Wesselink Evertine, Staritsky Laura E, van Zutphen Moniek, Geijsen Anne J M R, Kok Dieuwertje E, Kruyt Flip, Veenstra Renzo P, Spillenaar Bilgen Ernst Jan, Kouwenhoven Ewout A, de Wilt Johannes H W, Kampman Ellen, van Duijnhoven Fränzel J B
Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
Clin Nutr. 2021 Jun;40(6):4436-4443. doi: 10.1016/j.clnu.2021.01.004. Epub 2021 Jan 11.
BACKGROUND & AIMS: The inflammatory potential of the diet has been linked to colorectal cancer (CRC) development and mortality. However, it is unknown whether it is also associated with CRC recurrence. Therefore, the aim of this study was to investigate the associations between the inflammatory potential of the diet and plasma inflammation markers as well as recurrence and all-cause mortality in CRC patients.
Data of the Colorectal cancer, Observational, LONgitudinal (COLON) study, a prospective cohort study, was used. Dietary intake, assessed using a semi-quantitative food frequency questionnaire, was available for 1478 patients at diagnosis and for 1334 patients six months after diagnosis. Dietary intake data were used to calculate the adapted dietary inflammatory index (ADII). Data about cancer recurrence and all-cause mortality, were assessed through linkage with the Netherlands Cancer Registry and the Municipal Personal Records Database, respectively. The association between the ADII (continuous) and inflammation markers (Interleukin (IL)6, IL8, IL10, Tumor Necrosis Factor (TNF)α, high sensitivity C-reactive protein (hsCRP) and a summary inflammatory z-score), measured with a multiplex assay using electrochemiluminiscence detection, was assessed using quantile regression analyses. Restricted cubic splines (RCS) analyses and multivariable Cox proportional hazard models were used to explore the relationship between the ADII and CRC outcomes.
During a median follow-up time of 3.2 years (Interquartile range (IQR) 2.0-4.1) for recurrence and 4.8 years (IQR 3.5-5.9) for all-cause mortality, 228 recurrences and 279 deaths occurred. A more pro-inflammatory diet at diagnosis as well as six months after diagnosis was associated with higher levels of TNFα, hsCRP and the summary inflammatory z-score. Results of RCS showed no relationship between the ADII and CRC outcomes at both time points. Also results of the Cox proportional hazard models showed no associations between the ADII at both time points and recurrence (HR (95%CI) 0.98 (0.94-1.04) & 0.96 (0.91-1.02) or all-cause mortality (HR (95%CI) 1.03 (0.98-1.07) & 1.00 (0.95-1.05)).
Our study did not show an association between the ADII and recurrence and all-cause mortality in CRC patients. Further research should also take into account molecular tumor subtypes, as the effect of the inflammatory potential of the diet on cancer recurrence and mortality is more likely to be present in tumors with an inflammatory signature.
The colon study: NCT03191110; clinical trials.gov.
饮食的炎症潜能与结直肠癌（CRC）的发生及死亡率相关。然而，其是否也与CRC复发有关尚不清楚。因此，本研究旨在探讨饮食的炎症潜能与血浆炎症标志物以及CRC患者复发和全因死亡率之间的关联。
采用前瞻性队列研究——结直肠癌观察性纵向（COLON）研究的数据。通过半定量食物频率问卷评估饮食摄入量，诊断时1478例患者及诊断后6个月1334例患者有相关数据。饮食摄入数据用于计算调整后的饮食炎症指数（ADII）。癌症复发和全因死亡率数据分别通过与荷兰癌症登记处和市政个人记录数据库的链接进行评估。使用电化学发光检测的多重分析方法测量ADII（连续变量）与炎症标志物（白细胞介素（IL）6、IL8、IL10、肿瘤坏死因子（TNF）α、高敏C反应蛋白（hsCRP）和炎症z评分汇总）之间的关联，并采用分位数回归分析进行评估。使用受限立方样条（RCS）分析和多变量Cox比例风险模型探讨ADII与CRC结局之间的关系。
复发的中位随访时间为3.2年（四分位间距（IQR）2.0 - 4.1），全因死亡率的中位随访时间为4.8年（IQR 3.5 - 5.9），发生228例复发和279例死亡。诊断时以及诊断后6个月饮食炎症性越强，TNFα、hsCRP水平及炎症z评分汇总越高。RCS结果显示两个时间点ADII与CRC结局均无关联。Cox比例风险模型结果也显示两个时间点的ADII与复发（风险比（95%置信区间）0.98（0.94 - 1.04）和0.96（0.91 - 1.02））或全因死亡率（风险比（95%置信区间）1.03（0.98 - 1.07）和1.00（0.95 - 1.05））均无关联。
我们的研究未显示ADII与CRC患者复发及全因死亡率之间存在关联。进一步研究还应考虑分子肿瘤亚型，因为饮食的炎症潜能对癌症复发和死亡率的影响更可能存在于具有炎症特征的肿瘤中。
结肠研究：NCT03191110；clinicaltrials.gov
