Dietary Inflammatory Potential and Premenopausal Breast Cancer Risk: A Case-Control Study in Türkiye

Öz

Objective: Breast cancer is the most common cancer in women worldwide. Studies on the link between dietary inflammation and breast cancer risk have shown inconsistent results. This study aimed to evaluate the relationships between the Dietary Inflammatory Index (DII), the Dietary Phytochemical Index (DPI), and breast cancer risk. Material and Methods: This case-control study included 90 premenopausal women newly diagnosed with breast cancer and 90 age-matched healthy controls. Dietary intake was assessed via 153-item Food Frequency Questionnaire (FFQ), and DII and DPI scores were calculated. Logistic regression models were used to estimate multivariable odds ratios (ORs) after adjusting for potential confounders. Results: The DII scores of the breast cancer patients (-0.99 ± 0.95) were significantly higher than those of the controls (-1.84 ± 1.15) (p <0.001). After adjusting for age, higher DII scores were associated with increased breast cancer risk (OR = 4.44; 95% CI: 2.37–8.30; p <0.001). Further adjustments for marital status, employment, age at menarche, breastfeeding history, smoking status, body mass index, and family history of cancer showed an OR of 5.63 (95% CI: 2.10–15.12; p <0.001). No significant association was found between the DPI and breast cancer risk. Conclusion: This study revealed a positive association between a pro-inflammatory diet, measured by the DII, and breast cancer risk in premenopausal women. Further prospective cohort studies are needed to confirm these findings.

Anahtar Kelimeler

• Breast cancer
• dietary inflammatory index
• dietary phytochemical index
• inflammation
• nutrition

Destekleyen Kurum

This research was supported by the Scientific and Technological Research Council of Turkey (TÜBİTAK).

Proje Numarası

1919B012306709

Etik Beyan

This study was conducted in accordance with the principles of the Helsinki Declaration and was approved by the Independent Ethics Committee of Ege University (Medical Ethics Committee decision no: 22-1.1T/40, date: 14.01.2022). Verbal and written informed consent was obtained from all participants.

Teşekkür

We gratefully acknowledge the volunteers who participated in this study. We also thank TÜBİTAK for their financial support, which made this research possible.

Premenopozal Kadınlarda Diyetin İnflamatuvar Potansiyeli ile Meme Kanseri Riski Arasındaki İlişki: Türkiye’den Bir Olgu-Kontrol Çalışması

Öz

Amaç: Meme kanseri, dünyada kadınlar arasında en yaygın kanser türüdür. Diyetin neden olduğu inflamasyon ve meme kanseri riski arasındaki ilişkiyi inceleyen çalışmalarda tutarsız sonuçlar elde edilmiştir. Bu çalışmanın amacı, Diyet İnflamatuar İndeksi (DII), Diyet Fitokimyasal İndeksi (DPI) ve meme kanseri riski arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntem: Bu olgu kontrol çalışması, yeni tanı almış 90 premenopozal meme kanseri hastası ve 90 yaş eşleştirilmiş sağlıklı kontrol grubunu içermektedir. Diyet alımı, 153 maddelik Besin Tüketim Sıklığı anketi kullanılarak değerlendirilmiş ve DII ile DPI puanları hesaplanmıştır. Lojistik regresyon modelleri, potansiyel karıştırıcı faktörler için düzenleme yapıldıktan sonra meme kanseri odds oranlarını (OR) tahmin etmiştir. Bulgular: Meme kanseri DII puanları (-0,99 ± 0,95), kontrol grubuna göre (-1,84 ± 1,15) anlamlı şekilde daha yüksektir (p<0.001). Yaşa göre düzenleme yapıldıktan sonra, yüksek DII puanları meme kanseri riskinin artışıyla ilişkili bulunmuştur (OR = 4,44; 95% CI: 2,37–8,30; p<0,001). Evlilik durumu, çalışma durumu, menarş yaşı, emzirme öyküsü, sigara içme, beden kütle indeksi ve ailesinde kanser geçmişi gibi düzenlemeler sonrasında OR 5,63 (95% CI: 2,10–15,12; p<0,001) olarak bulunmuştur. Meme kanseri riski ile DPI arasında anlamlı bir ilişki saptanmamıştır. Sonuç: Bu çalışmada premenopozal kadınlarda DII ile değerlendirilen pro-inflamatuar bir diyetin, meme kanseri riski ile pozitif bir ilişki gösterdiği belirlenmiştir. Bu bulguları doğrulamak için daha fazla prospektif kohort çalışmasına ihtiyaç vardır.

