Association between dietary inflammatory index and body fat percentage among newly diagnosed breast cancer patients

Figures & data

Figure 1. Flow chart of study participants.

Table 1. Sociodemographic and medical characteristics of study participants according to E-DII tertile.

Characteristics	Tertile of E-DII			Statistical (X^2/ F)	p-value
	Tertile 1 (≤−0.26) Mean ± SD (−0.97 ± 0.834) n = 41 n (%)	Tertile 2 (−0.27 – 1.36) Mean ± SD (0.85 ± 0.326) n = 42 n (%)	Tertile 3 (≥1.37) Mean ± SD (2.15 ± 0.584) n = 41 n (%)
Demographic
Age, years (median)^a	49 (42.5, 58.5)	48 (42.0, 61.0)	52 (43.0, 60.0)	0.517	0.772
Age, years^b
<50 years old	21 (33.9)	23 (37.1)	18 (29.0)	1.015	0.602
≥50 years old	20 (32.3)	19 (30.6)	23 (37.1)
Education^b				0.341	0.843
High school or less	27 (33.8)	28 (35.0)	25 (31.2)
College or university	14 (31.8)	14 (31.8)	16 (36.4)
Ethnicity^b				3.76	0.709
Malay	28 (32.6)	29 (33.7)	29 (33.7)
Chinese	10 (45.5)	7 (31.8)	5 (22.7)
Indian	3 (21.4)	5 (35.7)	6 (42.9)
Others	0 (0)	1 (50.0)	1 (50.0)
Marital Status^b				2.067	0.356
Married	29 (29.8)	34 (35.1)	34 (35.1)
Single/ Widowed/ Divorced	12 (44.5)	8 (29.6)	7 (25.9)
Household Income, RM (median)^a	3000 (2500, 6000)	4500 (1950, 6625)	4000 (1425, 8000)	0.189	0.91
Household Income, RM^b				2.961	0.228
<5000	27 (40.9)	19 (28.8)	20 (30.3)
≥ 5000	12 (26.7)	19 (42.2)	14 (31.1)
Prefer not to say	2 (15.4)	4 (30.8)	7 (53.8)
Menopause Status^b				2.237	0.327
Pre-menopausal	23 (34.8)	25 (37.9)	18 (27.3)
Post-menopausal	18 (31.0)	17 (29.3)	23 (39.7)
Smoking history^b				3.184	0.203
Never	34 (37.4)	30 (33.0)	27 (29.7)
Active/ Second-hand smoker	7 (21.2)	12 (36.4)	14 (42.4)
Comorbidities^b
NKMI	27 (38.0)	25 (35.2)	19 (26.8)	3.322	0.19
T2DM	3 (18.8)	5 (31.3)	8 (50.0)	2.769	0.25
Hypertension	11 (26.2)	14 (33.3)	17 (40.5)	1.968	0.374
Dyslipidemia	10 (38.5)	7 (26.9)	9 (34.6)	0.783	0.676
Staging^b				1.074	0.585
1 to 2	20 (37.0)	17 (31.5)	17 (31.5)
3 to 4	17 (28.3)	23 (38.3)	20 (33.3)
Yet to rule out	4 (40.0)	2 (20.0)	4 (40.0)

^a Kruskal-Wallis test;.

^b Chi Square test for proportions.

Table 2. Body composition and biochemical parameters, physical activity and functional status of study participants according to E-DII tertiles.

