Antioxidant and inflammatory potential of diet among women at risk of cervical cancer: findings from a cross-sectional study in Italy

Abstract

Objective: To evaluate the association of Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII) with the prevalence of high-grade cervical intraepithelial neoplasia (CIN).

Design: A cross-sectional study was conducted on women with abnormal Papanicolaou test, who underwent high-risk human papillomavirus (HPV) screening and histological test through colposcopy. Dietary data were collected using a FFQ and used to assess both CDAI and DII.

Setting: Women were recruited from 2012 to 2015 at the Cervical Cancer Screening Unit of the 'Azienda Sanitaria Provinciale' of Catania (Italy).

Participants: The study included 539 women with a mean age of 40·2 years, who were classified as cases (n 127 with CIN2 or more severe lesions) and controls (n 412 with normal cervical epithelium or CIN1).

Results: Although we observed a lower proportion of HPV-positive women among those with higher CDAI (P < 0·001), the index was not associated with the diagnosis of CIN2 or more severe lesions. By contrast, women with medium or high DII showed higher odds to be diagnosed with CIN2 or more severe lesions than those with low DII (OR = 2·15; 95 % CI 1·11, 4·17; P = 0·024 and OR = 3·14; 95 % CI 1·50, 6·56; P = 0·002, respectively), after adjusting for age, HPV status, educational level, BMI, smoking status, parity, use of oral contraceptives and supplements.

Conclusions: Our findings suggested that a pro-inflammatory diet might be associated with an increased risk of CIN2 and more severe lesions. However, further prospective studies should be encouraged to support this evidence.

Keywords: Diet; HPV infection; Inflammation; Nutritional epidemiology; Oxidative stress.

Fig. 1

Description of the study population according to high-risk HPV status and histological diagnosis. CIN, cervical intraepithelial neoplasia; HPV, human papillomavirus

Fig. 2

Radar plot illustrating dietary intakes between cases and controls. This plot shows the Z-scores of dietary factors and their comparison between cases (CIN2 + women; blue line) and controls (women with diagnosis of normal cervical epithelium or CIN1; green line). CIN, cervical intraepithelial neoplasia

Fig. 3

Proportions of cases and controls across tertiles of Dietary Inflammatory Index (a) and Composite Dietary Antioxidant Index (b). The bars represent the proportion women with CIN2 or more severe lesions (cases; blue bars) and those with diagnosis of normal cervical epithelium or CIN1 (controls; green bars). ***P-value<0·001 based on the chi-square test