Dietary inflammatory index and risk of reflux oesophagitis, Barrett's oesophagus and oesophageal adenocarcinoma: A population-based case-control study

Nitin Shivappa, James R. Hebert, Lesley A. Anderson, Martha J. Shrubsole, Liam J. Murray, Lauren B. Getty, Helen G. Coleman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


The dietary inflammatory index (DIITM) is a novel composite score based on a range of nutrients and foods known to be associated with inflammation. DII scores have been linked to the risk of a number of cancers, including oesophageal squamous cell cancer and oesophageal adenocarcinoma (OAC). Given that OAC stems from acid reflux and that the oesophageal epithelium undergoes a metaplasia-dysplasia transition from the resulting inflammation, it is plausible that a high DII score (indicating a pro-inflammatory diet) may exacerbate risk of OAC and its precursor conditions. The aim of this analytical study was to explore the association between energy-adjusted dietary inflammatory index (E-DIITM) in relation to risk of reflux oesophagitis, Barrett's oesophagus and OAC. Between 2002 and 2005, reflux oesophagitis (n 219), Barrett's oesophagus (n 220) and OAC (n 224) patients, and population-based controls (n 256), were recruited to the Factors influencing the Barrett's Adenocarcinoma Relationship study in Northern Ireland and the Republic of Ireland. E-DII scores were derived from a 101-item FFQ. Unconditional logistic regression analysis was applied to determine odds of oesophageal lesions according to E-DII intakes, adjusting for potential confounders. High E-DII scores were associated with borderline increase in odds of reflux oesophagitis (OR 1·87; 95 % CI 0·93, 3·73), and significantly increased odds of Barrett's oesophagus (OR 2·05; 95 % CI 1·22, 3·47), and OAC (OR 2·29; 95 % CI 1·32, 3·96), when comparing the highest with the lowest tertiles of E-DII scores. In conclusion, a pro-inflammatory diet may exacerbate the risk of the inflammation-metaplasia-adenocarcinoma pathway in oesophageal carcinogenesis.

Original languageEnglish
Pages (from-to)1323-1331
Number of pages9
JournalBritish Journal of Nutrition
Issue number9
Publication statusPublished - 14 May 2017

Bibliographical note

The authors appreciate the contributions made by the study participants, their families and all who assisted with the study, particularly the Northern Ireland Cancer Registry and National Cancer Registry, Cork.
The FINBAR study was supported by funding from Cancer Focus Northern Ireland (formerly the Ulster Cancer Foundation), the Northern Ireland R&D office and the Health Research Board. H. G. C., M. M. Cantwell and L. J. M. are all co-investigators of the UK Clinical Research Collaboration Centre of Excellence for Public Health NI. Both Drs N. S. and J. R. H. were supported by grant no. R44DK103377 from the US National Institute of Diabetes and Digestive and Kidney Diseases. None of the funders had any role in the design, analysis or writing of this article.
N. S. calculated the DII scores and wrote the first draft of the manuscript; H. G. C. performed analyses and worked on the methods and results sections of the manuscript. N. S., J. R. H.,
L. A. A., M. J. S., L. J. M., L. B. G. and H. G. C. carefully reviewed and edited, provided suggestions and revised the manuscript.
All the authors approved the final version of the manuscript. Dr J. R. H. owns the controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right
to his invention of the DII from the University of South Carolina in order to develop computer and smart phone applications for patient counselling and dietary intervention in clinical settings. Dr N. S. is an employee of CHI.


  • Diets
  • Inflammation
  • Reflux oesophagitis
  • Barrett’s oesophagus
  • Oesophageal adenocarcinoma
  • dietary inflammatory index
  • energy-adjusted dietary inflammatory index
  • oesophageal adenocarcinoma
  • reflux esophagitis


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