Characteristics	Tertile of E-DII			Statistical (J-T)	p-value for trend
	T1 (≤ −0.26) Mean ± SD (−0.97 ± 0.834) n = 41 n (%)/ Mean ± SD/ Median (IQR)	T2 (−0.27 −1.36) Mean ± SD (0.85 ± 0.326) n = 42 n (%)/ Mean ± SD/ Median (IQR)	T3 (≥1.37) Mean ± SD (2.15 ± 0.584) n = 41 n (%)/ Mean ± SD/ Median (IQR)
Body Composition
BMI (kg/m2)^a	25.5 ± 4.61	26.0 ± 4.54	27.8 ± 5.37	1.902	0.057
Body weight (kg)^a	61.0 ± 11.26	64.3 ± 12.54	67.6 ± 12.52	2.306	0.021*
Body Fat Percentage^a	36.0 ± 6.69	36.8 ± 6.43	39.1 ± 6.87	2.021	0.043*
FM/FFM^a	0.58 ± 0.165	0.60 ± 0.167	0.66 ± 0.191	2.007	0.045*
Muscle Mass^a	36.1 ± 3.31	37.6 ± 4.18	38.0 ± 3.52	2.338	0.019*
Visceral Fat^a	7.0 (5.0, 9.5)	8.0 (5.8, 9.0)	9.0 (7.0, 10.5)	2.185	0.029*
Biochemical
Albumin^a	40.0 (42.0, 44.0)	41.0 (39.0, 43.3)	41.0 (40.0, 43.0)	−1.19	0.234
Haemoglobin^a	12.70 (11.95, 13.55)	12.55 (11.90, 13.25)	12.50 (11.73, 13.00)	−1.132	0.258
White blood cell^a	6.7 ± 1.68	7.2 ± 2.00	7.5 ± 1.78	2.281	0.023*
Neutrophil^a	3.65 (2.87, 4.82)	4.00 (3.15, 5.25)	3.92 (3.17, 5.11)	0.771	0.441
Lymphocyte^a	2.1 ± 0.62	2.2 ± 0.69	2.5 ± 0.71	2.68	0.007**
Handgrip strength, kg (Median)^a	12.7 (10.6, 15.6)	13.1 (10.5, 16.7)	11.1 (8.4, 13.8)	−1.544	0.123
Physical Activity, METs/week^b
Sedentary	15 (42.9%)	12 (34.3%)	8 (22.9%)	2.953	0.228
Moderate-High	26 (29.2%)	30 (33.7%)	33 (37.1%)

^a Jonckheere–Terpstra test; ^bChi Square test for proportions.

* p < 0.05, **p < 0.01.

Table 3. Intakes of 24 food parameters according to E-DII tertiles.

Food parameter	Tertile of E-DII			Statistical (F/ H)	p-value
	T1 (≤−0.26) Mean ± SD (−0.97 ± 0.834) n = 41 n (%)/ Mean ± SD/ Median (IQR)	T2 (−0.27 −1.36) Mean ± SD (0.85 ± 0.326) n = 42 n (%)/ Mean ± SD/ Median (IQR)	T3 (≥1.37) Mean ± SD (2.15 ± 0.584) n = 41 n (%)/ Mean ± SD/ Median (IQR)
DII^a	−0.29 (-1.12, 0.64)	1.24 (0.71, 1.60)	2.13 (1.62, 2.63)	73.054	<0.001***
Energy^b	1902 ± 456.1	1871 ± 554.1	1850 ± 443.2	0.117	0.89
Protein^b	81.6 ± 22.09	71.5 ± 26.21	70.8 ± 23.87	2.586	0.08
Carbohydrate^b	261.6 ± 68.86	255.8 ± 76.13	231.1 ± 62.45	2.238	0.111
Total Fat^a	57.5 (46.2, 68.9)	59.0 (47.3, 79.1)	69.8 (56.7, 83.1)	7.447	0.024*
SFA^b	21.0 ± 6.63	24.0 ± 9.45	27.5 ± 7.03	6.932	0.001*
MUFA^b	24.0 ± 8.70	24.9 ± 8.44	28.4 ± 7.07	3.325	0.039*
PUFA^a	11.9 (9.2, 14.6)	11.8 (9.4, 15.8)	11.7 (9.8, 14.9)	0.024	0.988
Cholesterol^a	292.5 (206.3, 455.6)	251.5 (188.8, 350.4)	302.1 (190.6, 416.3)	1.72	0.423
Vitamin A^a	876.71 (616.42, 1119.63)	610.89 (496.35, 786.04)	432.27 (362.17, 588.80)	33.416	<0.001***
B-carotene^a	3328.35 (2515.61, 4639.54)	2037.39 (1399.82, 2884.69)	1511.64 (1143.44, 1713.12)	47.621	<0.001***
Vitamin C^a	271.00 (213.31, 350.34)	157.02 (109.17, 188.38)	98.80 (85.37, 151.88)	53.689	<0.001***
Iron^a	16.49 (13.08, 21.01)	15.24 (10.91, 18.64)	13.40 (10.48, 17.41)	8.972	0.011*
Thiamine^b	1.49 ± 0.532	1.23 ± 0.485	1.01 ± 0.409	10.199	<0.001***
Riboflavin^b	2.01 ± 0.701	1.67 ± 0.702	1.47 ± 0.643	6.574	0.002**
Niacin^b	15.26 ± 5.258	12.79 ± 5.581	11.85 ± 4.127	5.014	0.008**
Vitamin B6^a	2.15 (1.74, 2.70)	1.64 (1.29, 2.31)	1.68 (1.21, 2.06)	15.597	<0.001***
Folic acid^a	298.29 (223.91, 402.67)	241.62 (179.61, 310.41)	176.23 (136.97, 260.40)	16.433	<0.001***
Vitamin B12^a	5.35 (3.08, 7.88)	3.78 (2.30, 6.71)	4.06 (2.56, 5.31)	4.801	0.091
Zinc^a	10.59 (8.15, 15.30)	8.56 (6.91, 12.02)	8.38 (6.05, 9.69)	13.533	0.001**
Magnesium^b	324.42 ± 84.678	257.18 ± 86.000	224.93 ± 71.555	16.093	<0.001***
Selenium^a	126.74 (92.80, 181.04)	104.63 (84.09, 147.76)	110.48 (74.90, 138.58)	7.354	0.025*
Fiber^a	13.9 (8.2, 19.8)	9.0 (6.1, 12.9)	6.0 (4.9, 8.6)	31.512	<0.001***
Caffeine^a	27.26 (0.51, 80.35)	80.35 (20.45, 140.74)	47.73 (11.84, 114.76)	7.899	0.019*
Alcohol^a	0 (0, 0)	0 (0, 0)	0 (0, 0)	4.695	0.096

