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Principal Investigator
Guo-Chao Zhong
The Second Affiliated Hospital of Chongqing Medical University
Position Title
About this CDAS Project
PLCO (Learn more about this study)
Project ID
Initial CDAS Request Approval
Apr 10, 2019
Dietary inflammatory index (DII) and risk of hepatocellular carcinoma in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial
Background: Substantial biologic evidence supports that inflammation is causally linked with the pathogenesis of hepatocellular carcinoma (HCC). Currently, two case-control studies investigated the inflammation potential of diet and HCC risk (1, 2), and they consistently found that a higher dietary inflammatory index (DII) was associated with an increased risk of HCC. However, there is no prospective cohort study investigating the association between inflammatory potential of diet and risk of HCC. Our proposed study plans to utilize the data from PLCO to fill this gap.
Method: The development and construct validation of the DII have been described previously in detail (3). The main exposure of DII score will be calculated based on inflammatory effect scores for each food parameter included in the DII and diet data from the PLCO diet history questionnaire (DHQ). Cox proportional hazard modeling will be used to estimate the hazard ratios and 95% confidence intervals. Subgroup analysis will be conducted to identify potential effect modifiers for the association between inflammatory potential of diet and risk of HCC.
Significance: Evidence form our study may indicate a potential prevention approach for HCC from the dietary inflammatory perspective and also provide clues for the mechanism of this association.
1. Shivappa N, Hebert JR, Polesel J, Zucchetto A, Crispo A, Montella M, Franceschi S, et al. Inflammatory potential of diet and risk for hepatocellular cancer in a case-control study from Italy. Br J Nutr 2016;115:324-331.
2. Wang XY, Fang AP, Chen PY, Liao GC, Zhang YJ, Shivappa N, Hebert JR, et al. High dietary inflammatory index scores are associated with an elevated risk of hepatocellular carcinoma in a case-control study. Food Funct 2018;9:5832-5842.
3. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hebert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 2014;17:1689-1696.

1. Investigate the association between DII and HCC risk using Cox proportional hazard modeling. DII will be treated as both continuous variable and categorized as quintiles to examine the dose-response relationship.
2. Investigate if the association between DII and HCC risk is modified by age, sex, body mass index, HBV infection , type 2 diabetes, smoking, alcohol.


(1) Yong Zhao, School of Public Health and Management, Chongqing Medical University;
(2) Jian-Ping Gong, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University;
(3) Fa-Bao Hao, Pediatric Surgery Center, Qingdao Women and Children’s Hospital, Qingdao University.

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