Development and Validation of an Empirical Dietary Inflammatory Index

Tabung, Fred K.; Smith‐Warner, Stephanie A.; Chavarro, Jorge E.; Wu, Kana; Fuchs, Charles S.; Hu, Frank B.; Chan, Andrew T.; Willett, Walter C.; Giovannucci, Edward

doi:10.3945/jn.115.228718

Cited by 312 publications

(382 citation statements)

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“…One advantage of the empirical hypothesis-oriented dietary patterns is their focus on a specific biological pathway linking diet and disease outcomes. Dietary indices have been developed with inflammation [24]**[17, 74] and insulin response [25]** as the central theme in their development. Association of these indices with disease incidence indicates that inflammation or insulin response, respectively may be mediating the development of the disease, e.g., dietary inflammatory potential has been found to be associated with colorectal cancer risk in several studies [43]*[75].…”

Section: Discussionmentioning

confidence: 99%

“…The validity of the score relative to the underlying hypothesis is evaluated in independent study populations, and the dietary pattern score is then derived and used in different study populations (in the same manner as a priori patterns) to examine its association with disease risk [24, 25]**. For example, Tabung et al , used reduced rank regression [26] to develop an empirical dietary inflammatory pattern (EDIP) score [24]**, and stepwise linear regression analyses to develop empirical indices to assess the insulinemic potential of diet and lifestyle [25]**. These indices may then be used to examine associations with diseases whose development is hypothesized to be mediated through the inflammatory or insulin response pathways respectively.…”

Section: Methodsmentioning

confidence: 99%

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Dietary Patterns and Colorectal Cancer Risk: a Review of 17 Years of Evidence (2000–2016)

Tabung

Brown

Fung

2017

Curr Colorectal Cancer Rep

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Purpose of review Colorectal cancer (CRC) is a global public health problem, with an estimated 1.4 million cases diagnosed worldwide in 2012. Evidence suggests that diet may be important for primary prevention. Recent findings The 2017 WCRF/AICR Continuous Update Project on colorectal cancer concluded that there is convincing evidence linking several individual dietary factors with CRC risk but the evidence for dietary patterns was limited and inconclusive. Also, previous reviews and meta-analyses have not critically synthesized various dietary patterns. This review synthesized data from dietary patterns studies over a 17-year period from 2000 to 2016. Summary We included 49 studies (28 cohort and 21 case-control) that examined the association of index-based and empirically-derived dietary patterns and CRC risk. A synthesis of food group components comprising the different index-based and empirically-derived patterns revealed two distinct dietary patterns associated with CRC risk. A “healthy” pattern, generally characterized by high intake of fruits and vegetables, wholegrains, nuts and legumes, fish and other seafood, milk and other dairy products, was associated with lower CRC risk. In contrast, the “unhealthy” pattern, characterized by high intakes of red meat, processed meat, sugar-sweetened beverages, refined grains, desserts and potatoes was associated with higher CRC risk. It is notable that the number of food groups, the intake quantity, the exact types of foods in each food group, differed between populations, yet the two dietary patterns remained consistent across regions, especially in empirically-derived patterns, an indication of the high reproducibility of these patterns. However, findings for CRC risk in both index-based and empirically-derived patterns, differed by sex, with stronger associations among men than women; study design, a higher proportion of case-control studies reported significant findings compared to prospective studies. Consuming a dietary pattern high in fruits and vegetables and low in meats and sweets is protective against CRC risk. However, important questions remain about mechanisms underlying differences by sex; life-course timing of exposure to dietary patterns; interaction of dietary patterns with the microbiome or with lifestyle factors including physical activity; and elucidation of subsite differences.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Dietary Patterns and Colorectal Cancer Risk: a Review of 17 Years of Evidence (2000–2016)

Tabung

Brown

Fung

2017

Curr Colorectal Cancer Rep

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“…2–4 We have developed an empirical dietary inflammatory pattern (EDIP) score based on eighteen food groups that correlate with concentrations of inflammatory plasma biomarkers in the Nurses’ Health Study (NHS). 6 The EDIP score has been validated in two independent cohorts of men and women, the Health Professionals Follow-up Study (HPFS) and the Nurses' Health Study-II, respectively. 6 …”

Section: Introductionmentioning

confidence: 99%

“…6 The EDIP score has been validated in two independent cohorts of men and women, the Health Professionals Follow-up Study (HPFS) and the Nurses' Health Study-II, respectively. 6 …”

Section: Introductionmentioning

confidence: 99%

Association Between Inflammatory Diet Pattern and Risk of Colorectal Carcinoma Subtypes Classified by Immune Responses to Tumor

et al. 2017

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Background & Aims Dietary patterns affect systemic and local intestinal inflammation, which have been linked to colorectal carcinogenesis. Chronic inflammation can interfere with the adaptive immune response. We investigated whether the association of a diet that promotes intestinal inflammation with risk of colorectal carcinoma was stronger for tumors with lower lymphocytic reactions than tumors with higher lymphocytic reactions. Methods We collected data from the molecular pathological epidemiology databases of 2 prospective cohort studies: the Nurses’ Health Study (since 1976) and the Health Professional Follow-up Study (since 1986). We used duplication-method time-varying Cox proportional cause-specific hazards regression to assess the association of empirical dietary inflammatory pattern (EDIP) score (derived from food frequency questionnaire data) with colorectal carcinoma subtype. Foods that contribute to high EDIP scores include red and processed meats, refined grains, carbonated beverages, and some vegetables; foods that contribute to low EDIP scores include beer, wine, coffee, tea, yellow and leafy vegetables, and fruit juice. Colorectal tissue samples were analyzed histologically for patterns of lymphocytic reactions (Crohn’s-like lymphoid reaction, peritumoral lymphocytic reaction, intratumoral periglandular reaction, and tumor-infiltrating lymphocytes). Results During follow up of 124,433 participants, we documented 1311 incident colon and rectal cancer cases with available tissue data. The association between the EDIP and colorectal cancer risk was significant (Ptrend = .02), and varied with degree of peritumoral lymphocytic reaction (Pheterogeneity < .001). Higher EDIP scores were associated with increased risk of colorectal cancer with an absent or low peritumoral lymphocytic reaction (highest vs lowest EDIP score quintile hazard ratio = 2.60; 95% CI, 1.60–4.23; Ptrend < .001) but not risk of tumors with intermediate or high peritumoral lymphocytic reaction (Ptrend > .80). Conclusions In a prospective cohort study, we associated inflammatory diets with a higher risk of colorectal cancer subtype that contains little or no peritumoral lymphocytic reaction. These findings suggest that diet-related inflammation might contribute to development of colorectal cancer, by suppressing the adaptive anti-tumor immune response.

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“…Moreover, the different studies did not always use the standard FFQ, further increasing the variability when trying to compare the results from diverse populations. To circumvent these limitations, new dietary indexes assessing inflammation have been developed and validated most recently [29–31], to numerically evaluate dietary patterns in a standardized and reproducible manner across different populations.…”

Section: Dii: a Standard Index With A Lot Of Variabilitymentioning

confidence: 99%