^a Kruskal-Wallis test; ^bOne way ANOVA.

* p < 0.05; **p < 0.01; ***p < 0.001.

Table 4. The ORs and 95% CIs for the associations between the E-DII and body fat (N = 124).

	E-DII score [ref: Tertile 1 (≤−0.26)]
	Tertile 2 (−0.27 −1.36)				Tertile 3 (≥1.37)
	Adjusted Coefficient	OR (95% CI)	SE	p-value	Adjusted Coefficient	OR (95% CI)	SE	p-value
Body Fat Percentage
Model 1	0.644	1.905 (0.785, 4.624)	0.453	0.154	1.083	2.952 (1.154, 7.556)	0.479	0.024*
Model 2	0.680	1.974 (0.786, 4.954)	0.470	0.148	1.194	3.300 (1.223, 8.901)	0.506	0.018*
Model 3	0.792	2.208 (0.828, 5.885)	0.500	0.113	1.385	3.996 (1.311, 12.174)	0.568	0.015*

Model 1: energy-adjusted DII.

Model 2: adjusted for energy intake and cancer stage.

Model 3: further adjustments for age, physical activity (continuous), ethnicity, smoking history, comorbidities of NKMI, T2DM, hypertension, and dyslipidemia.

OR, Odds ratio; SE Standard error; CI Confidence interval; E-DII, energy-adjusted dietary inflammatory index.

* p < 0.05.

Table 5. The ORs and 95% CIs for the associations between the E-DII and body fat according to menopausal status (N = 124).

	E-DII score [ref: Tertile 1 (≤−0.26)]
	Pre-menopausal (n = 66)				Post-menopausal (n = 58)
	Tertile 3 (≥1.37)				Tertile 3 (≥1.37)
	Adjusted Coefficient	OR (95% CI)	SE	p-value	Adjusted Coefficient	OR (95% CI)	SE	p-value
Body Fat Percentage
Model 1	1.522	4.583 (1.038, 20.240)	0.758	0.045*	0.827	2.286 (0.634, 8.234)	0.654	0.206
Model 2	1.614	5.022 (1.053, 23.948)	0.797	0.043*	1.080	2.945 (0.741, 11.699)	0.704	0.125
Model 3	1.977	7.218 (1.148, 45.366)	0.938	0.035*	1.043	2.838 (0.494, 16.311)	0.892	0.242

Model 1: energy-adjusted DII.

Model 2: adjusted for energy, cancer stage.

Model 3: further adjustments for age, physical activity (continuous), ethnicity, smoking history, comorbidities of NKMI, T2DM, hypertension, and dyslipidemia.

OR, Odds ratio; SE Standard error; CI Confidence interval; E-DII, energy-adjusted dietary inflammatory index.

* p < 0.05.

Data availability statement

The data supporting the findings of this study are available from the corresponding author, Zalina Abu Zaid, upon reasonable request.