Skip to main content
SpringerLink
Log in

Inflammatory potential of diet and pancreatic cancer risk in the EPIC study

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

There is existing evidence on the potential role of chronic inflammation in the pathogenesis of pancreatic cancer (PC) and on how risk may be modulated by dietary factors. Pro-inflammatory diets are suggested to be associated with increased risk of PC but, so far, evidence remains not conclusive. We examined the association between the dietary inflammatory potential and PC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which includes 450,112 participants.

Methods

After a 14-year follow-up, a total of 1239 incident PC cases were included in this study. The inflammatory potential of the diet was estimated using an Inflammatory Score of the Diet (ISD). Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the ISD and PC were estimated using multivariable Cox regression models, adjusted for known risk factors for PC.

Results

Participants with higher ISDs had a higher risk of developing PCs. In the fully adjusted multivariate model, the risk of PC increased by 11% (HR 1.11, 95% CI 1.02–1.22) for 1 point each standard deviation increase in the ISD score. Neither obesity nor any other known risk factor for PC showed statistically significant interactions.

Conclusion

To the best of our knowledge, this is the first prospective study reporting a positive relationship between the inflammatory potential of diet and PC. Since early diagnosis and treatment of pancreatic cancer might be challenging, prevention remains the major hope for reducing the burden of this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Author elects to not share data.

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  2. World Cancer Research Fund/American Institute for Cancer Research (2018) Diet, nutrition, physical activity and cancer: a global perspective. Contin Updat Proj Expert Rep 15(136):E359–E386

    Google Scholar 

  3. Rawla P, Sunkara T, Gaduputi V (2019) Epidemiology of pancreatic cancer: global trends, etiology and risk factors. World J Oncol 10(1):10–27. https://doi.org/10.14740/wjon1166

    Article  PubMed  PubMed Central  Google Scholar 

  4. Maisonneuve P (2019) Epidemiology and burden of pancreatic cancer. Presse Med 48(3 Pt 2):e113–e123. https://doi.org/10.1016/j.lpm.2019.02.030

    Article  PubMed  Google Scholar 

  5. Herder C, Peltonen M, Koenig W et al (2009) Anti-inflammatory effect of lifestyle changes in the Finnish diabetes prevention study. Diabetologia 52:433–442. https://doi.org/10.1007/s00125-008-1243-1

    Article  CAS  PubMed  Google Scholar 

  6. Hamer M, Sabia S, Batty GD et al (2012) Physical activity and inflammatory markers over 10 years: follow-up in men and women from the Whitehall II cohort study. Circulation 126:928–933. https://doi.org/10.1161/CIRCULATIONAHA.112.103879

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Galland L (2010) Diet and inflammation. Nutr Clin Pract 25(6):634–640. https://doi.org/10.1177/0884533610385703

    Article  PubMed  Google Scholar 

  8. Agudo A, Cayssials V, Bonet C et al (2018) Inflammatory potential of the diet and risk of gastric cancer in the European prospective investigation into cancer. Am J Clin Nutr 107(4):607–616. https://doi.org/10.1093/ajcn/nqy002

    Article  PubMed  Google Scholar 

  9. Jakszyn P, Cayssials V, Buckland G et al (2020) Inflammatory potential of the diet and risk of colorectal cancer in the European prospective investigation into cancer and nutrition (EPIC) study. Int J Cancer 147(4):1027–1039. https://doi.org/10.1002/ijc.32870

    Article  CAS  PubMed  Google Scholar 

  10. Shivappa N, Bosetti C, Zucchetto A et al (2015) Dietary inflammatory index and risk of pancreatic cancer in an Italian case-control study. Br J Nutr 113(2):292–298. https://doi.org/10.1017/S0007114514003626

    Article  CAS  PubMed  Google Scholar 

  11. Antwi SO, Oberg AL, Shivappa N et al (2016) Pancreatic cancer: associations of inflammatory potential of diet, cigarette smoking and long-standing diabetes. Carcinogenesis 37(5):481–490. https://doi.org/10.1093/carcin/bgw022

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Antwi SO, Bamlet WR, Pedersen KS et al (2018) Pancreatic cancer risk is modulated by inflammatory potential of diet and ABO genotype: a consortia-based evaluation and replication study. Carcinogenesis 39(8):1056–1067. https://doi.org/10.1093/carcin/bgy072

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Zheng J, Wirth MD, Merchant AT et al (2019) Inflammatory potential of diet, inflammation-related lifestyle factors, and risk of pancreatic cancer: results from the NIH-AARP diet and health study. Cancer Epidemiol Biomark Prev 28(7):1266–1270. https://doi.org/10.1158/1055-9965.EPI-19-0250

