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01-04-2020 | Colorectal Cancer | Original Contribution

Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women’s Health Initiative

Authors: Jiali Zheng, Fred K. Tabung, Jiajia Zhang, E. Angela Murphy, Nitin Shivappa, Judith K. Ockene, Bette Caan, Candyce H. Kroenke, James R. Hébert, Susan E. Steck

Published in: European Journal of Nutrition | Issue 3/2020

Abstract

Purpose

Dietary factors may influence colorectal cancer (CRC) survival through effects on inflammation. We examined the association between post-CRC diagnosis inflammatory potential of diet and all-cause and cancer-specific mortality in the Women’s Health Initiative.

Methods

The study included 463 postmenopausal women who developed CRC during follow-up and completed a food frequency questionnaire (FFQ), on average 1.7 years after diagnosis. Women were followed from CRC diagnosis until death, censoring, or the end of follow-up in October 2014. Energy-adjusted dietary inflammatory index (E-DII)^® scores were calculated from the FFQ and dietary supplement inventory. Cox proportional hazards models were fitted to estimate multivariable-adjusted HRs and 95% confidence intervals (CIs) for all-cause, total cancer, and CRC-specific mortality with the most pro-inflammatory E-DII scores (tertile 3) as referent.

Results

After a median 11.6 years of follow-up, 162 deaths occurred, including 77 from CRC. Lowest tertile (i.e., most anti-inflammatory) E-DII scores from diet plus supplements were associated with significantly lower all-cause mortality (HR_T1vsT3 = 0.49; 95% CI 0.31–0.79) compared to the most pro-inflammatory E-DII tertile. Modest associations with total cancer mortality or CRC-specific mortality were observed, though 95% CIs included 1.

Conclusions

Consuming a dietary pattern and supplements with more anti-inflammatory potential after CRC diagnosis may improve overall survival among postmenopausal women.

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Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30. https://doi.org/10.3322/caac.21442 CrossRef

American Cancer Society. Cancer treatment & survivorship facts & figures, 2016–2017

Denlinger CS, Engstrom PF (2011) Colorectal cancer survivorship: movement matters. Cancer Prev Res (Phila) 4(4):502–511. https://doi.org/10.1158/1940-6207.capr-11-0098 CrossRef

Vrieling A, Kampman E (2010) The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr 92(3):471–490CrossRef

Ratjen I, Schafmayer C, di Giuseppe R, Waniek S, Plachta-Danielzik S, Koch M, Nöthlings U, Hampe J, Schlesinger S, Lieb W (2017) Postdiagnostic Mediterranean and healthy nordic dietary patterns are inversely associated with all-cause mortality in long-term colorectal cancer survivors. J Nutr 147(4):636–644CrossRef

World Cancer Research Fund/American Institute for Cancer Research (2018) Diet, nutrition, physical activity, and cancer: a global perspective. Third expert report. AICR, Washington, DC

Schoenberg MH (2016) Physical activity and nutrition in primary and tertiary prevention of colorectal cancer. Visc Med 32(3):199–204CrossRef

Krebs-Smith SM, Subar AF, Reedy J (2015) Examining dietary patterns in relation to chronic disease: matching measures and methods to questions of interest. Circulation 132(9):790–793. https://doi.org/10.1161/circulationaha.115.018010 CrossRefPubMed

Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, Nelson H, Whittom R, Hantel A, Thomas J (2007) Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA 298(7):754–764CrossRef

10.

Fung TT, Kashambwa R, Sato K, Chiuve SE, Fuchs CS, Wu K, Giovannucci E, Ogino S, Hu FB, Meyerhardt JA (2014) Post diagnosis diet quality and colorectal cancer survival in women. PLoS One 9(12):e115377CrossRef

11.

Crozier JE, McKee RF, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, McMillan DC (2006) The presence of a systemic inflammatory response predicts poorer survival in patients receiving adjuvant 5-FU chemotherapy following potentially curative resection for colorectal cancer. Br J Cancer 94(12):1833–1836. https://doi.org/10.1038/sj.bjc.6603185 CrossRefPubMedPubMedCentral

12.

