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Research Articles

Dietary Inflammatory Index and Risk of Colorectal Cancer in the Iowa Women's Health Study

Nitin Shivappa, Anna E. Prizment, Cindy K. Blair, David R. Jacobs Jr, Susan E. Steck and James R. Hébert
Nitin Shivappa
1Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.
2Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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Anna E. Prizment
3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
4Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
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Cindy K. Blair
3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
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David R. Jacobs Jr
3Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
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Susan E. Steck
1Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.
2Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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James R. Hébert
1Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.
2Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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  • For correspondence: jhebert@sc.edu
DOI: 10.1158/1055-9965.EPI-14-0537 Published November 2014
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Article Figures & Data

Tables

  • Table 1.

    Prevalence of characteristics at baseline across quintiles of DII (with supplements), IWHS, 1986–2010

    DII (with supplements)b
    Quintile 1Quintile 2Quintile 3Quintile 4Quintile 5
    <−2.75−2.75 to −1.76−1.75 to −0.57−0.56 to 1.10>1.10
    Median = −3.29Median = −2.26Median = −1.21Median = 0.23Median = 2.13
    Characteristicsa [mean (SD) or %](N = 6,940)(N = 6,941)(N = 6,941)(N = 6,941)(N = 6,940)
    Age (years)62.0 (4.2)61.7 (4.2)61.6 (4.2)61.4 (4.1)61.2 (4.2)
    Total energy intake (kcal/day)2,119.1 (664.5)2,009.5 (631.4)1,816.4 (532.2)1,684.8 (446.7)1,362.9 (406.7)
    Total fat (% kcal/day)31.4 (5.4)33.5 (5.3)34.2 (5.5)34.7 (5.6)36.0 (6.0)
    Dietary fiber (g/1,000 kcal/day)13.5 (3.2)11.6 (2.9)10.8 (2.9)10.5 (2.9)9.5 (2.8)
    Vitamin supplement use (% taking)
     Any85.073.965.547.334.1
     Multivitamin68.950.235.39.92.0
     Calcium63.253.046.637.429.2
     Vitamin C32.021.916.99.53.8
     Vitamin E28.619.814.97.42.0
    BMI (%; kg/m2)
     ≤24.942.540.239.438.538.6
     25–3037.137.137.436.936.2
     ≥3020.522.723.224.725.2
    Education (%)
     Less than high school15.216.617.619.321.6
     High school36.440.842.143.747.5
     More than high school48.442.640.337.030.9
    Smoking (%)
     Never70.368.565.764.659.0
     Former20.319.119.119.718.9
     Current9.512.515.315.722.1
    Alcohol intake (%)
     0 g/day58.654.252.754.355.0
     <15 g/day34.139.841.139.438.2
     ≥15 g/day7.46.06.26.46.8
    Level of physical activityc (%)
     Low33.742.348.451.961.2
     Middle29.830.227.427.422.8
     High36.527.524.220.716.1
    Hormone therapy use (yes, %)43.839.939.236.934.0
    Diabetes at baseline (yes, %)6.66.46.25.95.3
    History of aspirin use (1992 survey, ever %)73.572.771.671.471.0
    History of NSAIDs use (1992 survey, ever %)84.283.882.682.481.6
    • ↵aAll variables are measured at baseline (1986) unless otherwise noted. Some column percentages are presented; they do not always add to 100 because of rounding.

    • ↵bQuintile 1 refers to scores indicating the most antiinflammatory diet, and quintile 5 refers to scores indicating the most proinflammatory diet.

    • ↵cPhysical activity level: High, more than 4 times per week for moderate physical activities (e.g., bowling, golf, light sports or physical exercise, gardening, taking long walks) or more than 2 times per week for vigorous physical activities (e.g., jogging, racquet sports, swimming, aerobics, strenuous sports); Middle, more than 2 times per week for moderate physical activities or a few times a month for both moderate and vigorous physical activities; Low, those not belonging to activity level 2 or 3.

  • Table 2.

