Researchers unveils a correlation between inflammatory and antioxidant diets and the risk of developing colorectal – breast cancer

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Researchers from the Molecular Mechanisms and Experimental Therapy in Oncology program (Oncobell) of the Bellvitge Biomedical Research Institute (IDIBELL) and the Catalan Institute of Oncology (ICO), together with the Biodonostia Health Research Institute (IIS Biodonostia), among others, have published in Nutrients the results of a multicenter study that unveils a correlation between inflammatory and antioxidant diets and the risk of developing colorectal and breast cancer.

Dr. Mireia Obón-Santacana from IDIBELL-ICO is the first author of a research which was led by Dr. Pilar Amiano, principal investigator at IIS Biodonostia, and Dr. Víctor Moreno, head of the colorectal cancer research group at IDIBELL-ICO.

Part of the study has been possible thanks to the funding provided by the Spanish Association Against Cancer (AECC).

“We have observed an association between the risk of developing colorectal cancer and the inflammatory potential of the diet.

That is, the participants who followed an inflammatory diet had almost twice the risk of developing colorectal cancer, which is the 4th most frequent cancer worldwide,” explains Dr. Mireia Obón.

“On the other hand, we have not appreciated a significant increase in breast cancer risk.

That is why we need to carry out more studies to check if there is really any correlation with other factors,” she adds.

An inflammatory diet is usually characterized by the consumption of refined carbohydrates, red and processed meat, and saturated or trans fats.

In an antioxidant diet, the consumption of vegetables, legumes, fruits and nuts predominates.

“In this study we have focused on the role of diet, and specifically on its inflammatory and antioxidant capacity, as there is evidence that both chronic inflammation and oxidative stress influence the development of these two types of cancer,” says Dr. Víctor Moreno.

“Following a pro-inflammatory and pro-oxidant diet is a very important risk factor for colon cancer.

The positive part is that this is a modifiable factor and, therefore, it can be changed,” underlines Dr. Mireia Obón.

“Therefore, in order to prevent such cancers, it is very important to follow the recommendations of official agencies and international agencies.

We should reorient our eating habits towards a Mediterranean diet, rich in fruits and vegetables, nuts, whole grains and healthy oils, such as olive oil and move away from a more pro-inflammatory diet,” she argues.

What the IDIBELL-ICO researcher suggests is to “implement education strategies created by nutrition and health professionals, so that the general population can follow dietary recommendations and change their habits”.

In this new study, scientists have specifically analysed the Spanish population through the Dietary Inflammatory Index (DII) and the Non-Enzymatic Antioxidant Capacity (NEAC), which are two useful and validated tools to estimate the inflammatory and the antioxidant potential of the diet.

To carry out the study, 1852 cases of colorectal cancer and 1567 cases of breast cancer were included, together with 3447 and 1487 control cases, respectively. The study drew on data from 12 Spanish provinces.


Colorectal cancer (CRC) is the third most common form of cancer worldwide and is one of the leading causes of cancer-related deaths [1].

Incidence and mortality rates of CRC vary widely with higher incidence rates in developed nations and lower incidence rates in Asia, Africa, and most Latin American countries [2].

Inflammation typically occurs as part of the body’s normal response to tissue insult/injury [3,4].

Chronic inflammation is a persistent condition in which tissue destruction and repair occur simultaneously [5,6], involving continuous recruitment of pro-inflammatory cytokines (associated with increased blood flow to the injured tissue, due to histamine released by damaged mast cells) [3].

Increased levels of these cytokines also are believed to be associated with CRC [7,8,9].

Furthermore, some research suggests a direct association between specific dietary components and inflammation [10,11,12,13].

Various dietary components may be involved in the development of CRC [14].

The 2012 American Institute for Cancer Research/World Cancer Research Fund Continuous Update Project (CUP) reported that consumption of red and processed meat, which are pro-inflammatory, is associated with an increased risk of CRC [14].

Conversely, the consumption of dietary fiber, which is anti-inflammatory, is inversely associated with risk of CRC [14].

Furthermore, other dietary components, such as tea and coffee, which we have found to be anti-inflammatory, have demonstrated various health benefits , including lower cancer incidence [15,16] and mortality [17,18].

