Nitin Shivappa1,2,3, Renwei Wang4, James R Hébert5,6,7, Aizhen Jin8, Woon-Puay Koh9,10, Jian Min Yuan4,11. 1. Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA. shivappa@mailbox.sc.edu. 2. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA. shivappa@mailbox.sc.edu. 3. Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA. shivappa@mailbox.sc.edu. 4. Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. 5. Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA. 6. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA. 7. Connecting Health Innovations LLC, 1417 Gregg Street, Columbia, SC, 29201, USA. 8. National Registry of Diseases Office, Health Promotion Board, Singapore, 168937, Singapore. 9. Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, 169857, Singapore. 10. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. 11. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
BACKGROUND: Diet and inflammation have been suggested to be important risk factors for lung cancer. We examined the ability of the dietary inflammatory index (DII®) to predict lung cancer in the Singapore Chinese Health Study (SCHS). The DII is a diet quality index based on the literature linking foods and nutrients with inflammatory biomarkers. PATIENTS AND METHODS: Using data from the SCHS for 60,232 participants, including 1851 lung cancer cases, we investigated the associations of baseline DII scores calculated from a food frequency questionnaire with risk of developing lung cancer over an average of 17.6 years of follow-up. Hazard ratios (HR) were estimated using Cox regression, adjusting for smoking status and other risk factors. RESULTS: After excluding cancers diagnosed in the first 2 years of follow-up, the DII was non-significantly associated with risk of lung cancer (HRQ5vsQ1 = 1.13; 95% CI 0.94-1.35; P-trend = 0.24) after adjusting for age, dialect group, sex, interview year, education, body mass index, total calorie intake, physical activity and various smoking variables. In stratified analysis, stronger, statistically significant associations were evident in current smokers (HR 1.44; 95% CI 1.11-1.86; Ptrend = 0.03, P for interaction = 0.003) and in male ever-smokers (HRQ5vsQ1 = 1.37; 95% CI 1.07-1.77; P-trend = 0.03). CONCLUSION: A pro-inflammatory diet, as shown by higher DII scores, is associated with an elevated risk of lung cancer for subjects with a history of smoking. Public health measures should be adopted to promote consumption of a healthy, anti-inflammatory diet to reduce the risk of lung cancer, especially in current and former smokers.
BACKGROUND: Diet and inflammation have been suggested to be important risk factors for lung cancer. We examined the ability of the dietary inflammatory index (DII®) to predict lung cancer in the Singapore Chinese Health Study (SCHS). The DII is a diet quality index based on the literature linking foods and nutrients with inflammatory biomarkers. PATIENTS AND METHODS: Using data from the SCHS for 60,232 participants, including 1851 lung cancer cases, we investigated the associations of baseline DII scores calculated from a food frequency questionnaire with risk of developing lung cancer over an average of 17.6 years of follow-up. Hazard ratios (HR) were estimated using Cox regression, adjusting for smoking status and other risk factors. RESULTS: After excluding cancers diagnosed in the first 2 years of follow-up, the DII was non-significantly associated with risk of lung cancer (HRQ5vsQ1 = 1.13; 95% CI 0.94-1.35; P-trend = 0.24) after adjusting for age, dialect group, sex, interview year, education, body mass index, total calorie intake, physical activity and various smoking variables. In stratified analysis, stronger, statistically significant associations were evident in current smokers (HR 1.44; 95% CI 1.11-1.86; Ptrend = 0.03, P for interaction = 0.003) and in male ever-smokers (HRQ5vsQ1 = 1.37; 95% CI 1.07-1.77; P-trend = 0.03). CONCLUSION: A pro-inflammatory diet, as shown by higher DII scores, is associated with an elevated risk of lung cancer for subjects with a history of smoking. Public health measures should be adopted to promote consumption of a healthy, anti-inflammatory diet to reduce the risk of lung cancer, especially in current and former smokers.
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