    Distribution of food groups across quintiles of DII (with supplements)a, IWHS, 1986–2010

    Quintile1Quintile2Quintile3Quintile4Quintile5
    Food groups (servings/week)Direction increase with DIIbDifference (Q5 − Q1)/Q1MeanMeanMeanMeanMean
    Other vegetables (other than green leafy vegetables or potatoes)——65%27.319.816.013.89.7
    Low-fat dairy——63%10.69.17.96.63.9
    Green leafy vegetables——62%7.55.54.43.92.8
    Fish/seafood——62%2.61.91.51.31.0
    Fruit (no juice)——61%19.915.612.911.27.7
    Nuts——61%3.52.82.21.91.4
    Whole grains——60%16.812.910.89.36.7
    Beans without soy——56%0.70.60.50.40.3
    Fruit juice——52%6.65.85.04.53.1
    Poultry——52%2.62.01.81.61.2
    Wine——39%0.70.60.50.50.4
    Potatoes——31%3.53.53.23.12.4
    Salty snacks——30%4.54.43.93.73.1
    Margarine——27%10.410.19.69.27.6
    Tea——26%3.43.33.02.92.5
    Eggs——24%2.42.42.32.11.8
    Sweets without chocolate——22%8.19.18.27.76.3
    Low-calorie beverages——20%2.01.81.71.61.6
    Red meat——13%5.86.56.25.95.0
    Chocolate0—3%0.60.80.80.70.6
    High-fat dairy0—3%9.610.910.410.29.3
    Refined grains00%8.38.99.09.28.2
    Nitrate processed meat01%1.82.12.12.01.8
    French fries+6%0.30.40.40.40.4
    High-sugar beverages+18%1.21.41.41.41.4
    Liquor+24%0.80.80.80.91.0
    Fried food+29%1.82.22.32.32.3
    Coffee+36%9.911.411.812.113.5
    Beer+37%0.50.60.60.70.7
    Butter+56%1.41.92.02.02.2
    • ↵aThe foods listed are meant to give the reader a sense of how dietary intake varies across DII quintiles; though some listed foods are indeed among the 37 parameters that are used in computation of DII in the IWHS, these are not meant to be a list of contributors to the DII.

    • ↵b+ indicates increase across quintiles;—indicates decrease across quintiles; 0 indicates no or <5% change.

  • Table 3.

    DII from food and supplements and colorectal cancer risk; IWHS, 1986–2010

    Cases (n)HRa (95% CI)HRb (95% CI)Cases (n)HRa (95% CI)HRb (95% CI)Cases (n)HRa (95% CI)HRb (95% CI)
    Colorectal cancerColon cancerRectal cancer
    DII continuous1,6361.09 (1.03–1.14)1.07 (1.01–1.13)1,3291.08 (1.02–1.13)1.05 (0.99–1.12)3251.10 (0.99–1.23)1.11 (0.98–1.25)
    DII quintiles
     Quintile 12901 (referent)1 (referent)2361 (referent)1 (referent)581 (referent)1 (referent)
     Quintile 23181.11 (0.94–1.30)1.04 (0.89–1.22)2671.14 (0.96–1.34)1.07 (0.89–1.28)540.93 (0.64–1.35)0.91 (0.62–1.32)
     Quintile 33351.18 (1.01–1.38)1.11 (0.95–1.31)2701.17 (0.98–1.40)1.10 (0.92–1.31)731.28 (0.91–1.81)1.23 (0.86–1.76)
     Quintile 43411.20 (1.03–1.40)1.13 (0.95–1.33)2701.17 (0.98–1.39)1.08 (0.89–1.29)711.24 (0.88–1.76)1.25 (0.87–1.80)
     Quintile 53521.29 (1.10–1.51)1.20 (1.01–1.43)2861.28 (1.08–1.53)1.19 (0.98–1.45)691.25 (0.88–1.77)1.21 (0.81–1.79)
    P trend0.0010.030.0080.100.090.16
    • ↵aAge-adjusted.

    • ↵bAdjusted for age, BMI, smoking status, pack-years of smoking, HRT use, education, diabetes, and total energy intake.

  • Table 4.

    DII from foods only, DII from vitamin supplements, and colorectal cancer risk; IWHS, 1986–2010.

