by Ashley Jordan Ferira, PhD, RDN
Colorectal cancer (CRC) is the third leading cause of cancer-related death for men and women in the US.1 Chronic inflammation contributes to cancer development.2 Pro-inflammatory conditions, such as obesity and inflammatory bowel disease, have been associated with CRC risk.3-4 It is plausible that a dietary pattern that induces more inflammation could impact CRC risk.
The relationship between dietary inflammatory potential and CRC risk was investigated by Dr. Frank Hu of Harvard University and his colleagues, evaluating data of more than 120,000 participantsfrom two prospective cohort studies, the Health Professionals Follow-Up Study and Nurses’ Health Study.5 Dietary assessment data using a validated, self-reported food frequency questionnaire (FFQ) collected every four years was utilized to calculate an empirical dietary inflammatory pattern (EDIP) score. A higher EDIP score indicates greater inflammatory potential. During 26 years of follow-up, 2,699 CRC cases were documented.
Compared to the lowest EDIP, the highest EDIP category was associated with:
- 44% higher risk of developing CRC in men
- 22% higher risk of developing CRC in women
- 32% higher risk of developing CRC when combining men and women
- These associations were significant at all anatomic sites, except for the rectum in women
Subgroup analyses revealed that BMI and alcohol intake modified the relationship between high vs. low EDIP and CRC, with a higher CRC risk seen among overweight and obese men. Perhaps less anticipated findings included a higher CRC risk observed among:
- Lean women (BMI < 25)
- Men and women consuming no alcohol
Limiting food groups associated with higher inflammation biomarkers (e.g. processed meat, red meat, organ meat, vegetables other than leafy-green and dark yellow varieties, refined grains, high- and low-energy carbonated beverages and fruit drinks) may help reduce colorectal cancer risk. Alcohol may influence CRC risk through mechanisms other than inflammation.
Why is this Clinically Relevant?
- Nutrition is a modifiable lifestyle risk factor for many chronic diseases
- Chronic inflammation offers a plausible mechanistic link between dietary pattern and colorectal cancer development
- Healthcare practitioners can partner with patients to empower them to follow a healthful dietary pattern, limiting foods and beverages associated with higher inflammation, to help reduce colorectal cancer risk
- American Cancer Society. Key Statistics for Colorectal Cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Accessed January 25, 2018.
- Grivennikov SI, Greten FR. Immunity, inflammation, and cancer. Cell. 2010;140(6):883-899.
- World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Report: Diet, Nutrition, Physical Activity, and Colorectal Cancer. Washington DC. 2017. http://www.aicr.org/continuous-update-project/reports/colorectal-cancer-2017-report.pdf. Accessed January 30, 2018.
- Beaugerie L, Svrcek M, Seksik P, et al. CESAME Study Group. Risk of colorectal high-grade dysplasia and cancer in a prospective observational cohort of patients with inflammatory bowel disease. Gastroenterology. 2013;145(1):166-175.
- Tabung FK, Liu L, Wang W, et al. Association of dietary inflammatory potential with colorectal cancer risk in men and women. JAMA Oncol. 2018;4(3):366-373.