Whole Grains Temper Immune-Mediated Inflammation in Chinese Esophageal Squamous-Cell Carcinoma Survivors : A Multicenter Questionnaire Study

Ya-Qiong Ren¹Yu-Xiang Wang²Yang Li³Lei Li⁴You Guo⁵Ning-gang Zhang^6*

• ¹Department of Radiotherapy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
• ²Department of Ultrasound,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
• ³Shanxi Bethune Hospital, Shanxi Medical University, Taiyuan, China
• ⁴Department of Radiotherapy, Shanxi Provincial People’s Hospital, Taiyuan, China
• ⁵Department of General Medicine, Xinzhou People’s Hospital, Xinzhou, China
• ⁶Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China

Objectives: To examine whether habitual whole-grain intake is associated with lower patient-reported systemic inflammatory distress among ambulatory survivors of oesophageal squamous-cell carcinoma (ESCC). Methods: We conducted a cross-sectional questionnaire study (May 2023–July 2025) at four tertiary hospitals in Shanxi Province among adults with stage I–IIIA ESCC (n = 392). A validated semi-quantitative FFQ quantified five whole-grain categories. Exposures were modelled as grams day⁻¹ (sex-specific quartiles; continuous per 10 g), an energy-adjusted density metric (g·1 000 kcal⁻¹), and a diversity score (0–5 categories consumed ≥once week⁻¹). Systemic inflammatory symptoms were measured with the seven-item Inflammation Distress Index (IDI). Multivariable logistic models estimated adjusted odds ratios (aOR) for elevated IDI (≥10); γ-log generalised linear models analysed continuous IDI; restricted cubic splines assessed dose–response. Models adjusted for sociodemographic, clinical and behavioural covariates, with total energy included when grams were the exposure. Results: Median whole-grain intake was 35.4 g·day⁻¹ (IQR 22.1–58.7); 28.1% had elevated IDI. Prevalence fell across quartiles (39.8%, 34.7%, 25.5%, 12.2%). Fully adjusted aORs (vs Q1) were 0.95 (0.62–1.47), 0.49 (0.31–0.76) and 0.19 (0.11–0.33) for Q2–Q4 (p-trend < 0.001). Each 10 g·day⁻¹ increment corresponded to a 6% lower mean IDI (mean-ratio 0.94; 0.92–0.96). Splines showed a steep inverse slope to ~60 g·day⁻¹ with a plateau (p-non-linearity = 0.031). Findings were consistent by stage (interaction p = 0.59) and smoking status (p = 0.67), robust in sensitivity analyses, and supported by density (Q4 vs Q1 aOR 0.21; per +5 g·1 000 kcal⁻¹ aOR 0.93) and diversity (per +1 category aOR 0.86; ≥3 vs 0–1 aOR 0.48) metrics. Conclusion: In Shanxi ESCC survivorship care, higher whole-grain intake—particularly ~50 g·day⁻¹ and with greater variety—aligns with substantially lower systemic inflammatory distress, supporting grain-centred dietary counselling.