Moreover, comprehensive investigations on whole dietary patterns have indicated that unhealthy dietary patterns are associated with higher risk of CRC and adenoma, while healthy diets are associated with lower risk [19,20].

In response to the absence of an instrument that could summarize diets’ ability to influence inflammatory processes, in 2009 researchers at the University of South Carolina developed the first Dietary Inflammatory Index, which was created based on literature published on diet and inflammation through 2007 [21].

In 2014 the new refined and improved Dietary Inflammatory Index (DII®) was based on literature published on diet and inflammation through 2010 [22].

The DII categorizes individuals’ diets according to their inflammatory potential on a continuum from maximally pro-inflammatory to maximally anti-inflammatory.

A higher DII score indicates a more pro-inflammatory diet, whereas a lower DII score represents a more anti-inflammatory diet. The DII is composed of 45 food parameters, out of which 36 are anti-inflammatory.

These include: fiber, alcohol, monounsaturated fatty acids, polyunsaturated fatty acids, omega 3, omega 6, niacin, thiamin, riboflavin, vitamin B6, B12, zinc, magnesium, selenium, vitamin A, vitamin C, vitamin D, vitamin E, folic acid, beta carotene, anthocyanidins, flavan3ols, flavonols, flavanones, flavones, isoflavones, garlic, ginger, onions, thyme, oregano, saffron, turmeric, rosemary, eugenol, caffeine, and tea.

The remaining 9 are pro-inflammatory components: energy, carbohydrates, proteins, total fat, trans fat, cholesterol, vitamin B12, saturated fatty acids and iron.

As a rule, foods that have low DII scores tend to be flavorful, colorful, nutrient-dense, and calorie-sparse.

By contrast, those foods that have high DII scores tend to be flavorless (even though they may have a strong taste, such as sweet), are white or colorless, nutrient-sparse and calorie-dense.

The DII was found to predict changes in high sensitivity-C-reactive protein (hs-CRP) in the Seasonal Variation in Blood Cholesterol Study [21,23].

Subsequently, the DII has been used in several studies from around the world to test the effect of diet-associated inflammation on inflammation markers such as CRP, interleukin (IL)-6, and (tumor necrosis factor) and TNF-α-R2 [23,24,25,26,27,28,29,30].

In the Seasonal Variation of Blood Cholesterol Study, higher DII scores were associated with values of hs-CRP > 3 mg/L [odds ratio (OR) = 1.08; 95% confidence interval (CI): 1.01, 1.16, p = 0.035 for the 24 hour recall (24 HR) subset; and OR = 1.10; 95% CI: 1.02, 1.19, p = 0.015 for the 7-Day Dietary Recall] [23]; in the Women’s Health Initiative, the DII was associated with the four biomarkers with beta estimates comparing the highest with lowest DII quintiles as follows: Interleukin-6: 1.26 (1.15–1.38), ptrend < 0.0001; tumor necrosis factor alpha receptor 2: 81.43 (19.15–143.71), p trend = 0.004; dichotomized hs-CRP (odds ratio for higher vs. lower hs-CRP): 1.30 (0.97–1.67), p trend = 0.34; and the combined inflammatory biomarker score: 0.26 (0.12–0.40), p trend = 0.0001 [24].

Additionally, the DII has been linked to various health outcomes including cancer incidence [31,32,33]; all-cause, cardiovascular and cancer-specific mortality [34,35,36]; respiratory conditions such as asthma [28,37]; and cognitive disorders [38,39].

The most consistent results have been observed with CRC, with nine studies published exploring this association [40,41,42,43,44,45,46,47,48].

The current meta-analysis aimed to investigate the cumulative association between the inflammatory potential of diet, as estimated by the DII score, and CRC risk based on the results from nine previous studies.


More information: Obón-Santacana et al, Dietary Inflammatory Index, Dietary Non-Enzymatic Antioxidant Capacity, and Colorectal and Breast Cancer Risk (MCC-Spain Study), Nutrients (2019). DOI: 10.3390/nu11061406

Provided by IDIBELL-Bellvitge Biomedical Research Institute

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