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Inflammatory potential of the diet and risk of breast cancer in the European Investigation into Cancer and Nutrition (EPIC) study

European Journal of Epidemiology volume 36, pages 953–964 (2021)Cite this article

Abstract

The role of chronic inflammation on breast cancer (BC) risk remains unclear beyond as an underlying mechanism of obesity and physical activity. We aimed to evaluate the association between the inflammatory potential of the diet and risk of BC overall, according to menopausal status and tumour subtypes. Within the European Prospective Investigation into Cancer and Nutrition cohort, 318,686 women were followed for 14 years, among whom 13,246 incident BC cases were identified. The inflammatory potential of the diet was characterized by an inflammatory score of the diet (ISD). Multivariable Cox regression models were used to assess the potential effect of the ISD on BC risk by means of hazard ratios (HR) and 95% confidence intervals (CI). ISD was positively associated with BC risk. Each increase of one standard deviation (1-Sd) of the score increased by 4% the risk of BC (HR = 1.04; 95% CI 1.01–1.07). Women in the highest quintile of the ISD (indicating a most pro-inflammatory diet) had a 12% increase in risk compared with those in the lowest quintile (HR = 1.12; 95% CI 1.04–1.21) with a significant trend. The association was strongest among premenopausal women, with an 8% increased risk for 1-Sd increase in the score (HR = 1.08; 95% CI 1.01–1.14). The pattern of the association was quite homogeneous by BC subtypes based on hormone receptor status. There were no significant interactions between ISD and body mass index, physical activity, or alcohol consumption. Women consuming more pro-inflammatory diets as measured by ISD are at increased risk for BC, especially premenopausal women.

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Abbreviations

BC:

Breast cancer

BMI:

Body mass index

CI:

Confidence interval

DII:

Dietary inflammatory index

EPIC:

European prospective investigation into cancer and nutrition

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

IARC:

International agency for research on cancer

ICD-O:

International classification of diseases for oncology

ISD:

Inflammatory score of the diet

LR:

Likelihood ratio

PR:

Progesterone receptor

SD/Sd:

Standard deviation

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Acknowledgements

We thank CERCA Programme/Generalitat de Catalunya for institutional support. We also thank the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands, for their contribution and ongoing support to the EPIC Study.

Funding

This work was funded by Instituto de Salud Carlos III through the project PI15/00639 (Co-funded by European Regional Development Fund [ERDF], a way to build Europe). C. Castro-Espin was funded by Instituto de Salud Carlos III through the Grant FI19/00197 (Co-funded by European Social Fund. ESF investing in your future). The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford) (United Kingdom). The funders of this study had no role in the decisions about the analysis or interpretation of the data; or preparation, review or approval of the manuscript.

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Authors and Affiliations

  1. Unit of Nutrition and Cancer, Catalan Institute of Oncology – ICO; and Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute – IDIBELL, L’Hospitalet de Llobregat, Av. Granvia 199-203, 08908, L’Hospitalet de Llobregat, Barcelona , Spain

    Carlota Castro-Espin, Antonio Agudo, Catalina Bonet & Paula Jakszyn

  2. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Verena Katzke & Renée Turzanski-Fortner

  3. Nutrition, Immunity and Metabolism Senior Scientist Group, Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbruecke (DIfE), Nuthetal, Germany

    Krasimira Aleksandrova

  4. Institute of Nutritional Science, University of Potsdam, Potsdam, Germany

    Krasimira Aleksandrova & Matthias B. Schulze

  5. Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam, Nuthetal, Germany

    Matthias B. Schulze

  6. Danish Cancer Society Research Center, Diet, Genes and Environment, Copenhagen, Denmark

    Anne Tjønneland

  7. Department of Public Health, Aarhus University, 8000, Aarhus C, Denmark

    Christina C. Dahm

  8. Public Health Directorate, Asturias, Spain

    José-Ramón Quirós

  9. Escuela Andaluza de Salud Pública (EASP), Granada, Spain

    María-José Sánchez

  10. Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Spain

    María-José Sánchez

  11. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    María-José Sánchez, Pilar Amiano, María-Dolores Chirlaque & Eva Ardanaz

  12. Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain

    María-José Sánchez

  13. Public Health Division of Gipuzkoa, BioDonostia Research Institute, Donostia-San Sebastian, Spain

    Pilar Amiano

  14. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain

    María-Dolores Chirlaque

  15. Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain

    María-Dolores Chirlaque

  16. Navarra Public Health Institute, Pamplona, Spain

    Eva Ardanaz

  17. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    Eva Ardanaz

  18. Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network -ISPRO, Florence, Italy

    Giovanna Masala

  19. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy

    Sabina Sieri

  20. Cancer Registry and Histopathology Department, Provincial Health Authority, Ragusa, Italy

    Rosario Tumino

  21. Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital Via Santena, Turin, Italy

    Carlotta Sacerdote

  22. Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy

    Salvatore Panico

  23. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

    Anne M. May

  24. Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden

    Stina Bodén

  25. Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsö, Norway

    Inger T. Gram & Guri Skeie

  26. Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK

    Guri Skeie

  27. Inserm, Gustave Roussy, “Exposome and Heredity” Team, CESP, Paris-Saclay University, UVSQ, 94805, Villejuif, France

    Nasser Laouali, Sanam Shah & Gianluca Severi

  28. Departement of Statistics, Computer Science and Applications “G. Parenti”, University of Florence, Florence, Italy

    Gianluca Severi

  29. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Dagfinn Aune, Melissa A. Merritt & Elio Riboli

  30. Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, USA

    Melissa A. Merritt

  31. Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France

    Manon Cairat & Laure Dossus

  32. Director Office, International Agency for Research on Cancer, World Health Organization, Lyon, France

    Elisabete Weiderpass

  33. Facuty of Health Science Blanquerna, Ramon Llull University, Barcelona, Spain

    Paula Jakszyn

Authors
  1. Carlota Castro-Espin
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  2. Antonio Agudo
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  3. Catalina Bonet
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Correspondence to Antonio Agudo.

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Castro-Espin, C., Agudo, A., Bonet, C. et al. Inflammatory potential of the diet and risk of breast cancer in the European Investigation into Cancer and Nutrition (EPIC) study. Eur J Epidemiol 36, 953–964 (2021). https://doi.org/10.1007/s10654-021-00772-2

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