Cooney RV, Chai W, Franke AA, Wilkens LR, Kolonel LN, Le Marchand L (2013) C-reactive protein, lipid-soluble micronutrients, and survival in colorectal cancer patients. Cancer Epidemiol Biomark Prev 22(7):1278–1288. https://doi.org/10.1158/1055-9965.epi-13-0199 CrossRef

13.

Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Caan B, Hou L, Johnson KC, Mossavar-Rahmani Y, Shivappa N, Wactawski-Wende J, Ockene JK, Hebert JR (2015) 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(3):399–408. https://doi.org/10.1007/s10552-014-0515-y CrossRefPubMed

14.

Steck SE, Guinter M, Zheng J, Thomson CA (2015) Index-based dietary patterns and colorectal cancer risk: a systematic review. Adv Nutr 6(6):763–773. https://doi.org/10.3945/an.115.009746 CrossRefPubMedPubMedCentral

15.

Shivappa N, Prizment AE, Blair CK, Jacobs DR, Steck SE, Hébert JR (2014) Dietary inflammatory index and risk of colorectal cancer in the Iowa Women’s Health Study. Cancer Epidemiol Biomark Prev 23(11):2383–2392. https://doi.org/10.1158/1055-9965.epi-14-0537 CrossRef

16.

Wirth MD, Shivappa N, Steck SE, Hurley TG, Hebert JR (2015) The dietary inflammatory index is associated with colorectal cancer in the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Br J Nutr 113(11):1819–1827. https://doi.org/10.1017/s000711451500104x CrossRefPubMedPubMedCentral

17.

Harmon BE, Wirth MD, Boushey CJ, Wilkens LR, Draluck E, Shivappa N, Steck SE, Hofseth L, Haiman CA, Le Marchand L, Hébert JR (2017) The dietary inflammatory index is associated with colorectal cancer risk in the multiethnic Cohort 1–3. J Nutr 147(3):430–438. https://doi.org/10.3945/jn.116.242529 CrossRefPubMedPubMedCentral

18.

Shivappa N, Hebert JR, Steck SE, Hofseth LJ, Shehadah I, Bani-Hani KE, Al-Jaberi T, Al-Nusairr M, Heath D, Tayyem R (2017) Dietary inflammatory index and odds of colorectal cancer in a case-control study from Jordan. Appl Physiol Nutr Metab 42(7):744–749. https://doi.org/10.1139/apnm-2017-0035 CrossRefPubMed

19.

Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Lane DS, Ho GYF, Hou L, Snetselaar L, Ockene JK, Hebert JR (2017) Changes in the inflammatory potential of diet over time and risk of colorectal cancer in postmenopausal women. Am J Epidemiol 186(5):514–523. https://doi.org/10.1093/aje/kwx115 CrossRefPubMedPubMedCentral

20.

Ratjen I, Shivappa N, Schafmayer C, Burmeister G, Nothlings U, Hampe J, Hebert JR, Lieb W, Schlesinger S (2019) Association between the dietary inflammatory index and all-cause mortality in colorectal cancer long-term survivors. Int J Cancer 144(6):1292–1301. https://doi.org/10.1002/ijc.31919 CrossRefPubMed

21.

Guinter MA, McCullough ML, Gapstur SM, Campbell PT (2018) Associations of pre- and postdiagnosis diet quality with risk of mortality among men and women with colorectal cancer. J Clin Oncol. https://doi.org/10.1200/jco.18.00714 CrossRefPubMedPubMedCentral

22.

Study TWsHI (1998) Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 19(1):61–109CrossRef

23.

Hays J, Hunt JR, Hubbell FA, Anderson GL, Limacher M, Allen C, Rossouw JE (2003) The Women’s Health Initiative recruitment methods and results. Ann Epidemiol 13(9 Suppl):S18–S77CrossRef

24.

Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M (2003) The Women’s Health Initiative Observational Study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol 13(9 Suppl):S107–S121CrossRef

25.

Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T (1999) Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol 9(3):178–187CrossRef

26.

Schakel S, Sievert Y, Buzzard I (1988) Sources of data for developing and maintaining a nutrient database. J Am Diet Assoc 88(10):1268–1271PubMed

27.

Patterson RE, Kristal A, Rodabough R, Caan B, Lillington L, Mossavar-Rahmani Y, Simon MS, Snetselaar L, van Horn L (2003) Changes in food sources of dietary fat in response to an intensive low-fat dietary intervention: early results from the Women’s Health Initiative. J Am Diet Assoc 103(4):454–460PubMed

28.

Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR (2014) Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 17(8):1689–1696. https://doi.org/10.1017/s1368980013002115 CrossRefPubMed

29.

Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Tabung F, Hébert JR (2014) A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr 17(08):1825–1833CrossRef

30.

Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Agalliu I, Hingle M, Hou L, Hurley TG, Jiao L (2015) Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol 25(6):398–405CrossRef

31.

Shivappa N, Hébert JR, Rietzschel ER, De Buyzere ML, Langlois M, Debruyne E, Marcos A, Huybrechts I (2015) Associations between dietary inflammatory index and inflammatory markers in the Asklepios Study. Br J Nutr 113(04):665–671CrossRef

32.

George SM, Ballard-Barbash R, Shikany JM, Caan BJ, Freudenheim JL, Kroenke CH, Vitolins MZ, Beresford SA, Neuhouser ML (2014) Better postdiagnosis diet quality is associated with reduced risk of death among postmenopausal women with invasive breast cancer in the Women’s Health Initiative. Cancer Epidemiol Biomark Prev 23(4):575–583CrossRef

33.

Irwin ML, McTiernan A, Manson JE, Thomson CA, Sternfeld B, Stefanick ML, Wactawski-Wende J, Craft L, Lane D, Martin LW, Chlebowski R (2011) Physical activity and survival in postmenopausal women with breast cancer: results from the Women’s Health Initiative. Cancer Prev Res (Philadelphia, Pa) 4(4):522–529. https://doi.org/10.1158/1940-6207.capr-10-0295 CrossRef

34.

Seidell JC, Flegal KM (1997) Assessing obesity: classification and epidemiology. Br Med Bull 53(2):238–252CrossRef

35.

Curb JD, McTiernan A, Heckbert SR, Kooperberg C, Stanford J, Nevitt M, Johnson KC, Proulx-Burns L, Pastore L, Criqui M, Daugherty S (2003) Outcomes ascertainment and adjudication methods in the Women’s Health Initiative. Ann Epidemiol 13(9 Suppl):S122–S128CrossRef

36.

Fritz A, Ries L (1998) The SEER Program code manual. National Cancer Institute, Bethesda (United States Cancer Statistics: 2004 incidence and mortality)

37.

Coghill AE, Phipps AI, Bavry AA, Wactawski-Wende J, Lane DS, LaCroix A, Newcomb PA (2012) The association between NSAID use and colorectal cancer mortality: results from the Women’s Health Initiative. Cancer Epidemiol Biomark Prev 21(11):1966–1973. https://doi.org/10.1158/1055-9965.epi-12-0672 CrossRef

38.

Zheng J, Tabung FK, Zhang J, Liese AD, Shivappa N, Ockene JK, Caan B, Kroenke CH, Hebert JR, Steck SE (2018) Association between post-cancer diagnosis dietary inflammatory potential and mortality among invasive breast cancer survivors in the Women’s Health Initiative. Cancer Epidemiol Biomark Prev 27(4):454–463. https://doi.org/10.1158/1055-9965.epi-17-0569 CrossRef

39.

Schoenfeld D (1980) Chi squared goodness-of-fit tests for the proportional hazards regression model. Biometrika 67(1):145–153CrossRef

40.

Hess KR (1994) Assessing time-by-covariate interactions in proportional hazards regression models using cubic spline functions. Stat Med 13(10):1045–1062CrossRef

41.

Therneau TM, Grambsch PM (2000) Modeling survival data: extending the Cox model. Springer Science & Business Media, BerlinCrossRef

42.

Desquilbet L, Mariotti F (2010) Dose-response analyses using restricted cubic spline functions in public health research. Stat Med 29(9):1037–1057. https://doi.org/10.1002/sim.3841 CrossRefPubMed

43.

Kerr J, Anderson C, Lippman SM (2017) Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol 18(8):e457–e471. https://doi.org/10.1016/s1470-2045(17)30411-4 CrossRefPubMed

44.

Galas A, Kulig J (2014) Low-grade dietary-related inflammation and survival after colorectal cancer surgery. J Cancer Res Clin Oncol 140(9):1517–1525. https://doi.org/10.1007/s00432-014-1711-6 CrossRefPubMedPubMedCentral

45.

