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Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study

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Abstract

Purpose

To test whether the inflammatory potential of diet, as measured using the dietary inflammatory index (DII), is associated with risk of lung cancer or other respiratory conditions and to compare results obtained with those based on the aMED score, an established dietary index that measures adherence to the traditional Mediterranean diet.

Methods

In 4336 heavy smokers enrolled in a prospective, non-randomized lung cancer screening program, we measured participants’ diets at baseline using a self-administered food frequency questionnaire from which dietary scores were calculated. Cox proportional hazards and logistic regression models were used to assess association between the dietary indices and lung cancer diagnosed during annual screening, and other respiratory outcomes that were recorded at baseline, respectively.

Results

In multivariable analysis, adjusted for baseline lung cancer risk (estimated from age, sex, smoking history, and asbestos exposure) and total energy, both DII and aMED scores were associated with dyspnoea (p trend = 0.046 and 0.02, respectively) and radiological evidence of emphysema (p trend = 0.0002 and 0.02). After mutual adjustment of the two dietary scores, only the association between DII and radiological evidence of emphysema (Q4 vs. Q1, OR 1.30, 95 % CI 1.01–1.67, p trend = 0.012) remained statistically significant. At univariate analysis, both DII and aMED were associated with lung cancer risk, but in fully adjusted multivariate analysis, only the association with aMED remained statistically significant (p trend = 0.04).

Conclusions

Among heavy smokers, a pro-inflammatory diet, as indicated by increasing DII score, is associated with dyspnoea and radiological evidence of emphysema. A traditional Mediterranean diet, which is associated with a lower DII, may lower lung cancer risk.

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Acknowledgments

This work was in part supported by the Italian Association for Cancer Research (AIRC), the Italian Foundation for Cancer Research (FIRC), and the European Institute of Oncology (IEO). Dr. Hébert was supported by an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the National Cancer Institute (K05 CA136975).

Conflict of interest

Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is a paid employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project. On behalf of all other co-authors, the corresponding author states that there is no conflict of interest.

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    Authors and Affiliations

    1. Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy

      Patrick Maisonneuve & Patrizia Gnagnarella

    2. Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA

      Nitin Shivappa & James R. Hébert

    3. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

      Nitin Shivappa & James R. Hébert

    4. Division of Radiology, European Institute of Oncology, Milan, Italy

      Massimo Bellomi & Cristiano Rampinelli

    5. Department of Health Sciences, University of Milan, Milan, Italy

      Massimo Bellomi & Lorenzo Spaggiari

    6. Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy

      Raffaella Bertolotti & Lorenzo Spaggiari

    7. Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy

      Domenico Palli

    8. Division of Thoracic and General Surgery, Humanitas Research Hospital, Rozzano, Italy

      Giulia Veronesi

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    1. Patrick Maisonneuve
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    Correspondence to Patrick Maisonneuve.

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    Patrick Maisonneuve and Nitin Shivappa have contributed equally to this article and therefore share first-authorship.

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    Maisonneuve, P., Shivappa, N., Hébert, J.R. et al. Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study. Eur J Nutr 55, 1069–1079 (2016). https://doi.org/10.1007/s00394-015-0920-3

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    • DOI: https://doi.org/10.1007/s00394-015-0920-3

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