Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women | Colorectal Cancer | JAMA Oncology | JAMA Network
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Original Investigation
January 18, 2018

Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women

Author Affiliations
  • 1Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 3Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 4Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
  • 5Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, P.R. China
  • 6Department of Nutrition, Simmons College, Boston, Massachusetts
  • 7Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston
  • 8Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Massachusetts
  • 9Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Massachusetts
  • 10Smilow Cancer Hospital at Yale University Cancer Center, New Haven, Connecticut
JAMA Oncol. 2018;4(3):366-373. doi:10.1001/jamaoncol.2017.4844
Key Points

Questions  Do proinflammatory dietary patterns increase the risk of developing colorectal cancer?

Findings  In this cohort study that followed 121 050 adults for 26 years, intake of proinflammatory diets as evidenced by higher scores on an empirical dietary inflammatory pattern score was associated with a significantly higher risk of developing colorectal cancer in both men and women.

Meaning  Inflammation is a potential mechanism linking dietary patterns and colorectal cancer development, and strategies to reduce the adverse role of a proinflammatory diet may reduce colorectal cancer risk.


Importance  Inflammation is important in colorectal cancer development. Diet modulates inflammation and may thus be a crucial modifiable factor in colorectal cancer prevention.

Objective  To examine whether proinflammatory diets are associated with increased colorectal cancer risk by using an empirical dietary inflammatory pattern (EDIP) score based on a weighted sum of 18 food groups that characterizes dietary inflammatory potential based on circulating levels of inflammation biomarkers.

Design, Settings, and Participants  Cohort study of 46 804 men (Health Professionals Follow-up Study: 1986-2012) and 74 246 women (Nurses’ Health Study: 1984-2012) followed for 26 years to examine associations between EDIP scores and colorectal cancer risk using Cox regression. We also examined associations in categories of alcohol intake and body weight. Data analysis began January 17, 2017, and was completed August 9, 2017.

Exposures  EDIP scores calculated from food frequency questionnaires administered every 4 years.

Main Outcomes and Measures  Incident colorectal cancer.

Results  We documented 2699 incident colorectal cancer cases over 2 571 831 person-years of follow-up. Compared with participants in the lowest EDIP quintile (Q) who had a colorectal cancer incidence rate (per 100 000 person-years) of 113 (men) and 80 (women), those in the highest Q had an incidence rate of 151 (men) and 92 (women), leading to an unadjusted rate difference of 38 and 12 more colorectal cancer cases, respectively, among those consuming highly proinflammatory diets. Comparing participants in the highest vs lowest EDIP Qs in multivariable-adjusted analyses, higher EDIP scores were associated with 44% (men: hazard ratio [HR], 1.44; 95% CI, 1.19-1.74; P < .001 for trend), 22% (women: HR, 1.22; 95% CI, 1.02-1.45; P = .007 for trend), and 32% (men and women: pooled HR, 1.32; 95% CI, 1.12-1.55; P < .001 for trend) higher risk of developing colorectal cancer. In both men and women, associations were observed in all anatomic subsites except for the rectum in women. In subgroups (P ≤ .02 for all interactions), associations differed by alcohol intake level, with stronger associations among men (Q5 vs Q1 HR, 1.62; 95% CI, 1.05-2.49; P = .002 for trend) and women (Q5 vs Q1 HR, 1.33; 95% CI, 0.97-1.81; P = .03 for trend) not consuming alcohol; and by body weight, with stronger associations among overweight/obese men (Q5 vs Q1 HR, 1.48; 95% CI, 1.12-1.94; P = .008 for trend) and lean women (Q5 vs Q1 HR, 1.31; 95% CI, 0.99-1.74; P = .01 for trend).

Conclusions and Relevance  Findings suggest that inflammation is a potential mechanism linking dietary patterns and colorectal cancer development. Interventions to reduce the adverse role of proinflammatory diets may be more effective among overweight/obese men and lean women or men and women who do not consume alcohol.