    Article  Google Scholar 

  14. Zheng J, Merchant AT, Wirth MD et al (2018) Inflammatory potential of diet and risk of pancreatic cancer in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial. Int J Cancer 142(12):2461–2470. https://doi.org/10.1002/ijc.31271

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Hémon B, Casagrande C, Vignat J et al (2002) European prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124. https://doi.org/10.1079/PHN2002394

    Article  PubMed  Google Scholar 

  16. Margetts B, Pietinen P (1997) European prospective investigation into cancer and nutrition: validity studies on dietary assessment methods. Int J Epidemiol 26:S1–S5. https://doi.org/10.1093/ije/26.suppl_1.S1

    Article  PubMed  Google Scholar 

  17. World Health Organization (2004) ICD-10: international statistical classification of diseases and related health problems: tenth revision, 2nd ed. World Health Organization. https://apps.who.int/iris/handle/10665/42980.

  18. Shivappa N, Steck SE, Hurley TG et al (2014) Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 17:1689–1696. https://doi.org/10.1017/S1368980013002115

    Article  PubMed  Google Scholar 

  19. Ferrari P, Day NE, Boshuizen HC et al (2008) The evaluation of the diet/disease relation in the EPIC study: considerations for the calibration and the disease models. Int J Epidemiol 37(2):368–378. https://doi.org/10.1093/ije/dym242

    Article  PubMed  Google Scholar 

  20. Lu PY, Shu L, Shen SS et al (2017) Dietary patterns and pancreatic cancer risk: a meta-analysis. Nutrients 9(1):38. https://doi.org/10.3390/nu9010038

    Article  CAS  PubMed Central  Google Scholar 

  21. Greer JB, Whitcomb DC (2009) Inflammation and pancreatic cancer: an evidence-based review. Curr Opin Pharmaco 9(4):411–418. https://doi.org/10.1016/j.coph.2009.06.011

    Article  CAS  Google Scholar 

  22. Molina-Montes E, Sánchez MJ, Buckland G et al (2017) Mediterranean diet and risk of pancreatic cancer in the European prospective investigation into cancer and nutrition cohort. BR J Cancer 116(6):811–820. https://doi.org/10.1038/bjc.2017.14

    Article  PubMed  PubMed Central  Google Scholar 

  23. Naudin S, Viallon V, Hashim D et al (2020) Healthy lifestyle and the risk of pancreatic cancer in the EPIC study. Eur J Epidemiol 35(10):975–986. https://doi.org/10.1007/s10654-019-00559-6

    Article  PubMed  Google Scholar 

  24. Ramallal R, Toledo E, Martínez-González MA et al (2017) Inflammatory potential of diet, weight gain, and incidence of overweight/obesity: the SUN cohort. Obesity (Silver Spring) 25(6):997–1005. https://doi.org/10.1002/oby.21833

    Article  Google Scholar 

  25. Doyle SL, Donohoe CL, Lysaght J et al (2012) Symposium 3: obesity-related cancers visceral obesity, metabolic syndrome, insulin resistance and cancer. Proc Nutr Soc 71(1):181–189. https://doi.org/10.1017/S002966511100320X

    Article  CAS  PubMed  Google Scholar 

  26. Turnbaugh PJ, Ley RE, Mahowald MA et al (2006) An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 444(7122):1027–1031. https://doi.org/10.1038/nature05414

    Article  PubMed  Google Scholar 

  27. Wirth MD, Hébert JR, Net S, al, (2016) Anti-inflammatory dietary inflammatory index scores are associated with healthier scores on other dietary indices. Nutr Res 36(3):214–219. https://doi.org/10.1016/j.nutres.2015.11.009

    Article  CAS  PubMed  Google Scholar 

Download references

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). We thank CERCA Programme/Generalitat de Catalunya for institutional support. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by the 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), Federal Ministry of Education and Research (BMBF), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); The Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy 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); Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); 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; C570/A16491 and C8221/A19170 and A29017 to EPIC-Oxford), to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom). We also thank Aarhus and Oxford centres for their participation. The funders of this study were not involved in the processes of analysis or interpretation of the data; nor did they play any role in the preparation, review or approval of the manuscript.

