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J Gynecol Oncol. 2019 May;30(3):e23. English. Meta-Analysis.
Liu ZY , Gao XP , Zhu S , Liu YH , Wang LJ , Jing CX , Zeng FF .
Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China.
Department of Medical Statistics, School of Medicine, Jinan University, Guangzhou, China.
Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Nutrition, School of Medicine, Jinan University, Guangzhou, China.


There has been growing body of literatures showing that chronic inflammation might play an important role in cancer development. This meta-analysis aimed to assess the association between the dietary inflammation index (DII) score and gynecological cancers.


A systematic search of PubMed, EMBASE and Web of Science up until October 20, 2018 was carried out to retrieve all related cohort and case-control studies. The summary risk assessments were pooled using random-effects models. The dose-response relationship was estimated by linear relationship model.


Twelve case-control studies (10,774 cases/15,958 controls) and six prospective cohort studies (330,363 participants/23,133 incident cases) were included in this meta-analysis. The pooled adjusted relative risk (RR) of gynecological cancers for the highest DII category compared to the lowest category was 1.38, (95% confidence intervals [CIs], 1.21–1.56, p < 0.001). A positive dose-response relationship was also noticed. Stratified by study design indicated that, the pooled RRs was significantly higher for case-control studies than cohort studies (p for interaction < 0.001), for studies conducted among participants with body mass index (BMI) ≥25 kg/m² than participants with BMI < 25 kg/m² (p for interaction=0.026), among participants with ovarian cancer and endometrial cancer than participants with breast cancer (p for interaction = 0.038). Meta-regression analysis further confirmed that study design significantly contributed to inter-study heterogeneity (p < 0.001).


This meta-analysis suggests that elevated DII is independently associated with a higher risk of gynecological cancers, especially patients with ovarian cancer and endometrial cancer and among obese participants.

Copyright © 2019. Korean Association of Medical Journal Editors.