Maisonneuve Patrick, Shivappa Nitin, Hébert James R, Bellomi Massimo, Rampinelli Cristiano, Bertolotti Raffaella, Spaggiari Lorenzo, Palli Domenico, Veronesi Giulia, Gnagnarella Patrizia
Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy.
Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.
Eur J Nutr. 2016 Apr;55(3):1069-79. doi: 10.1007/s00394-015-0920-3. Epub 2015 May 8.
To test whether the inflammatory potential of diet, as measured using the dietary inflammatory index (DII), is associated with risk of lung cancer or other respiratory conditions and to compare results obtained with those based on the aMED score, an established dietary index that measures adherence to the traditional Mediterranean diet.
In 4336 heavy smokers enrolled in a prospective, non-randomized lung cancer screening program, we measured participants' diets at baseline using a self-administered food frequency questionnaire from which dietary scores were calculated. Cox proportional hazards and logistic regression models were used to assess association between the dietary indices and lung cancer diagnosed during annual screening, and other respiratory outcomes that were recorded at baseline, respectively.
In multivariable analysis, adjusted for baseline lung cancer risk (estimated from age, sex, smoking history, and asbestos exposure) and total energy, both DII and aMED scores were associated with dyspnoea (p trend = 0.046 and 0.02, respectively) and radiological evidence of emphysema (p trend = 0.0002 and 0.02). After mutual adjustment of the two dietary scores, only the association between DII and radiological evidence of emphysema (Q4 vs. Q1, OR 1.30, 95 % CI 1.01-1.67, p trend = 0.012) remained statistically significant. At univariate analysis, both DII and aMED were associated with lung cancer risk, but in fully adjusted multivariate analysis, only the association with aMED remained statistically significant (p trend = 0.04).
Among heavy smokers, a pro-inflammatory diet, as indicated by increasing DII score, is associated with dyspnoea and radiological evidence of emphysema. A traditional Mediterranean diet, which is associated with a lower DII, may lower lung cancer risk.
使用饮食炎症指数（DII）衡量饮食的炎症潜力，测试其是否与肺癌或其他呼吸道疾病风险相关，并将所得结果与基于aMED评分的结果进行比较，aMED评分是一种既定的饮食指数，用于衡量对传统地中海饮食的依从性。
在4336名参加前瞻性、非随机肺癌筛查项目的重度吸烟者中，我们在基线时使用自行填写的食物频率问卷测量参与者的饮食，并据此计算饮食评分。Cox比例风险模型和逻辑回归模型分别用于评估饮食指数与年度筛查期间诊断出的肺癌以及基线时记录的其他呼吸道结局之间的关联。
在多变量分析中，对基线肺癌风险（根据年龄、性别、吸烟史和石棉暴露情况估算）和总能量进行调整后，DII和aMED评分均与呼吸困难（p趋势分别为0.046和0.02）以及肺气肿的影像学证据相关（p趋势分别为0.0002和0.02）。在对两种饮食评分进行相互调整后，只有DII与肺气肿影像学证据之间的关联（四分位数4 vs. 四分位数1，OR 1.30，95%CI 1.01 - 1.67，p趋势 = 0.012）仍具有统计学意义。在单变量分析中，DII和aMED均与肺癌风险相关，但在完全调整的多变量分析中，只有与aMED的关联仍具有统计学意义（p趋势 = 0.04）。
在重度吸烟者中，DII评分升高表明的促炎饮食与呼吸困难和肺气肿的影像学证据相关。与较低DII相关的传统地中海饮食可能会降低肺癌风险。
