Strong association between the dietary inflammatory index(DII) and breast cancer: a systematic review and meta-analysis

The association between the Dietary Inflammatory Index (DII) and breast cancer risk has been widely reported in recent years, but there is still controversy about whether a pro-inflammatory diet is a risk factor for breast cancer. We conducted a meta-analysis to investigate the relationship between the DII and breast cancer risk in pre-menopausal and post-menopausal women. We comprehensively searched PubMed, Embase and the Cochrane Library in January 2021 to identify articles reporting an association between the DII and breast cancer risk. A pooled analysis was conducted with 14 studies covering 312,885 participants. Overall, women in the most pro-inflammatory diet category were at greater risk for breast cancer than those in the most anti-inflammatory category (relative risk [RR]=1.37, 95% confidence interval [CI] 1.17-1.60, P<0.001). This association was strong in both pre-menopausal women (RR=1.87, 95% CI 1.17-2.99, P=0.001) and post-menopausal women (RR=1.23, 95% CI 1.08-1.40, P<0.001). Thus, a strong and independent association was observed between a pro-inflammatory diet (assessed using the DII score) and breast cancer risk, irrespective of menopausal status. Further studies will be required to determine the relationship between a pro-inflammatory diet and different subtypes of breast cancer.