A systematic review, which included some of the same studies as the above meta-analysis, also demonstrated a significant association between a high DII and an increased risk for CRC in case-control and cohort studies.5 Following a Mediterranean diet or having a high Healthy Eating Index, however, decreased the risk of CRC.

An analysis of the prospective Women’s Health Initiative cohort study, which included 87,042 postmenopausal women and was not included in the above meta-analysis, demonstrated that, among individuals not using nonsteroidal anti-inflammatory drugs (NSAIDs), a high DII was significantly associated with the risk of CRC, colon cancer, and proximal colon cancer.6

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A case-control study conducted in Argentina, which was also not included in the meta-analysis, demonstrated an increased risk of CRC with increasing DII (OR, 1.34; 95% CI, 1.07-1.69).7 In this study, the association was significant among men (OR, 1.29; 95% CI, 1.21-1.37), but not women (OR, 1.05; 95% CI, 0.83-1.33).

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Among patients with Lynch syndrome, however, a high DII does not appear to increase the risk of CRC.8 Lynch syndrome is the result of a germline mutation in a mismatch repair gene that increases the risk of CRC. A cohort study that included 457 patients with Lynch syndrome found no association among NSAID users and nonusers between high DII and CRC compared with low DII.


Epidemiologic evidence suggests that a proinflammatory diet, as measured by the DII, can increase the risk of developing CRC, particularly proximal colon cancer.

A proinflammatory diet may not affect the risk of CRC among patients with Lynch syndrome, who are already at an increased risk of the disease.


  1. Cavicchia PP, Steck SE, Hurley TG, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr. 2009;139:2365-72. doi: 10.3945/jn.109.114025
  2. Fowler ME, Akinyemiju TF. Meta-analysis of the association between dietary inflammatory index (DII) and cancer outcomes. Int J Cancer. 2017;141:2215-27. doi: 10.1002/ijc.30922
  3. Fan Y, Jin X, Man C, Gao Z, Wang X. Meta-analysis of the association between the inflammatory potential of diet and colorectal cancer risk. Oncotarget. 2017;8:59592-600.
  4. Tabung FK, Steck SE, Ma Y, et al. The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women’s Health Initiative. Cancer Causes Control. 2015;26:399-408. doi: 10.1007/s10552-014-0515-y
  5. Steck SE, Guinter M, Zheng J, Thomson CA. Index-based dietary patterns and colorectal cancer risk: a systematic review. Adv Nutr. 2015;6:763-73. doi: 10.3945/an.115.009746
  6. Tabung FK, Steck SE, Ma Y, et al. Changes in the inflammatory potential of diet over time and risk of colorectal cancer in postmenopausal women. Am J Epidemiol. 2017;186:514-23. doi: 10.1093/aje/kwx115
  7. Niclis C, Pou SA, Shivappa N, Hebért JR, Steck SE, Díaz MD. Proinflammatory dietary intake is associated with increased risk of colorectal cancer: results of a case-control study in Argentina using a multilevel modeling approach. Nutr Cancer. 2017 Nov 15. doi: 10.1080/01635581.2018.1397710 [Epub ahead of print]
  8. Brouwer G, Makama M, van Woudenbergh GJ, et al. Inflammatory potential of the diet and colorectal tumor risk in persons with Lynch syndrome. Am J Clin Nutr. 2017 Sep 20. doi: 10.3945/​ajcn.117.152900 [Epub ahead of print]