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Patients with colorectal cancer (CRC) are at high risk of frailty, leading to reduced quality of life and survival. Diet is associated with frailty in the elderly through regulating inflammation. Thus, we hypothesized that dietary inflammatory potential (as assessed by dietary inflammatory index [DII]) might be associated with frailty in patients with CRC through regulating inflammatory biomarkers. A total of 231 patients with CRC were included in this cross-sectional study. Dietary intake was evaluated by 3-day, 24-hour dietary recalls, and frailty status was assessed in accordance with the Fried frailty criteria. Plasma inflammatory cytokines were determined in 126 blood samples. A total of 67 patients (29.0%) were frail, with significantly higher DII scores than nonfrail patients, accompanied with significantly increased interleukin-6 (IL-6) and decreased interleukin-10 (IL-10) concentrations. Each 1-point increase of DII was related to a 25.0% increased risk of frailty. IL-6 was positively correlated with frailty and DII, whereas IL-10 was negatively correlated. After adjusting for age, sex, body mass index, education level, smoking status, and energy, mediation analysis revealed that the association between DII and frailty was significantly mediated by IL-6 (average causal mediation effect [ACME], 0.052; 95% confidence interval, 0.020–0.087; P =.002) and IL-10 (ACME, 0.025; 95% confidence interval, 0.004–0.063; P =.016). The ρ values for the sensitivity measure at which estimated ACMEs were zero were 0.3 and –0.2 for IL-6 and IL-10, respectively. Therefore, a pro-inflammatory diet was associated with frailty in patients with CRC possibly in part by affecting circulating IL-6 and IL-10 concentrations. In a sample of 231 patients with colorectal cancer, compared with nonfrail patients, frail patients consumed more pro-inflammatory diets indicated by higher DII scores and had higher plasma IL-6 and lower IL-10 concentrations. Higher DII was associated with increased risk of frailty. IL-6 was positively correlated with frailty and DII, whereas IL-10 was negatively correlated. Mediation analysis showed that the association between DII and frailty might be mediated in part by IL-6 and IL-10. Abbreviations : DII, dietary inflammatory index; IL-6, interleukin 6; IL-10, interleukin 10. [Display omitted] • 29.0% (67/231) patients with colorectal cancer were frail and 71.0% were non-frail. • Frail colorectal cancer patients consumed lower macronutrients and micronutrients. • Frail colorectal cancer patients had a higher dietary inflammatory index score. • A higher dietary inflammatory index was associated with a higher risk of frailty. • IL-6 and IL-10 were mediators in the association between diet and frailty. [ABSTRACT FROM AUTHOR]

[Display omitted] • 169 accessions representing ca. 68 (85% of total) species of Bolbitis are sampled. • Species of Bolbitis are resolved into four major clades. • Six well-supported subclades are identified in the most speciose Asian clade. • Evolution of six characters is analyzed and free venation evolved from anastomosing venation in Bolbitis. • Bolbitis originated from Africa and a dispersal from Asia resulted in continental disjunction between Africa and America. Bolbitis is a pantropical fern genus of Dryopteridaceae with ca. 80 species mainly in tropical Asia. Earlier studies confirmed the monophyly of Bolbitis when Mickelia is excluded and identified three major clades in Bolbitis. However, earlier studies are based on relatively small sampling and the majority of Asian species are not sampled. In this study, DNA sequences of three plastid markers of 169 accessions representing ca. 68 (85 % of total) species of Bolbitis in nine out of the 10 series recognized by Hennipman (1977), and 54 accessions representing the five remaining bolbitidoid genera are used to infer a global phylogeny with a focus on Asian species. The major results include: (1) Bolbitis is strongly supported as monophyletic; (2) species of Bolbitis are resolved into four major clades and their relationships are: the Malagasy/Mascarene clade is sister to the rest, followed by the African clade which is sister to the American clade + the Asian clade; (3) six well-supported subclades are identified in the most speciose Asian clade; (4) the free-veined Egenolfia is embedded in Bolbitis and is paraphyletic in relation to species with anastomosing venation; (5) three series sensu Hennipman (1977), B. ser. Alienae , B. ser. Egenolfianae , and B. ser. Heteroclitae , are paraphyletic or polyphyletic; (6) evolution of six morphological characters is analyzed and free venation is found to have evolved from anastomosing venation and reversed to free venation in Bolbitis ; and (7) biogeographical implications are drawn and it is shown that a single recent dispersal from Asia resulted in continental disjunction of closely related ferns of Bolbitis between Africa and America. [ABSTRACT FROM AUTHOR]