ReviewDietary Inflammatory Potential Score and Risk of Breast Cancer: Systematic Review and Meta-analysis
Introduction
Breast cancer is one of the most commonly diagnosed cancers and is the leading cause of mortality among women around the world.1, 2 In 2012, an estimated 1.7 million women were diagnosed with breast cancer, and 522,000 died. Breast cancer imposes a high burden and cost on public health systems. Therefore, understanding its contributing factors and developing appropriate strategies to prevent this cancer are required.3
Interaction among genetic and environmental factors, particularly diet, contributes to breast cancer. Diet is a modifiable risk factor that can influence the risk of breast cancer.4, 5 It is estimated that almost one third of breast cancer cases could be prevented by dietary modifications. Although previous studies have shown the potential association between dietary factors and breast cancer risk and mortality, this association is still controversial. Some studies have found a higher risk of breast cancer with Western diets, and some studies have found that healthy dietary patterns can decrease the risk of breast cancer.6
Dietary factors have shown to be related to systemic low-grade inflammation, which plays a key role in several chronic diseases, including metabolic7 and degenerative diseases,8 and in specific cancers, including breast cancer.9 Dietary inflammatory potential (DIP), as updated by Shivappa et al10 (of the work of Cavicchia et al11), is a literature-based scoring system that represents the potential inflammatory properties of the diet from anti-inflammatory to proinflammatory. Indeed, DIP was developed to determine the positive or negative influence of each dietary component on inflammation on a continuum ranging from maximally anti-inflammatory to maximally proinflammatory. Although substantial research has investigated the association between DIP and the risk of several cancers such as breast, prostate, ovarian, lung, and colorectal,12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 the association remains unclear.
DIP has been investigated in relation to breast cancer; however, findings are conflicting. We performed a meta-analysis to summarize the findings on the association between DIP and the risk of breast cancer. Breast cancer has a poor prognosis and a rising incidence,24 so understanding contributing factors and developing appropriate strategies to prevent this cancer are beneficial.
Section snippets
Search Strategy
The present study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol.25 To ensure a comprehensive assessment of all available evidence and publications on the association of dietary inflammatory index with breast cancers, we reviewed and screened all related articles searched according to the study protocol.
We used the following keywords to search the databases: “dietary inflammatory index” or “DIP,” and all related domains to
Results
Overall, 147 potential records were identified after searching the databases, and 7 articles were removed because of duplication. After screening the titles and abstracts and removing irrelevant studies, 11 articles were selected for detailed assessment. Of these, only 9 reports fulfilled our inclusion criteria, including 6 cohort and 3 case–control studies. The flowchart for study selection is presented in Figure 1.
In the present systematic review, 5 cohort15, 27, 28, 29, 30 and 3 case–control
Discussion
The results of the meta-analysis suggested that there is a significant association between DIP and the risk of breast cancer (pooled OR, 1.14; 95% CI, 1.01–1.27). A similar finding was also found in the studies presenting DIP as a continuous variable (pooled OR, 1.08; 95% CI, 1.01–1.15). To our knowledge, this is the first study summarizing the findings on DIP and breast cancer risk.
We found that DIP was positively associated with breast cancer risk. In line with our findings, Shivappa et al32
Disclosure
The authors have stated that they have no conflict of interest.
Acknowledgment
Supported in part by National Institute for Medical Research Development grant 958724.
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