Abstract
This project sought to test the role of diet-related inflammation in modulating the risk of oesophageal cancer. A nationwide population-based case-control study was conducted from 1 December 1994 through 31 December 1997 in Sweden. All newly diagnosed patients with adenocarcinoma of the oesophagus or gastroesophageal junction and a randomly selected half of patients with oesophageal squamous cell carcinoma were eligible as cases. Using the Swedish Registry of the Total Population, the control group was randomly selected from the entire Swedish population and frequency-matched on age (within 10years) and sex. The literature-derived dietary inflammatory index (DII) was developed to describe the inflammatory potential of diet. DII scores were computed based on a food frequency questionnaire. Higher DII scores indicate more pro-inflammatory diets. Odds ratios and 95% confidence intervals (CI) were computed to assess risk associated between DII scores and oesophageal cancer using logistic regression adjusted by potential confounders. In total, 189 oesophageal adenocarcinomas, 262 gastroesophageal junctional adenocarcinomas, 167 oesophageal squamous cell carcinomas, and 820 control subjects were recruited into the study. Significant associations with DII were observed for oesophageal squamous cell carcinoma (ORQuartile4vs1 4.35, 95% CI 2.24, 8.43), oesophageal adenocarcinoma (ORQuartile4vs1 3.59, 95% CI 1.87, 6.89), and gastroesophageal junctional adenocarcinoma (ORQuartile4vs1 2.04, 95% CI 1.24, 3.36). Significant trends across quartiles of DII were observed for all subtypes of oesophageal cancer. Diet-related inflammation appears to be associated with an increased risk of oesophageal cancer, regardless of histological type.
Highlights
The incidence of adenocarcinoma of the oesophagus or gastroesophageal junction has risen at an alarming rate in Western populations over the past four decades, while rates of oesophageal squamous cell carcinoma, which were much higher relative to adenocarcinomas decades ago, have remained steady for many decades [1, 2]
We examined the association between dietary inflammatory index (DII) scores, used as a composite index for diet-associated inflammation, and the risk of oesophageal cancers in a nationwide case–control study in Sweden
Eligible for inclusion in the study were all patients with newly diagnosed adenocarcinoma of the oesophagus or gastroesophageal junction, and a random selection of patients with oesophageal squamous cell carcinoma
Summary
The incidence of adenocarcinoma of the oesophagus or gastroesophageal junction has risen at an alarming rate in Western populations over the past four decades, while rates of oesophageal squamous cell carcinoma, which were much higher relative to adenocarcinomas decades ago, have remained steady for many decades [1, 2]. Epidemiologic evidence has shown that chronic inflammation is important in triggering the development of oesophageal cancer. Inflammation has been implicated in oesophageal carcinogenesis through processes known to be associated with a variety of risk factors, including obesity [4], gastroesophageal reflux [5], smoking [6], the microbiome (e.g. human papillomavirus) [7], and diet [8]. Diet has been shown to modulate inflammation [9] Nutrients such as phytoestrogens, fibre, and folate possess anti-inflammatory properties that may offer protection against oesophageal cancer; while food/ nutrients such as processed meat, saturated fat, and compounds that can be metabolised from foods, such as dietary N-nitrosomethylbenzylamine, which are known to increase inflammation, may increase the risk [10,11,12]. No study has employed a measure of diet-related inflammation based on the whole diet
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