Antioxidant and inflammatory potential of diet among women at risk of cervical cancer: Findings from a cross-sectional study in Italy

Objective To evaluate the association of Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII) with the prevalence of high-grade cervical intraepithelial neoplasia (CIN). Design A cross-sectional study was conducted on women with abnormal Papanicolaou test, who underwent high-risk HPV screening and histological test through colposcopy. Dietary data were collected using a Food Frequency Questionnaire and used to assess both CDAI and DII. Setting Women were recruited from 2012 to 2015 at the Cervical Cancer Screening Unit of the "Azienda Sanitaria Provinciale"of Catania (Italy). Participants The study included 539 women with a mean age of 40.2 years, who were classified as cases (n=127 with CIN2 or more severe lesions) and controls (n= 412 with normal cervical epithelium or CIN1). Results Although we observed a lower proportion of HPV-positive women among those with higher CDAI (p<0.001), the index was not associated with the diagnosis of CIN2 or more severe lesions. By contrast, women with medium or high DII showed higher odds to be diagnosed with CIN2 or more severe lesions than those with low DII (OR=2.15; 95%CI=1.11-4.17; p=0.024 and OR=3.14; 95%CI=1.50-6.56; p=0.002, respectively), after adjusting for age, HPV status, educational level, body mass index, smoking status, parity, use of oral contraceptives and supplements. Conclusions Our findings suggested that a pro-inflammatory diet might be associated with an increased risk of CIN2 and more severe lesions. However, further prospective studies should be encouraged to support this evidence.