm. Des. 2009;15:1949–1955. doi: 10.2174/138161209788453167. - DOI - PubMed
1. Pan M.H., Lai C.S., Dushenkov S., Ho C.T. Modulation of inflammatory genes by natural dietary bioactive compounds. J. Agric. Food Chem. 2009;57:4467–4477. doi: 10.1021/jf900612n. - DOI - PubMed
1. Coussens L.M., Werb Z. Inflammation and cancer. Nature. 2002;420:860–867. doi: 10.1038/nature01322. - DOI - PMC - PubMed

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[1] IARC Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalance Worldwide 2012. [(accessed on 18 September 2017)]; Available online: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.

[2] IARC Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalance Worldwide 2012. [(accessed on 18 September 2017)]; Available online: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.

[3] Vogel V.G., McPherson R.S. Dietary epidemiology of colon cancer. Hematol. Oncol. Clin. N. Am. 1989;3:35–63. - PubMed

[4] Vogel V.G., McPherson R.S. Dietary epidemiology of colon cancer. Hematol. Oncol. Clin. N. Am. 1989;3:35–63. - PubMed

[5] Keibel A., Singh V., Sharma M.C. Inflammation, microenvironment, and the immune system in cancer progression. Curr. Pharm. Des. 2009;15:1949–1955. doi: 10.2174/138161209788453167. - DOI - PubMed

[6] Keibel A., Singh V., Sharma M.C. Inflammation, microenvironment, and the immune system in cancer progression. Curr. Pharm. Des. 2009;15:1949–1955. doi: 10.2174/138161209788453167. - DOI - PubMed

[7] Pan M.H., Lai C.S., Dushenkov S., Ho C.T. Modulation of inflammatory genes by natural dietary bioactive compounds. J. Agric. Food Chem. 2009;57:4467–4477. doi: 10.1021/jf900612n. - DOI - PubMed

[8] Pan M.H., Lai C.S., Dushenkov S., Ho C.T. Modulation of inflammatory genes by natural dietary bioactive compounds. J. Agric. Food Chem. 2009;57:4467–4477. doi: 10.1021/jf900612n. - DOI - PubMed

[9] Coussens L.M., Werb Z. Inflammation and cancer. Nature. 2002;420:860–867. doi: 10.1038/nature01322. - DOI - PMC - PubMed

[10] Coussens L.M., Werb Z. Inflammation and cancer. Nature. 2002;420:860–867. doi: 10.1038/nature01322. - DOI - PMC - PubMed

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Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis

Affiliations

Dietary Inflammatory Index and Colorectal Cancer Risk-A Meta-Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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