Anahtar Kelimeler

• Meme kanseri
• diyet inflamasyon indeksi
• diyet fitokimyasal indeksi
• inflamasyon
• beslenme

Proje Numarası

1919B012306709

Kaynakça

1. Sasanfar B, Toorang F, Mozafari Nia M, Salehi-Abargouei A, Zendehdel K. Dietary Inflammatory Index and Breast Cancer: report from a Large-Scale Case-Control Study. Nutr Cancer. 2022;74(5):1692-700. DOI: 10.1080/01635581.2021.1957489
2. Larkin L. Breast cancer genetics and risk assessment: an overview for the clinician. Climacteric. 2023;26(3):229-34. DOI: 10.1080/13697137.2023.2184254.
3. Türkiye Kanser İstatistikleri 2020 [Internet]. Ankara: T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü; 2020 [cited 2025 Aug 30]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kanserdb/Dokumanlar/Istatistikler/ Turkiye_Kanser_Istatistikleri_2020.pdf.
4. Katsura C, Ogunmwonyi I, Kankam HK, Saha S. Breast cancer: presentation, investigation and management. Br J Hosp Med (Lond). 2022;83(2):1-7. DOI: 10.12968/hmed.2021.0459.
5. Shivappa N, Sandin S, Löf M, Hébert JR, Adami HO, Weiderpass E. Prospective study of dietary inflammatory index and risk of breast cancer in Swedish women. Br J Cancer. 2015;113(7):1099-103. DOI: 10.1038/bjc.2015.304.
6. Jiang X, Shapiro DJ. The immune system and inflammation in breast cancer. Mol Cell Endocrinol. 2014;382(1):673-82. DOI: 10.1016/j.mce.2013.06.003.
7. Stumpf F, Keller B, Gressies C, Schuetz P. Inflammation and Nutrition: Friend or Foe? Nutrients. 2023;15(5). DOI: 10.3390/nu15051159.
8. Hajji-Louati M, Cordina-Duverger E, Laouali N, Mancini FR, Guénel P. A case-control study in France showing that a pro-inflammatory diet is associated with a higher risk of breast cancer. Sci Rep. 2021;11(1):17019. DOI: 10.1038/s41598-021-95955-y.

