title: Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy. patrick.maisonneuve@ieo.it.
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.affiliation: Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Shivappa
authors.affiliation: Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
authors.affiliation: Division of Radiology, European Institute of Oncology, Milan, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.affiliation: Division of Radiology, European Institute of Oncology, Milan, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Rampinelli
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bertolotti
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy.|Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Division of Thoracic and General Surgery, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Gnagnarella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D038441:Diet, Mediterranean; D055088:Early Detection of Cancer; D004646:Emphysema / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires
keywords: Dietary inflammatory index; Dyspnoea; Emphysema; Lung cancer; Lung function; Mediterranean diet