Development of a Food-Based Inflammation Score and Its Associations with Colorectal Neoplasms Open Access
Holmes, Ashley (Summer 2018)
Published
Abstract
The ability to characterize the inflammatory potential of diet is a promising area of cancer prevention, as it is well-accepted that inflammation is implicated in colorectal carcinogenesis and that reducing inflammation reduces risk for colorectal adenoma and cancer. However, no a priori food-based inflammation index exists that accounts for national nutrition recommendations and few studies have examined the relationship of diet-related inflammation and risk for colorectal neoplasms.
The purpose of this dissertation was to create a food-based inflammation index to investigate associations of this score with systemic biomarkers of inflammation and risk for colorectal neoplasms. The specific research aims were to: 1) create a food-based inflammation (FBI) score based on current dietary guidelines, 2) investigate associations of the score with systemic inflammation biomarkers, 3) investigate associations of the score with risk of colorectal adenoma, and 4) investigate associations of the score with colorectal cancer incidence. These aims were addressed by using biomarker and food frequency questionnaire data from a subset of REasons for Geographic and Racial Differences in Stroke participants to create the score, then calculating and applying the score to four studies: two studies with available biomarker data, a previously-conducted endoscopy-based case-control study of incident, sporadic colorectal adenoma, and a large prospective cohort study of postmenopausal women.
We selected 18 food groups based on the 2015 Dietary Guidelines for Americans to comprise the FBI score and observed that a proinflammatory diet (indicated by higher FBI score) was significantly associated with higher circulating C-reactive protein concentrations. We observed a significant positive association between proinflammatory diet and adenoma risk when comparing cases to endoscopy-negative controls, but no association between proinflammatory diet and colorectal cancer incidence in a prospective cohort of older women. The results from this dissertation suggest that the FBI score may be a useful tool for quantifying the inflammatory potential of diet. While our data do not identify an optimal diet for colorectal cancer prevention, these findings support dietary guidelines to meet nutrient needs through healthy eating patterns. Further examination is warranted to clarify the role of diet-related inflammation in the development of colorectal neoplasms and other chronic diseases.
Table of Contents
list of tables AND FIGURES
CHAPTER 1: INTRODUCTION AND BACKGROUND....……………………………………………...1
INTRODUCTION…………………………………………………………………………………1
BACKGROUND…………………………………………………………………………………..3
Colorectal Cancer…………………………………………………………………………3
Inflammation and Colorectal Cancer……………………………………………………..4
Diet and Colorectal Cancer……………………………………………………………….6
Diet, Inflammation, and Colorectal Cancer………………………………………………8
Gaps in the Literature Addressed by this Dissertation…………………………………...10
DISSERTATION RESEARCH PLAN…………………………………………………………...11
Objectives, Specific Aims, and Study Hypotheses………………………………………11
Methods for Aim 1a……………………………………………………………………...12
Methods for Aim 1b……………………………………………………………………...13
Methods for Aim 2..……………………………………………………………………...15
Methods for Aim 3..……………………………………………………………………...16
Significance and Impact of the Dissertation……………………………………………..17
REFERENCES…………………………………………………………………………………...18
CHAPTER 2: DEVELOPMENT AND APPLICATION OF THE FOOD-BASED INFLAMMATION SCORE…………………………………………………………………………………………………….27
ABSTRACT………………………………………………………………………………………27
INTRODUCTION………………………………………………………………………………..28
MATERIALS AND METHODS…………………………………………………………………31
RESULTS………………………………………………………………………………………...37
DISCUSSION…………………………………………………………………………………….39
TABLES AND FIGURES………………………………………………………………………..44
Appendix A Tables………………………………………………………………………54
REFERENCES…………………………………………………………………………………...58
CHAPTER 3: THE FOOD-BASED INFLAMMATION SCORE AND RISK OF INCIDENT, SPORADIC COLORECTAL ADENOMA……………………………………………………………….65
ABSTRACT………………………………………………………………………………………65
INTRODUCTION………………………………………………………………………………..66
METHODS………………………….……………………………………………………………67
RESULTS………………………………………………………………………………………...72
DISCUSSION…………………………………………………………………………………….73
TABLES AND FIGURES………………………………………………………………………..78
Appendix B Tables………………………………………………………………………84
REFERENCES…………………………………………………………………………………...86
CHAPTER 4: THE FOOD-BASED INFLAMMATION SCORE AND RISK OF COLORECTAL CANCER IN THE IOWA WOMEN’S HEALTH STUDY …91
ABSTRACT………………………………………………………………………………………91
INTRODUCTION………………………………………………………………………………..92
METHODS…………….…………………………………………………………………………93
RESULTS………………………………………………………………………………………...97
DISCUSSION…………………………………………………………………………………….99
TABLES AND FIGURES………………………………………………………………………103
Appendix C Tables……………………………………………………………………..107
REFERENCES……………………………………………………………………………….....109
CHAPTER 5: DISCUSSION AND FUTURE DIRECTIONS…………………………………………..113
SUMMARY AND PUBLIC HEALTH IMPLICATIONS……………………………………...113
FUTURE DIRECTIONS………………………………………………………………………..115
REFERENCES………………………………………………………………………………….117
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