TNF and cancer: The following mechanisms may further explain these findings: A high DII score reflects a diet with higher pro-inflammatory levels, and chronic inflammation is a well-established cause of cancer due to inflammatory cytokines like TNF-α, IL-6, and IL-1β causing DNA damage, abnormal DNA methylation, and activating NF-κB, leading to oncogene activation and tumor suppressor gene inactivation [24–26].