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J Nutr. 2019 Sep 1;149(9):1606-1616. doi: 10.1093/jn/nxz098.

Prediagnostic Proinflammatory Dietary Potential Is Associated with All-Cause Mortality among African-American Women with High-Grade Serous Ovarian Carcinoma.

Author information

Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA.
Cancer Prevention and Control Program.
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Connecting Health Innovations LLC, Columbia, SC.
Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX.
Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI.
Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
Department of Epidemiology, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA.
Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN.



Chronic inflammation is associated with ovarian carcinogenesis; yet, the impact of inflammatory-related exposures on outcomes has been understudied.


Given the poor survival of women diagnosed with ovarian cancer, especially African-Americans, we examined whether diet-associated inflammation, a modifiable source of chronic systemic inflammation measured by the dietary inflammatory index (DII), was associated with all-cause mortality among African-American women with ovarian carcinoma.


Data were available from 490 ovarian carcinoma patients enrolled in a population-based case-control study of African-American women with ovarian cancer, the African-American Cancer Epidemiology Study. Energy-adjusted DII (E-DII) scores were calculated based on prediagnostic dietary intake of foods alone or foods and supplements, which was self-reported using the 2005 Block Food Frequency Questionnaire. Cox proportional hazards regression was used to estimate risk of mortality overall and for the most common histotype, high-grade serous carcinoma. Additionally, we assessed interaction by age at diagnosis and smoking status.


Women included in this study had a median age of 57 y, and the majority of women were obese (58%), had late-stage disease (Stage III or IV, 66%), and had high-grade serous carcinoma (64%). Greater E-DII scores including supplements (indicating greater inflammatory potential) were associated with an increased risk of mortality among women with high-grade serous carcinoma (HR1-unit change: 1.08; 95% CI: 1.01, 1.17). Similar associations were observed for the E-DII excluding supplements, although not statistically significant (HR1-unit change: 1.07; 95% CI: 0.97, 1.17). There was an interaction by smoking status, where the positive association with mortality was present only among ever smokers (HRQuartile 4/Quartile 1: 2.36; 95% CI: 1.21, 4.60) but not among never smokers.


Greater inflammatory potential of prediagnostic diet may adversely impact prognosis among African-American women with high-grade serous carcinoma, and specifically among ever smokers.


African-American women; cancer epidemiology; diet; dietary inflammatory index; gynecologic malignancies; inflammation; ovarian cancer; race/ethnicity


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