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The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women’s Health Initiative

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Abstract

Purpose

Inflammation is a process central to carcinogenesis and in particular to colorectal cancer (CRC). Previously, we developed a dietary inflammatory index (DII) from extensive literature review to assess the inflammatory potential of diet. In the current study, we utilized this novel index in the Women’s Health Initiative to prospectively evaluate its association with risk of CRC in postmenopausal women.

Methods

The DII was calculated from baseline food frequency questionnaires administered to 152,536 women aged 50–79 years without CRC at baseline between 1993 and 1998 and followed through 30 September 2010. Incident CRC cases were ascertained through a central physician adjudication process. Multiple covariate-adjusted Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95 % confidence intervals (95 % CI) for colorectal, colon (proximal/distal locations), and rectal cancer risk, by DII quintiles (Q).

Results

During an average 11.3 years of follow-up, a total of 1,920 cases of CRC (1,559 colon and 361 rectal) were identified. Higher DII scores (representing a more pro-inflammatory diet) were associated with an increased incidence of CRC (HRQ5–Q1 1.22; 95 % CI 1.05, 1.43; p trend = 0.02) and colon cancer, specifically proximal colon cancer (HRQ5–Q1 1.35; 95 % CI 1.05, 1.67; p trend = 0.01) but not distal colon cancer (HRQ5–Q1 0.84; 95 % CI 0.61, 1.18; p trend = 0.63) or rectal cancer (HRQ5–Q1 1.20; 95 % CI 0.84, 1.72; p trend = 0.65).

Conclusion

Consumption of pro-inflammatory diets is associated with an increased risk of CRC, especially cancers located in the proximal colon. The absence of a significant association for distal colon cancer and rectal cancer may be due to the small number of incident cases for these sites. Interventions that may reduce the inflammatory potential of the diet are warranted to test our findings, thus providing more information for colon cancer prevention.

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Acknowledgments

This project is supported by the Prevent Cancer Foundation Living in Pink grant. The University of South Carolina SPARC grant supported Dr. Fred Tabung, and the National Institutes of Health/National Cancer Institute provided support to Dr. James Hebert (via U54 CA153461 and K05 CA136975). Dr. Yunsheng Ma was partly supported by grant Nos. 1R21 DK083700-01A1 and 1R01HL094575-01A1. The National Institutes of Health funded the WHI program through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.

Conflict of interest

All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Discovery I Building, Columbia, SC, 29208, USA

    Fred K. Tabung, Susan E. Steck, Nitin Shivappa & James R. Hebert

  2. Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA

    Fred K. Tabung, Susan E. Steck, Angela D. Liese, Jiajia Zhang, Nitin Shivappa & James R. Hebert

  3. Center for Research in Nutrition and Health Disparities, University of South Carolina, Columbia, SC, USA

    Susan E. Steck, Angela D. Liese & James R. Hebert

  4. Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Yunsheng Ma & Judith K. Ockene

  5. Division of Research, Kaiser Permanente, Oakland, CA, USA

    Bette Caan

  6. Department of Preventive Medicine and The Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Lifang Hou

  7. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Karen C. Johnson

  8. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Yasmin Mossavar-Rahmani

  9. Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, NY, USA

    Jean Wactawski-Wende

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  1. Fred K. Tabung
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  2. Susan E. Steck
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  3. Yunsheng Ma
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  4. Angela D. Liese
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  5. Jiajia Zhang
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  6. Bette Caan
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  10. Nitin Shivappa
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  11. Jean Wactawski-Wende
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  12. Judith K. Ockene
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  13. James R. Hebert
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Corresponding author

Correspondence to Susan E. Steck.

Appendix: Short list of WHI investigators

Appendix: Short list of WHI investigators

Program Office (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam, Dale Burwen, Joan McGowan, Leslie Ford, and Nancy Geller.

Clinical Coordinating Center (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kooperberg.

Investigators and Academic Centers (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) JoAnn E. Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thomson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; and (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker.

Women’s Health Initiative Memory Study (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker.

For a list of all the investigators who have contributed to WHI science, please visit: https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pdf.

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Tabung, F.K., Steck, S.E., Ma, Y. et al. The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women’s Health Initiative. Cancer Causes Control 26, 399–408 (2015). https://doi.org/10.1007/s10552-014-0515-y

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