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Erschienen in: European Journal of Nutrition 3/2020

06.04.2019 | Original Contribution

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

verfasst von: 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

Erschienen in: European Journal of Nutrition | Ausgabe 3/2020

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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 (HRT1vsT3 = 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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Literatur
2.
Zurück zum Zitat American Cancer Society. Cancer treatment & survivorship facts & figures, 2016–2017 American Cancer Society. Cancer treatment & survivorship facts & figures, 2016–2017
4.
Zurück zum Zitat 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 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
5.
Zurück zum Zitat 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 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
6.
Zurück zum Zitat 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 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
7.
Zurück zum Zitat Schoenberg MH (2016) Physical activity and nutrition in primary and tertiary prevention of colorectal cancer. Visc Med 32(3):199–204CrossRef Schoenberg MH (2016) Physical activity and nutrition in primary and tertiary prevention of colorectal cancer. Visc Med 32(3):199–204CrossRef
9.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
13.
Zurück zum Zitat 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 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
20.
Zurück zum Zitat 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 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
22.
Zurück zum Zitat Study TWsHI (1998) Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 19(1):61–109CrossRef Study TWsHI (1998) Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 19(1):61–109CrossRef
23.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
29.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Seidell JC, Flegal KM (1997) Assessing obesity: classification and epidemiology. Br Med Bull 53(2):238–252CrossRef Seidell JC, Flegal KM (1997) Assessing obesity: classification and epidemiology. Br Med Bull 53(2):238–252CrossRef
35.
Zurück zum Zitat 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 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.
Zurück zum Zitat Fritz A, Ries L (1998) The SEER Program code manual. National Cancer Institute, Bethesda (United States Cancer Statistics: 2004 incidence and mortality) Fritz A, Ries L (1998) The SEER Program code manual. National Cancer Institute, Bethesda (United States Cancer Statistics: 2004 incidence and mortality)
38.
Zurück zum Zitat 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 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.
Zurück zum Zitat Schoenfeld D (1980) Chi squared goodness-of-fit tests for the proportional hazards regression model. Biometrika 67(1):145–153CrossRef Schoenfeld D (1980) Chi squared goodness-of-fit tests for the proportional hazards regression model. Biometrika 67(1):145–153CrossRef
40.
Zurück zum Zitat Hess KR (1994) Assessing time-by-covariate interactions in proportional hazards regression models using cubic spline functions. Stat Med 13(10):1045–1062CrossRef Hess KR (1994) Assessing time-by-covariate interactions in proportional hazards regression models using cubic spline functions. Stat Med 13(10):1045–1062CrossRef
41.
Zurück zum Zitat Therneau TM, Grambsch PM (2000) Modeling survival data: extending the Cox model. Springer Science & Business Media, BerlinCrossRef Therneau TM, Grambsch PM (2000) Modeling survival data: extending the Cox model. Springer Science & Business Media, BerlinCrossRef
46.
Zurück zum Zitat 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 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
52.
54.
55.
Zurück zum Zitat 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 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
57.
Zurück zum Zitat 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 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
59.
Zurück zum Zitat Wang S, Liu Z, Wang L, Zhang X (2009) NF-κB signaling pathway, inflammation and colorectal cancer. Cell Mol Immunol 6(5):327CrossRef Wang S, Liu Z, Wang L, Zhang X (2009) NF-κB signaling pathway, inflammation and colorectal cancer. Cell Mol Immunol 6(5):327CrossRef
62.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
66.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
Metadaten
Titel
Post-cancer diagnosis dietary inflammatory potential is associated with survival among women diagnosed with colorectal cancer in the Women’s Health Initiative
verfasst von
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
Publikationsdatum
06.04.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nutrition / Ausgabe 3/2020
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-019-01956-z

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