Dietary inflammatory index and cardiometabolic risk in US adults

doi:10.1016/j.atherosclerosis.2018.02.020

Atherosclerosis

Volume 276, September 2018, Pages 23-27

https://doi.org/10.1016/j.atherosclerosis.2018.02.020 Get rights and content

Highlights

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We investigated the association of cardio-metabolic risk factors, singly or in combination, and inflammatory markers with dietary inflammatory index (DII^®) scores.
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Our results indicate that adjusted levels of cardio-metabolic risk factors significantly increased (decreased for HDL-cholesterol) across increasing quartiles of DII score.
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The prevalence of metabolic syndrome, obesity, elevated high sensitivity C-reactive protein and glucose intolerance increased with increasing inflammatory potential of diet.

Abstract

Background and aims

We investigated the association between Dietary Inflammatory Index (DII^®) scores and cardio-metabolic risk factors singly and in combination as metabolic syndrome (MetS).

Methods

We used data from participants selected from the US National Health and Nutrition Examination Survey (NHANES). Analyses were restricted to participants with data available on dietary intake, biochemical data, and anthropometric measurements from 2005 to 2012. Statistical analyses used the SPSS^® Complex Samples v22.0 (IBM Corp, Armonk, NY) and accounted for the survey design and sample weights. Energy-adjusted-DII (E-DII^®) expressed per 1000 kcal was calculated from 24-h dietary recalls. Of the 17,689 participants with evaluable data, 8607 (48.3%) were men. The mean age was 45.8 years in the overall sample, with men being slightly younger than women (44.9 vs. 46.5 years, p = 0.05).

Results

In multivariable-adjusted regression models, the odds of MetS, its components, as well as obesity, and elevated high-sensitivity C-reactive protein (hsCRP) increased across increasing quartiles of E-DII (p < 0.001). In age, sex, race, income-to-poverty ratio-adjusted models, these and other cardiovascular disease risk factors (triglycerides/high density lipoprotein cholesterol (HDL-C) ratio, apolipoprotein (B) and HbA1C) increased across quartiles of the E-DII (all p < 0.001), while HDL-C levels decreased (p < 0.001).

Conclusions

This study suggests associations between MetS, its components, subclinical inflammation, and the DII. These results reinforce the view that diet plays an important role in the occurrence of cardiovascular diseases.

Introduction

Diet is one of the main modulators of subclinical inflammation, which can be evaluated in humans through levels of markers including tumor necrosis factor-α (TNFα), high sensitivity C-reactive protein (hsCRP), or cell adhesion molecules [1,2]. There have been reports of links between these markers and dietary patterns [3]. For instance, the Western dietary pattern (highly concentrated in red meat, high-fat dairy products and refined grains) is associated with high levels of hsCRP, interleukin-6 and fibrinogen [4,5]; while the Mediterranean diet (high in whole grains, fruit and green vegetables, and fish and low in red meat and butter, with moderate consumption of alcohol and olive oil) is associated with low levels of inflammatory markers [6,7].

The Dietary Inflammatory Index (DII^®) was developed in 2009 [8] and updated in 2014 [9,37,38]; based on extensive literature search. Its intended purpose is to specifically measure dietary inflammatory potential which is a contributor to many chronic conditions [8,9]. The DII assesses the inflammatory potential of the diet based on the balance of pro- and anti-inflammatory properties of its components, including macronutrients, vitamins, minerals, flavonoids and specific food items [8,9]. DII scores are standardized to global dietary intakes, allowing their use across different cultures and dietary patterns.

There is growing interest in inflammation's role modulation to prevent and control cardiovascular diseases [10]. In this regard, better characterizing the links between dietary inflammatory potential and CVD risk, can aid in tailoring food-based strategies to prevent and control CVDs. Accordingly, we investigated the association of DII scores with inflammatory markers and cardio-metabolic risk factors, singly or in combination. We postulated that cardiovascular risk profile deteriorates with increasing (i.e., more pro-inflammatory) DII scores.