Author information

Author notes

  1. Antonio Agudo and Paula Jakszyn share senior authorship.

Authors and Affiliations

  1. Unit of Nutrition and Cancer. Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL. L’Hospitalet de Llobregat, Av. Gran Via 199-203, 08908, L’Hospitalet de Llobregat, Barcelona, Spain

    Valerie Cayssials, Marta Crous-Bou, Catalina Bonet, Antonio Agudo & Paula Jakszyn

  2. Department of Public Health, Faculty of Veterinary, University of the Republic, Montevideo, Uruguay

    Valerie Cayssials

  3. Department of Quantitative Methods, Faculty of Medicine, University of the Republic, Montevideo, Uruguay

    Valerie Cayssials

  4. Center for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK

    Genevieve Buckland

  5. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA

    Marta Crous-Bou

  6. International Agency for Research On Cancer (IARC), 150 cours Albert Thomas, 69008, Lyon, France

    Elisabete Weiderpass, Inge Huybrechts & Pietro Ferrari

  7. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

    Guri Skie & Therese Haugdahl Nøst

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

    Dagfinn Aune & Alicia Heath

  9. Department of Nutrition, Bjørknes University College, Oslo, Norway

    Dagfinn Aune

  10. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway

    Dagfinn Aune

  11. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy

    Giovanna Masala

  12. Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale dei Tumori Di Milano, Via Venezian, 1, 20133, Milano, Italy

    Claudia Agnoli

  13. A.O.U. Federico II, Naples, Italy

    Maria Santucci De Magistris

  14. Dept. for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands

    Bas Bueno-de-Mesquita

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

    Jeroen Derksen

  16. Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden

    Oscar Franklin

  17. Dept. of Radiation Sciences, Oncology Umeå University, Umeå, Sweden

    Stina Bodén

  18. Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    Matthias Schulze

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

    Matthias Schulze

  20. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixca, Murcia, Spain

    Jose Maria Huerta

  21. CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain

    Jose Maria Huerta

  22. Navarra Public Health Institute, Pamplona, Spain

    Aurelio Barricarte

  23. Navarra Institute for Health Research (IdiSNA), Pamplona, Spain

    Aurelio Barricarte

  24. CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain

    Aurelio Barricarte, Pilar Amiano & Esther Molina-Montes

  25. Unit of Cancer Epidemiology, Città Della Salute E Della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy

    Carlotta Sacerdote

  26. Sub-Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastián, Spain

    Pilar Amiano

  27. Epidemiology and Public Health Area, Biodonostia Health Research Institute, San Sebastián, Spain

    Pilar Amiano

  28. Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy

    Rosario Tumino

  29. Departamento de Nutrición Y Ciencias de los Alimentos, Universidad de Granada, Campus de Cartuja, 18071, Granada, Spain

    Esther Molina-Montes

  30. Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre, José Mataix’, University of Granada, Granada, Spain

    Esther Molina-Montes

  31. Instituto de Investigación Biosanitaria de Granada (IBS GRANADA), Granada, Spain

    Esther Molina-Montes

  32. Danish Cancer Society Research Center, Diet, Genes and Environment, Nutrition and Biomarkers (NAB), Copenhagen, Denmark

    Anne Tjønneland & Cecilie Kyrø

  33. Universidad Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Equipo “Exposome and Heredity”, CESP, F-94805, Villejuif, France

    Gianluca Severi & Marie-Christine Boutron-Ruault

  34. Departamento de Pancreatología, Hospital Beaujon, AP-HP, Clichy, France

    Vinciane Rebours

  35. Inserm UMR1149, Unidad DHU, Universidad Paris-Diderot, Paris, France

    Vinciane Rebours

  36. Departamento de Estadística, Informática Y Aplicaciones “G. Parenti” (DISIA), Universidad de Florencia, Florence, Italy

    Gianluca Severi

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

    Verena Katzke

  38. Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain

    Paula Jakszyn

Authors
  1. Valerie Cayssials
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Genevieve Buckland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marta Crous-Bou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catalina Bonet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elisabete Weiderpass
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guri Skie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dagfinn Aune
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alicia Heath
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Therese Haugdahl Nøst
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giovanna Masala
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Claudia Agnoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Maria Santucci De Magistris
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Bas Bueno-de-Mesquita
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jeroen Derksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Inge Huybrechts
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Pietro Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Oscar Franklin
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Stina Bodén
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Matthias Schulze
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Jose Maria Huerta
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Aurelio Barricarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Carlotta Sacerdote
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Pilar Amiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Rosario Tumino
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Esther Molina-Montes
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Anne Tjønneland
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Cecilie Kyrø
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Gianluca Severi
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Marie-Christine Boutron-Ruault
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Vinciane Rebours
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Verena Katzke
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. Antonio Agudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. Paula Jakszyn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Antonio Agudo or Paula Jakszyn.

Ethics declarations

Conflict of interest

The authors have declared no conflicts of interest.

Ethical approval

All participants have signed a written informed consent (Ethical approval number PR102/15).

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 26 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cayssials, V., Buckland, G., Crous-Bou, M. et al. Inflammatory potential of diet and pancreatic cancer risk in the EPIC study. Eur J Nutr 61, 2313–2320 (2022). https://doi.org/10.1007/s00394-022-02809-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00394-022-02809-y

Keywords

Search

Navigation