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      Validation of a Dietary Inflammatory Index (DII) and Association with Risk of Gastric Cancer: a Case-Control Study

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          Abstract

          Background:

          Gastric cancer (GC) is the fifth most common malignancy and the second leading cause of cancer-related deaths worldwide. Studies have shown that dietary components and inflammation are implicated in the etiology of GC.

          Methods:

          We examined the ability of a dietary inflammatory index (DII) to predict the odds of GC in a case-control study conducted from December 2014 to May 2016. The subjects were 82 cases and 95 controls who attended specialized centers in Tabriz, Iran. DII scores were computed from a validated 168-item food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) adjusted for age, sex, body mass index, education, smoking, alcohol, H.pylori infection, physical activity, aspirin/NSAID use and total caloric intake.

          Results:

          In the fully adjusted model, subjects with a DII score >-1.77 had nearly 3.5 times higher odds of having GC compared with subjects with DII≤-1.77, (ORDII>-1.77≤-1.77=3.39; 95%CI=1.59, 7.22). Also, for every one-unit increase in DII, there was a corresponding increase in hs-C-reactive protein, tumor necrosis factor-alpha, interleukin (IL)-6 and IL-1b: β=0.09, 0.16, 0.16 and 0.10, respectively; and a corresponding decrease in IL-10: β=-0.11.

          Conclusion:

          Subjects who consumed a more pro-inflammatory diet were at increased odds of GC compared to those who consumed a more anti-inflammatory diet.

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          Most cited references31

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          Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).

          Inflammation has been suggested as a risk factor for the development of atherosclerosis. Recently, some components of the insulin resistance syndrome (IRS) have been related to inflammatory markers. We hypothesized that insulin insensitivity, as directly measured, may be associated with inflammation in nondiabetic subjects. We studied the relation of C-reactive protein (CRP), fibrinogen, and white cell count to components of IRS in the nondiabetic population of the Insulin Resistance Atherosclerosis Study (IRAS) (n=1008; age, 40 to 69 years; 33% with impaired glucose tolerance), a multicenter, population-based study. None of the subjects had clinical coronary artery disease. Insulin sensitivity (S(I)) was measured by a frequently sampled intravenous glucose tolerance test, and CRP was measured by a highly sensitive competitive immunoassay. All 3 inflammatory markers were correlated with several components of the IRS. Strong associations were found between CRP and measures of body fat (body mass index, waist circumference), S(I), and fasting insulin and proinsulin (all correlation coefficients >0.3, P<0.0001). The associations were consistent among the 3 ethnic groups of the IRAS. There was a linear increase in CRP levels with an increase in the number of metabolic disorders. Body mass index, systolic blood pressure, and S(I) were related to CRP levels in a multivariate linear regression model. We suggest that chronic subclinical inflammation is part of IRS. CRP, a predictor of cardiovascular events in previous reports, was independently related to S(I). These findings suggest potential benefits of anti-inflammatory or insulin-sensitizing treatment strategies in healthy individuals with features of IRS.
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            The effects of diet on inflammation: emphasis on the metabolic syndrome.

            Reducing the incidence of coronary heart disease with diet is possible. The main dietary strategies include adequate omega-3 fatty acids intake, reduction of saturated and trans-fats, and consumption of a diet high in fruits, vegetables, nuts, and whole grains and low in refined grains. Each of these strategies may be associated with lower generation of inflammation. This review examines the epidemiologic and clinical evidence concerning diet and inflammation. Dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, poor in natural antioxidants and fiber from fruits, vegetables, and whole grains, and poor in omega-3 fatty acids may cause an activation of the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines. The whole diet approach seems particularly promising to reduce the inflammation associated with the metabolic syndrome. The choice of healthy sources of carbohydrate, fat, and protein, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease. Western dietary patterns warm up inflammation, while prudent dietary patterns cool it down.
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              Cancer incidence and mortality in Iran.

              Cancer is the third main cause of death in Iran. This report was provided for explaining cancer incidence and mortality. The National Cancer Registry reports from 2003 to 2006, population-based cancer registry reports from five provinces in 2006 and National Death Registry reports from 1999 to 2004 have been applied in this report. The age-standardized incidence rate of cancers was 98 and 110 per 100,000 among females and males. The male to female standard ratio was 1.12. The most common cancer among women and men was breast cancer (24) and stomach cancer (15), respectively. The estimated mortality rate for cancer was 41.1 and 65 per 100,000 for females and males in 2004. The current low cancer incidence rates in Iran might be due to lack of national cancer screening programs for prostate, colorectal or breast cancer, a consequence of incomplete registration as well as incomplete diagnosis of cancer patients; it is expected that it will rise dramatically in the future because of anticipated increase in life expectancy and westernized lifestyle. The first priorities for health policy makers should be developing, establishing and implementing national cancer control; or else, the health system could not respond to the demands regarding to diagnosis, treatment and palliation for these patients in the future.
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                Author and article information

                Journal
                Asian Pac J Cancer Prev
                Asian Pac. J. Cancer Prev
                Asian Pacific Journal of Cancer Prevention : APJCP
                West Asia Organization for Cancer Prevention (Iran )
                1513-7368
                2476-762X
                2018
                : 19
                : 6
                : 1471-1477
                Affiliations
                [1 ] Department of Nutritional Sciences, National Nutrition and Food Technology Research Institute, Tehran
                [2 ] Cancer Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran
                [3 ] Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
                [4 ] Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
                [5 ] Connecting Health Innovations LLC, Columbia, SC 29208, USA
                [6 ] Food Safety Research Center, School of Nutrition and Food Sciences, Semnan University of Medical Sciences, Semnan, Iran
                [7 ] Student Research Committee, Faculty of Nutrition Sciences and Food Technology, Tehran
                [8 ] Proteomics Research Center and Department of Biostatics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran
                Author notes
                [* ] For Correspondence: hdavoodi1345@ 123456gmail.com
                Article
                APJCP-19-1471
                10.22034/APJCP.2018.19.6.1471
                6103570
                29936717
                3cd9cd61-3b8d-4784-af4f-6d6824d8230b
                Copyright: © Asian Pacific Journal of Cancer Prevention

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 03 June 2017
                : 05 May 2018
                Categories
                Research Article

                gastric cancer,inflammation,dietary inflammatory index (dii),nutritional assessment,validation of dii

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