Section snippets

Population

The current study was based on data from participants aged 18 years and above, who took part in 2005–2012 waves of the US National Health and Nutrition Examination Surveys (NHANES). These are ongoing repeated cross-sectional surveys conducted by the US National Center for Health Statistics (NCHS). In these surveys, NCHS uses multistage probabilistic sampling approaches to select participants. These include oversampling of certain segments of the population [11]. After processing, data collected

Results

The weighted distributions of study population characteristics across quartiles of DII are shown in Table 1. The 17,689 eligible participants included 8607 men (48.3%). The mean age was 45.8 years in the entire study sample, 44.9 years in men and 46.5 in women (p = 0.047 for men vs. women comparison). The overall prevalence of the MetS was 28.3%.

The DII scores ranged from −5.66 to 4.24. The distribution of participants' characteristics across quartiles of DII is shown in Table 2. Age-, sex- and

Discussion

A pro-inflammatory diet as measured by the DII was associated with a deteriorating cardio-metabolic risk profile. These findings were robust, persisting even after adjustment for a range of confounding factors including age, sex, race, smoking, energy intake, education level, marital status and BMI.

Few other studies have investigated the link between the DII and MetS or its components [[19], [20], [21]]. In the Buffalo Cardio-Metabolic Occupational Police Stress study comprising 464 US adults

Conflicts of interest

The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

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Citation Excerpt :
The odds of MetS, its components, as well as obesity, elevated hsCRP, TG/HDL-C ratio, apo B and HbA1c rose across increasing quartiles of E-DII (p < 0.001). In the models that were adjusted for age, sex, race and income-to-poverty ratio, the CVD risk factors (TG/HDL-C ratio, apo B and HbA1c) were increased across quartiles of the E-DII (all p < 0.001), while HDL-C levels decreased (p < 0.001) [94]. In a study with national representative sample of American adults, the association between dietary acid load, potential renal acid load (PRAL) and net endogenous acid production (NEAP) on one hand, and PAD on the other hand, was investigates [95].
Proteins play a crucial role in metabolism, in maintaining fluid and acid-base balance and antibody synthesis. Dietary proteins are important nutrients and are classified into: 1) animal proteins (meat, fish, poultry, eggs and dairy), and, 2) plant proteins (legumes, nuts and soy). Dietary modification is one of the most important lifestyle changes that has been shown to significantly decrease the risk of cardiovascular (CV) disease (CVD) by attenuating related risk factors. The CVD burden is reduced by optimum diet through replacement of unprocessed meat with low saturated fat, animal proteins and plant proteins. In view of the available evidence, it has become acceptable to emphasize the role of optimum nutrition to maintain arterial and CV health. Such healthy diets are thought to increase satiety, facilitate weight loss, and improve CV risk. Different studies have compared the benefits of omnivorous and vegetarian diets. Animal protein related risk has been suggested to be greater with red or processed meat over and above poultry, fish and nuts, which carry a lower risk for CVD. In contrast, others have shown no association of red meat intake with CVD.
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Dietary inflammatory index and cardiometabolic risk in US adults

Highlights

Abstract

Background and aims

Methods

Results

Conclusions

Introduction

Section snippets

Population

Results

Discussion

Conflicts of interest

Nutr. Res.

Am. J. Cardiol.

J. Nutr.

J. Am. Diet Assoc.

Nutr. Res.

Nutr. Metabol. Cardiovasc. Dis.

Nutr. Res.

Clin. Nutr.

Diabetes Metab.

Atherosclerosis

J. Am. Diet Assoc.

J. Acad. Nutr. Diet.

Ann. Epidemiol.

Serum hs-CRP varies with dietary cholesterol, but not dietary fatty acid intake in individuals free of any history of cardiovascular disease

Eur. J. Clin. Nutr.

Effect of statins on serum vitamin D concentrations: a systematic review and meta-analysis

Eur. J. Clin. Invest.

A high intake of dietary fiber influences C-reactive protein and fibrinogen, but not glucose and lipid metabolism, in mildly hypercholesterolemic subjects

Eur. J. Nutr.

Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial

Ann. Intern. Med.

Nutrient patterns and their relationship to metabolic syndrome in Iranian adults

Eur. J. Clin. Invest.

Designing and developing a literature-derived, population-based dietary inflammatory index

Publ. Health Nutr.