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Int J Cancer. 2020 Jan 16. doi: 10.1002/ijc.32870. [Epub ahead of print]

Inflammatory potential of the diet and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study.

Author information

1
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
2
Facultat Ciències Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain.
3
Department of Biostatistics and Informatics, Institute for Bioscience, University of the Republic, Montevideo, Uruguay.
4
Center for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
5
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
6
International Agency for Research on Cancer, Lyon, France.
7
Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany.
8
Department of Gastroenterology, Clinical Nutrition, Skåne University Hospital, Malmö, Sweden.
9
Department of Internal Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
10
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy.
11
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.
12
Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
13
Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy.
14
Department of Public Health, Aarhus University, Aarhus, Denmark.
15
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
16
Danish Cancer Society Research Center, Copenhagen, Denmark.
17
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.
18
Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
19
Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom.
20
Epidemiology and Prevention Unit, Fondazione IRCCS Instituto Nazionale dei Tumori di Milano, Milan, Italy.
21
Andalusian School of Public Health (EASP), Granada, Spain.
22
Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Universidad de Granada, Granada, Spain.
23
CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
24
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
25
Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain.
26
Department of Functional Biology, Oviedo University, Oviedo, Spain.
27
Navarra Public Health Institute, Pamplona, Spain.
28
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
29
CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.
30
Gustave Roussy, Villejuif, France.
31
Department of Gastroenterology, Bicêtre University Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
32
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
33
Hellenic Health Foundation, Athens, Greece.
34
Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
35
Cancer Registry and Histopathology Department, "Civic-M.P.Arezzo" Hospital, Ragusa, Italy.
36
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
37
Department of Public Health, The University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

Proinflammatory diets are associated with risk of developing colorectal cancer (CRC), however, inconsistencies exist in subsite- and sex-specific associations. The relationship between CRC and combined lifestyle-related factors that contribute toward a low-grade inflammatory profile has not yet been explored. We examined the association between the dietary inflammatory potential and an inflammatory profile and CRC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. This cohort included 476,160 participants followed-up of 14 years and 5,991 incident CRC cases (3,897 colon and 2,094 rectal tumors). Dietary inflammatory potential was estimated using an Inflammatory Score of the Diet (ISD). An Inflammatory Profile Score (IPS) was constructed, incorporating the ISD, physical activity level and abdominal obesity. The associations between the ISD and CRC and IPS and CRC were assessed using multivariable regression models. More proinflammatory diets were related to a higher CRC risk, particularly for colon cancer; hazard ratio (HR) for highest versus lowest ISD quartile was 1.15 (95% confidence interval [CI] 1.04-1.27) for CRC, 1.24 (95% CI 1.09-1.41) for colon cancer and 0.99 (95% CI 0.83-1.17) for rectal cancer. Associations were more pronounced in men and not significant in women. The IPS was associated with CRC risk, particularly colon cancer among men; HRs for the highest versus lowest IPS was 1.62 (95% CI 1.31-2.01) for colon cancer overall and 2.11 (95% CI 1.50-2.97) for colon cancer in men. Our study shows that more proinflammatory diets and a more inflammatory profile are associated with higher risk of CRC, principally colon cancer and in men.

KEYWORDS:

Europe; association; colorectal cancer; epidemiology; inflammatory potential of the diet; prospective cohort

PMID:
31945199
DOI:
10.1002/ijc.32870

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