Dietary Inflammatory Index and Risk of Breast Cancer Based on Hormone Receptor Status: A Case-Control Study in Korea

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Abstract

Breast cancer is the most common cancer in women globally, and the risk of developing breast cancer is associated with inflammation. The present study aimed to examine the association between the Dietary Inflammatory Index (DII ^®) and breast cancer in Korean women and investigate whether the tumor’s hormone receptor status affects this association. In this case-control study, we enrolled 364 breast cancer patients and 364 age-matched controls. DII scores were calculated from dietary intake evaluated by a 106-item food frequency questionnaire. The DII score was significantly higher in cases than in controls. After adjusting for potential confounders, the odds ratio (OR) of breast cancer was higher in the highest DII tertile (OR = 3.68, 95% confidence interval (CI): 2.34–5.80, p for trend < 0.0001) than in the lowest tertile. We found that higher DII scores were related to an increased risk of breast cancer for estrogen receptor (ER)+/progesterone receptor (PR)+ tumors regardless of menopausal status (OR = 2.59, 95% CI: 1.37–4.88 in the highest DII category, p for trend = 0.01 for premenopausal women; OR = 11.00, 95% CI: 2.93–41.30 in the highest DII category, p for trend = 0.0004 for postmenopausal women), but not for ER−/PR− status. Our results suggested that the DII scores are positively associated with breast cancer risk in Korean women and that this relationship is more robust in ER+/PR+ tumors.

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The effects of diet on inflammation: emphasis on the metabolic syndrome.

Dario Giugliano, Antonio Ceriello, Katherine Esposito (2006)

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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Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women.

T J Key, P N Appleby, G K Reeves … (2003)

Obesity is associated with increased breast cancer risk among postmenopausal women. We examined whether this association could be explained by the relationship of body mass index (BMI) with serum sex hormone concentrations. We analyzed individual data from eight prospective studies of postmenopausal women. Data on BMI and prediagnostic estradiol levels were available for 624 case subjects and 1669 control subjects; data on the other sex hormones were available for fewer subjects. The relative risks (RRs) with 95% confidence intervals (CIs) of breast cancer associated with increasing BMI were estimated by conditional logistic regression on case-control sets, matched within each study for age and recruitment date, and adjusted for parity. All statistical tests were two-sided. Breast cancer risk increased with increasing BMI (P(trend) =.002), and this increase in RR was substantially reduced by adjustment for serum estrogen concentrations. Adjusting for free estradiol reduced the RR for breast cancer associated with a 5 kg/m2 increase in BMI from 1.19 (95% CI = 1.05 to 1.34) to 1.02 (95% CI = 0.89 to 1.17). The increased risk was also substantially reduced after adjusting for other estrogens (total estradiol, non-sex hormone-binding globulin-bound estradiol, estrone, and estrone sulfate), and moderately reduced after adjusting for sex hormone-binding globulin, whereas adjustment for the androgens (androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and testosterone) had little effect on the excess risk. The results are compatible with the hypothesis that the increase in breast cancer risk with increasing BMI among postmenopausal women is largely the result of the associated increase in estrogens, particularly bioavailable estradiol.

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Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients.

Brandon Pierce, Rachel Ballard-Barbash, Leslie Bernstein … (2009)

PURPOSE Chronic inflammation is believed to contribute to the development and progression of breast cancer. Systemic C-reactive protein (CRP) and serum amyloid A (SAA) are measures of low-grade chronic inflammation and potential predictors of cancer survival. PATIENTS AND METHODS We evaluated the relationship between circulating markers of inflammation and breast cancer survival using data from the Health, Eating, Activity, and Lifestyle (HEAL) Study (a multiethnic prospective cohort study of women diagnosed with stage 0 to IIIA breast cancer). Circulating concentrations of CRP and SAA were measured approximately 31 months after diagnosis and tested for associations with disease-free survival (approximately 4.1 years of follow-up) and overall survival (approximately 6.9 years of follow-up) in 734 disease-free breast cancer survivors. Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios (HRs) and 95% CIs. Results Elevated SAA and CRP were associated with reduced overall survival, regardless of adjustment for age, tumor stage, race, and body mass index (SAA P trend < .0001; CRP P trend = .002). The HRs for SAA and CRP tertiles suggested a threshold effect on survival, rather than a dose-response relationship (highest v lowest tertile: SAA HR = 3.15; 95% CI, 1.73 to 5.65; CRP HR = 2.27; 95% CI, 1.27 to 4.08). Associations were similar and still significant after adjusting for self-reported history of cardiovascular events and censoring cardiovascular disease deaths. Elevated CRP and SAA were also associated with reduced disease-free survival, although these associations were of borderline significance (SAA P trend = .04; CRP P trend = .07). CONCLUSION Circulating SAA and CRP may be important prognostic markers for long-term survival in breast cancer patients, independent of race, tumor stage, and body mass index.

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Author and article information

Journal

Journal ID (nlm-ta): Nutrients

Journal ID (iso-abbrev): Nutrients

Journal ID (publisher-id): nutrients

Title: Nutrients

Publisher: MDPI

ISSN (Electronic): 2072-6643

Publication date (Electronic): 19 August 2019

Publication date Collection: August 2019

Volume: 11

Issue: 8

Electronic Location Identifier: 1949

Affiliations

[1 ]Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Korea

[2 ]Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Korea

[3 ]Department of Food and Nutrition, Sookmyung Women’s University, Seoul 04310, Korea

Author notes

[* ]Correspondence: jskim@ 123456ncc.re.kr ; Tel.: +82-31-920-2570

[†]

Those authors contributed equally to this work.

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Jeongseon Kim https://orcid.org/0000-0002-0889-2686

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Publisher ID: nutrients-11-01949

DOI: 10.3390/nu11081949

PMC ID: 6723443

PubMed ID: 31430979

SO-VID: 483f519d-4268-4a6c-8a7e-3cf135b6a5d6

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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Dietary Inflammatory Index and Risk of Breast Cancer Based on Hormone Receptor Status: A Case-Control Study in Korea

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Most cited references 44

The effects of diet on inflammation: emphasis on the metabolic syndrome.

Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women.

Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients.

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