Meyerhardt JA (2011) Beyond standard adjuvant therapy for colon cancer: role of nonstandard interventions. Semin Oncol 38(4):533–541. https://doi.org/10.1053/j.seminoncol.2011.05.007 CrossRefPubMedPubMedCentral

46.

Wirth MD, Hébert JR, Shivappa N, Hand GA, Hurley TG, Drenowatz C, McMahon D, Shook RP, Blair SN (2016) Anti-inflammatory Dietary Inflammatory Index scores are associated with healthier scores on other dietary indices. Nutr Res 36(3):214–219CrossRef

47.

Meyerhardt JA, Sato K, Niedzwiecki D, Ye C, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Wigler DS, Venook A, Fuchs CS (2012) Dietary glycemic load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Natl Cancer Inst 104(22):1702–1711. https://doi.org/10.1093/jnci/djs399 CrossRefPubMedPubMedCentral

48.

Yuan C, Bao Y, Sato K, Nimptsch K, Song M, Brand-Miller JC, Morales-Oyarvide V, Zoltick ES, Keum N, Wolpin BM, Meyerhardt JA, Chan AT, Willett WC, Stampfer MJ, Wu K, Giovannucci EL, Fuchs CS, Ng K (2017) Influence of dietary insulin scores on survival in colorectal cancer patients. Br J Cancer 117(7):1079–1087. https://doi.org/10.1038/bjc.2017.272 CrossRefPubMedPubMedCentral

49.

Macpherson H, Pipingas A, Pase MP (2013) Multivitamin-multimineral supplementation and mortality: a meta-analysis of randomized controlled trials. Am J Clin Nutr 97(2):437–444. https://doi.org/10.3945/ajcn.112.049304 CrossRefPubMed

50.

Schwingshackl L, Boeing H, Stelmach-Mardas M, Gottschald M, Dietrich S, Hoffmann G, Chaimani A (2017) Dietary supplements and risk of cause-specific death, cardiovascular disease, and cancer: a systematic review and meta-analysis of primary prevention trials. Adv Nutr 8(1):27–39. https://doi.org/10.3945/an.116.013516 CrossRefPubMedPubMedCentral

51.

Gaziano JM, Sesso HD, Christen WG, Bubes V, Smith JP, MacFadyen J, Schvartz M, Manson JE, Glynn RJ, Buring JE (2012) Multivitamins in the prevention of cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA 308(18):1871–1880. https://doi.org/10.1001/jama.2012.14641 CrossRefPubMedPubMedCentral

52.

Wassertheil-Smoller S, McGinn AP, Budrys N, Chlebowski R, Ho GY, Johnson KC, Lane DS, Li W, Neuhouser ML, Saquib J, Shikany JM, Song Y, Thomson C (2013) Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the Women’s Health Initiative. Breast Cancer Res Treat 141(3):495–505. https://doi.org/10.1007/s10549-013-2712-x CrossRefPubMedPubMedCentral

53.

Kwan ML, Greenlee H, Lee VS, Castillo A, Gunderson EP, Habel LA, Kushi LH, Sweeney C, Tam EK, Caan BJ (2011) Multivitamin use and breast cancer outcomes in women with early-stage breast cancer: the Life After Cancer Epidemiology study. Breast Cancer Res Treat 130(1):195–205. https://doi.org/10.1007/s10549-011-1557-4 CrossRefPubMedPubMedCentral

54.

Neuhouser ML, Wassertheil-Smoller S, Thomson C, Aragaki A, Anderson GL, Manson JE, Patterson RE, Rohan TE, van Horn L, Shikany JM, Thomas A, LaCroix A, Prentice RL (2009) Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med 169(3):294–304. https://doi.org/10.1001/archinternmed.2008.540 CrossRefPubMed

55.

Holmes RS, Zheng Y, Baron JA, Li L, McKeown-Eyssen G, Newcomb PA, Stern MC, Haile RW, Grady WM, Potter JD, Le Marchand L, Campbell PT, Figueiredo JC, Limburg PJ, Jenkins MA, Hopper JL, Ulrich CM, Colon Cancer Family R (2010) Use of folic acid-containing supplements after a diagnosis of colorectal cancer in the Colon Cancer Family Registry. Cancer Epidemiol Biomark Prev 19(8):2023–2034. https://doi.org/10.1158/1055-9965.EPI-09-1097 CrossRef

56.

