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Association Between Inflammatory Diets, Circulating Markers of Inflammation, and Risk of Diverticulitis

  • Wenjie Ma
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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  • Manol Jovani
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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  • Long H. Nguyen
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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  • Fred K. Tabung
    Affiliations
    Division of Medical Oncology, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, Ohio

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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  • Mingyang Song
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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  • Po-Hong Liu
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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  • Yin Cao
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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  • Idy Tam
    Affiliations
    Tufts University School of Medicine, Boston, Massachusetts
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  • Kana Wu
    Affiliations
    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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  • Edward L. Giovannucci
    Affiliations
    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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  • Author Footnotes
    b Authors share co-senior authorship.
    Lisa L. Strate
    Footnotes
    b Authors share co-senior authorship.
    Affiliations
    Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
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  • Author Footnotes
    b Authors share co-senior authorship.
    Andrew T. Chan
    Correspondence
    Reprint requests Address requests for reprints to: Andrew T. Chan, MD, MPH, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114. fax: (617) 726-3673.
    Footnotes
    b Authors share co-senior authorship.
    Affiliations
    Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

    Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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  • Author Footnotes
    b Authors share co-senior authorship.
Published:November 08, 2019DOI:https://doi.org/10.1016/j.cgh.2019.11.011

      Background & Aims

      Lifestyle and dietary risk factors for diverticulitis also have been associated with chronic inflammation. We performed a prospective study of associations among the inflammatory potential of diets, circulating markers of inflammation, and the incidence of diverticulitis.

      Methods

      We followed 46,418 men, initially free of diverticulitis, from 1986 through 2014 in the Health Professionals Follow-Up Study. We collected data on empiric dietary inflammatory pattern scores, which indicate the inflammatory potential of diets, and determined their association with the risk of incident diverticulitis using Cox proportional hazards regression. We used blood samples provided by 18,225 participants from 1993 through 1995 to conduct a nested case–control study; we used conditional logistic regression to evaluate prediagnostic plasma levels of markers of inflammation, including C-reactive protein (CRP), interleukin 6 (IL6), and tumor necrosis factor–receptor superfamily member 1B, in 310 diverticulitis cases and 310 matched diverticulitis-free individuals (controls).

      Results

      We documented 1110 cases of incident diverticulitis over 992,589 person-years of follow-up. Compared with participants in the lowest quintile of empiric dietary inflammatory pattern scores, men in the highest quintile had a multivariable-adjusted hazard ratio for diverticulitis of 1.31 (95% CI, 1.07–1.60; Ptrend = .01). The association did not differ significantly by strata of body mass index or vigorous activity (P for interaction > .05 for each). In the nested case–control study, plasma levels of CRP and IL6 were associated with risk of diverticulitis. When we compared extreme quintiles, the multivariable-adjusted relative risk for diverticulitis was 1.85 for CRP (95% CI, 1.04–3.30) and 2.04 for IL6 (95% CI, 1.09–3.84).

      Conclusions

      In a large prospective cohort of men, we found that the inflammatory potential of diet and prediagnostic plasma levels of markers of inflammation were associated with incident diverticulitis.

      Keywords

      Abbreviations used in this paper:

      BMI (body mass index), CRP (C-reactive protein), EDIP (Empiric Dietary Inflammatory Pattern), FFQ (food frequency questionnaire), HPFS (Health Professionals Follow-Up Study), HR (hazard ratio), IL (interleukin), TNFRSF1B (tumor necrosis factor–receptor superfamily member 1B)
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      Linked Article

      • Risk Factors of Diverticulitis With Special Reference to Inflammation
        Clinical Gastroenterology and HepatologyVol. 19Issue 1
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          I read with great interest the article by Ma et al.1 They conducted a prospective study to investigate the association between inflammation and the incidence of diverticulitis. Cox proportional hazards regression and conditional logistic regression models were applied to evaluate the risk of incident diverticulitis. The adjusted hazard ratio of the highest quintile of inflammatory potential of diet score in men against the lowest for diverticulitis was 1.31 (95% CI, 1.07–1.60). In addition, adjusted relative risks of the highest quintile of plasma C-reactive protein and interleukin 6 against the lowest for diverticulitis were 1.85 (95% CI, 1.04–3.30) and 2.04 (95% CI, 1.09–3.84), respectively.
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