9. Grosso G, Laudisio D, Frias-Toral E, Barrea L, Muscogiuri G, Savastano S, et al. Anti-Inflammatory Nutrients and Obesity-Associated Metabolic-Inflammation: State of the Art and Future Direction. Nutrients. 2022;14(6). DOI: 10.3390/nu14061137.
10. Malesza IJ, Malesza M, Walkowiak J, Mussin N, Walkowiak D, Aringazina R, et al. High-Fat, Western-Style Diet, Systemic Inflammation, and Gut Microbiota: A Narrative Review. Cells. 2021;10(11). DOI: 10.3390/cells10113164.
11. Tristan Asensi M, Napoletano A, Sofi F, Dinu M. Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review. Nutrients. 2023;15(6). DOI: 10.3390/nu15061546.
12. Lee S, Quiambao AL, Lee J, Ro J, Lee ES, Jung SY, et al. Dietary Inflammatory Index and Risk of Breast Cancer Based on Hormone Receptor Status: A Case-Control Study in Korea. Nutrients. 2019;11(8). DOI: 10.3390/nu11081949.
13. Ge I, Rudolph A, Shivappa N, Flesch-Janys D, Hébert JR, Chang-Claude J. Dietary inflammation potential and postmenopausal breast cancer risk in a German case-control study. Breast. 2015;24(4):491-6. DOI: 10.1016/j.breast.2015.04.012.
14. Hajji-Louati M, Gelot A, Frenoy P, Laouali N, Guénel P, Mancini FR. Dietary Inflammatory Index and risk of breast cancer: evidence from a prospective cohort of 67,879 women followed for 20 years in France. Eur J Nutr. 2023;62(5):1977-89. DOI: 10.1007/s00394-023-03108-w.
15. Hammad SS, Mahmoud R, Shivappa N, Hebert JR, Marie L, Tayyem RF. Dietary inflammatory index and odds of breast cancer: A case-control study. Food Sci Nutr. 2021;9(9):5211-9. DOI: 10.1002/fsn3.2493.
16. Shivappa N, Hébert JR, Rosato V, Montella M, Serraino D, La Vecchia C. Association between the dietary inflammatory index and breast cancer in a large Italian case-control study. Mol Nutr Food Res. 2017;61(3). DOI: 10.1002/mnfr.201600500.
17. Tabung FK, Steck SE, Liese AD, Zhang J, Ma Y, Caan B, et al. Association between dietary inflammatory potential and breast cancer incidence and death: results from the Women's Health Initiative. Br J Cancer. 2016;114(11):1277-85. DOI: 10.1038/bjc.2016.98.
18. Rakıcıoğlu N, Acar-Tek N, Ayaz A, Pekcan G. Yemek ve besin fotoğraf kataloğu: ölçü ve miktarlar (Food and meal photo catalog: measurements and quantities). Ankara: Ata Ofset; 2014.
19. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17(8):1689-96. DOI: 10.1017/s1368980013002115.
20. McCarty MF. Proposal for a dietary "phytochemical index". Med Hypotheses. 2004;63(5):813-7. DOI: 10.1016/j.mehy.2002.11.004.
21. Hopper MK, Moninger SL. Tracking weight change, insulin resistance, stress, and aerobic fitness over 4 years of college. J Am Coll Health. 2017;65(2):81-93. DOI: 10.1080/07448481.2016.1238385.
22. Kazemi A, Barati-Boldaji R, Soltani S, Mohammadipoor N, Esmaeilinezhad Z, Clark CCT, et al. Intake of Various Food Groups and Risk of Breast Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Adv Nutr. 2021;12(3):809-49. DOI: 10.1093/advances/nmaa147.
23. Shu L, Zhang X, Zhu Q, Lv X, Si C. Association between ultra-processed food consumption and risk of breast cancer: a systematic review and dose-response meta-analysis of observational studies. Front Nutr. 2023;10:1250361. DOI: 10.3389/fnut.2023.1250361.
24. Ergas IJ, Cespedes Feliciano EM, Bradshaw PT, Roh JM, Kwan ML, Cadenhead J, et al. Diet Quality and Breast Cancer Recurrence and Survival: The Pathways Study. JNCI Cancer Spectr. 2021;5(2). DOI: 10.1093/jncics/pkab019.
25. Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. Nutrients. 2017;9(10). DOI: 10.3390/nu9101063.
26. Xiao Y, Xia J, Li L, Ke Y, Cheng J, Xie Y, et al. Associations between dietary patterns and the risk of breast cancer: a systematic review and meta-analysis of observational studies. Breast Cancer Res. 2019;21(1):16. DOI: 10.1186/s13058-019-1096-1.
27. Chen H, Gao Y, Wei N, Du K, Jia Q. Strong association between the dietary inflammatory index (DII) and breast cancer: a systematic review and meta-analysis. Aging (Albany NY). 2021;13(9):13039-47. DOI: 10.18632/aging.202985.
28. Alkan Ş B, Artaç M, Aksoy F, Belviranlı MM, Gürbilek M, Akay Çizmecioğlu H, et al. The Evaluation of Dietary Antioxidant Capacity, Dietary Inflammatory Index and Serum Biomarkers in Breast Cancer: A Prospective Study. Nutr Cancer. 2023;75(8):1625-37. DOI: 10.1080/01635581.2023.2227404.
29. Huang WQ, Mo XF, Ye YB, Shivappa N, Lin FY, Huang J, et al. A higher Dietary Inflammatory Index score is associated with a higher risk of breast cancer among Chinese women: a case-control study. Br J Nutr. 2017;117(10):1358-67. DOI: 10.1017/s0007114517001192.
30. Sant M, Allemani C, Sieri S, Krogh V, Menard S, Tagliabue E, et al. Salad vegetables dietary pattern protects against HER-2-positive breast cancer: a prospective Italian study. Int J Cancer. 2007;121(4):911-4. DOI: 10.1002/ijc.22714.
31. Gholamalizadeh M, Afsharfar M, Fathi S, Tajadod S, Mohseni GK, Shekari S, et al. Relationship between breast cancer and dietary inflammatory index; a case-control study. Clin Nutr ESPEN. 2022;51:353-8. DOI: 10.1016/j.clnesp.2022.08.001.
32. George MA, Lustberg MB, Orchard TS. Psychoneurological symptom cluster in breast cancer: the role of inflammation and diet. Breast Cancer Res Treat. 2020;184(1):1-9. DOI: 10.1007/s10549-020-05808-x.