Lewis CM, Wolf WA, Xun P, Sandler RS, He K (2016) Racial differences in dietary changes and quality of life after a colorectal cancer diagnosis: a follow-up of the Study of Outcomes in Colorectal Cancer Survivors cohort. Am J Clin Nutr 103(6):1523–1530. https://doi.org/10.3945/ajcn.115.126276 CrossRefPubMedPubMedCentral

57.

Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, Jemal A, Cho H, Anderson RN, Kohler BA, Eheman CR, Ward EM (2014) Annual Report to the Nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 120(9):1290–1314. https://doi.org/10.1002/cncr.28509 CrossRefPubMed

58.

Erreni M, Mantovani A, Allavena P (2011) Tumor-associated macrophages (TAM) and inflammation in colorectal cancer. Cancer Microenviron 4(2):141–154. https://doi.org/10.1007/s12307-010-0052-5 CrossRefPubMed

59.

Wang S, Liu Z, Wang L, Zhang X (2009) NF-κB signaling pathway, inflammation and colorectal cancer. Cell Mol Immunol 6(5):327CrossRef

60.

Richmond A (2002) Nf-kappa B, chemokine gene transcription and tumour growth. Nat Rev Immunol 2(9):664–674. https://doi.org/10.1038/nri887 CrossRefPubMedPubMedCentral

61.

Ogino S, Kirkner GJ, Nosho K, Irahara N, Kure S, Shima K, Hazra A, Chan AT, Dehari R, Giovannucci EL, Fuchs CS (2008) Cyclooxygenase-2 expression is an independent predictor of poor prognosis in colon cancer. Clin Cancer Res 14(24):8221–8227. https://doi.org/10.1158/1078-0432.ccr-08-1841 CrossRefPubMedPubMedCentral

62.

Proctor MJ, McMillan DC, Horgan PG, Fletcher CD, Talwar D, Morrison DS (2015) Systemic inflammation predicts all-cause mortality: a glasgow inflammation outcome study. PLoS One 10(3):e0116206CrossRef

63.

McMillan DC (2013) The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treat Rev 39(5):534–540CrossRef

64.

Leung EY, Crozier JE, Talwar D, O’Reilly DS, McKee RF, Horgan PG, McMillan DC (2008) Vitamin antioxidants, lipid peroxidation, tumour stage, the systemic inflammatory response and survival in patients with colorectal cancer. Int J Cancer 123(10):2460–2464. https://doi.org/10.1002/ijc.23811 CrossRefPubMed

65.

Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Tylavsky FA, Vitolins MZ, Ockene JK, Hebert JR (2016) Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in postmenopausal women. Eur J Clin Nutr 70(12):1374–1380. https://doi.org/10.1038/ejcn.2016.116 CrossRefPubMedPubMedCentral

66.

Neuhouser ML, Tinker L, Shaw PA, Schoeller D, Bingham SA, Horn LV, Beresford SA, Caan B, Thomson C, Satterfield S, Kuller L, Heiss G, Smit E, Sarto G, Ockene J, Stefanick ML, Assaf A, Runswick S, Prentice RL (2008) Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women’s Health Initiative. Am J Epidemiol 167(10):1247–1259. https://doi.org/10.1093/aje/kwn026 CrossRefPubMed

67.

Tabung FK, Steck SE, Liese AD, Zhang J, Ma Y, Caan B, Chlebowski RT, Freudenheim JL, Hou L, Mossavar-Rahmani Y, Shivappa N, Vitolins MZ, Wactawski-Wende J, Ockene JK, Hebert JR (2016) Association between dietary inflammatory potential and breast cancer incidence and death: results from the Women’s Health Initiative. Br J Cancer 114(11):1277–1285. https://doi.org/10.1038/bjc.2016.98 CrossRefPubMedPubMedCentral

Title: Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women’s Health Initiative
Authors: Jiali Zheng
Fred K. Tabung
Jiajia Zhang
E. Angela Murphy
Nitin Shivappa
Judith K. Ockene
Bette Caan
Candyce H. Kroenke
James R. Hébert
Susan E. Steck
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: European Journal of Nutrition / Issue 3/2020
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-01956-z

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