    Cases (n)HRa (95% CI)HRb (95% CI)Cases (n)HRa (95% CI)HRb (95% CI)Cases (n)HRa (95% CI)HRb (95% CI)
    Colorectal cancerColon cancerRectal cancer
    DII from foods onlyc
    Continuous1,6361.09 (1.03–1.14)1.08 (1.01–1.15)1,3291.08 (1.02–1.14)1.06 (0.99–1.14)3251.11 (0.99–1.24)1.13 (0.98–1.31)
    Quintilesd
     Quintile 12941 (referent)1 (referent)2371 (referent)1 (referent)581 (referent)1 (referent)
     Quintile 23231.11 (0.95–1.30)1.07 (0.90–1.26)2711.15 (0.96–1.37)1.10 (0.91–1.32)601.07 (0.74–1.54)1.07 (0.73–1.56)
     Quintile 33381.16 (0.99–1.36)1.12 (0.94–1.33)2681.12 (0.94–1.34)1.07 (0.88–1.30)731.35 (0.95–1.92)1.37 (0.93–2.01)
     Quintile 43511.21 (1.03–1.43)1.16 (0.97–1.40)2931.23 (1.03–1.47)1.16 (0.95–1.43)611.16 (0.80–1.68)1.20 (0.79–1.84)
     Quintile 53301.17 (0.99–1.38)1.12 (0.91–1.38)2601.12 (0.93–1.35)1.06 (0.84–1.33)731.43 (0.99–2.05)1.48 (0.94–2.34)
    P trend0.0040.080.020.270.100.13
    DII from supplementse
    Continuous1,6361.04 (0.99–1.10)1.02 (0.97–1.08)1,3291.04 (0.98–1.09)1.02 (0.96–1.08)3251.05 (0.93–1.17)1.02 (0.91–1.15)
    Categoriesf
     1 (N = 5,824)2730.91 (0.79–1.04)0.94 (0.82–1.09)2260.84 (0.69–1.02)0.84 (0.69–1.03)521.10 (0.74–1.64)1.10 (0.73–1.64)
     2 (N = 5,824)2360.81 (0.70–0.94)0.84 (0.73–0.98)1860.91 (0.74–1.11)0.89 (0.72–1.09)531.30 (0.88–1.92)1.21 (0.81–1.81)
     3 (N = 5,826)2560.89 (0.77–1.02)0.89 (0.77–1.03)1991.09 (0.94–1.27)1.05 (0.90–1.23)611.08 (0.79–1.49)1.02 (0.74–1.42)
     4 (N = 17,229)8711 (referent)1 (referent)7181 (referent)1 (referent)1591 (referent)1 (referent)
    P trend0.090.290.150.360.560.88
    • ↵aAdjusted for age and the other DII variable.

    • ↵bAdjusted for age, the other DII variable, BMI, smoking status, pack-years of smoking, HRT use, education, diabetes, and total energy intake.

    • ↵cThese are for foods only, exclusive of supplement intake.

    • ↵dReference category is the lowest (i.e., most antiinflammatory) quintile; increasing quintiles of DII from food groups represent increasing inflammatory scores.

    • ↵eThis is obtained by subtracting the DII score for foods only from the DII derived by including both foods and supplements.

    • ↵fReference category represents nonsupplement users; categories 1 to 3 represent tertiles of the DII from supplement users. Category 1 represents women with the greatest contribution from supplements to the DII score. DII score median (range): categories 1, −3.00 (<—2.0552); 2, −1.31 (—2.0552 to −0.7616); 3, −0.34 (—0.7615 to 0.0000); 4, 0.00 (0.0000 to 0.1765).

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Cancer Epidemiology Biomarkers & Prevention: 23 (11)
November 2014
Volume 23, Issue 11
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Dietary Inflammatory Index and Risk of Colorectal Cancer in the Iowa Women's Health Study
Nitin Shivappa, Anna E. Prizment, Cindy K. Blair, David R. Jacobs Jr, Susan E. Steck and James R. Hébert
Cancer Epidemiol Biomarkers Prev November 1 2014 (23) (11) 2383-2392; DOI: 10.1158/1055-9965.EPI-14-0537

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Dietary Inflammatory Index and Risk of Colorectal Cancer in the Iowa Women's Health Study
Nitin Shivappa, Anna E. Prizment, Cindy K. Blair, David R. Jacobs Jr, Susan E. Steck and James R. Hébert
Cancer Epidemiol Biomarkers Prev November 1 2014 (23) (11) 2383-2392; DOI: 10.1158/1055-9965.EPI-14-0537
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