Dietary anti-inflammatory index, metabolic syndrome and transition in metabolic status; a gender-specific analysis of ATTICA prospective study

Abstract

Aims

To examine the association between dietary anti-inflammatory index (D-AII) and metabolic syndrome (MetS)prevalence, 10-year (2002–2012) diabetes, hypertension, hypercholesterolaemia incidence and 10-year transition from healthy (absence of all MetS traits, excluding waist circumference) to unhealthy metabolic status.

Methods

In 2001–2002, n = 1514 men and n = 1528 women (>18 years old) in Athens, Greece, free of cardiovascular disease were recruited. MetS was defined according to the revised NCEP ATP III (2005) or the IDF criteria or the harmonized criteria. The validated D-AII was calculated using a standardized procedure (range 10–77).

Results

Inverse associations were observed between D-AII and transition from healthy to unhealthy metabolic status (Odds Ratio (OR)_{3rd vs. 1st tertile} = 0.88 95% Confidence Interval (95%CI)(0.73, 0.98)) and diabetes (OR_{3rd vs. 1st tertile} = 0.55, 95%CI(0.29, 0.77)). In women, D-AII was inversely associated with transition from healthy to unhealthy metabolic status (OR_{3rd vs. 1st tertile} = 0.55, 95%CI(0.26, 0.90), diabetes (OR_{3rd vs. 1st tertile} = 0.41, 95%CI(0.18, 0.64) and hypertension (OR_{3rd vs. 1st tertile} = 0.75, 95%CI(0.20, 0.95), yet only with diabetes incidence in men (OR_{3rd vs. 1st tertile} = 0.62, 95%CI(0.38, 0.93).

Conclusions

Diet with high anti-inflammatory load seems an effective preventive measure to retain a metabolically benign status, principally in terms of glycemic control.

Introduction

Early cardiovascular disease (CVD) prevention still remains one of the principle challenges in preventive medicine. Adequate dietary intake is well established as an important modifiable factor towards acquiring and maintaining healthy metabolic profile. Therefore, it is very common that some of the dietary patterns are usually described as “healthy” or “unhealthy” according to their anti- or pro-inflammatory potential [1], [2]. Based on these observations the dietary inflammatory index (DII) was generated, relying on individual dietary components and nutrients, that are part of existing dietary patterns [3]. As such, DII can be considered as a specific characteristic of already existing dietary patterns rather than another, separate dietary pattern itself. Since its development, DII has been associated with a wide range of major clinical endpoints such as development of CVDs [4], cancer [5]and overall mortality [4], [6] while an alternative, yet with similar concept, version has been created to define the anti-inflammatory diet2. Nevertheless, the role of dietary inflammatory or anti-inflammatory load on intermediate multifactorial cardiometabolic conditions such as metabolic syndrome (MetS) and its components still remain inconclusive and probably less evident [7], [8], [9].

MetS and its components raise major public health concerns considering their strong involvement in pathophysiological CVD features [10]. Relatively recent studies proposed that the chronic low grade inflammation plays a radical role in the development of MetS [11], [12] further contributing to the development of number of different metabolic dysfunctions [13]. Several potential mechanisms were proposed including the role of adipose tissue in the inflammatory pathways; increase in production of tumor necrosis factor alpha (TNF-α), C-Reactive Protein (CRP), Interleukin-6 (IL-6) and Interleukin-10 (IL-10) [14], [15].

It is not surprising that adhering to anti-inflammatory dietary patters such as Mediterranean diet may protect against development of MetS [16], [17]. Therefore, the aim of the present work was to evaluate the association between inflammatory load of diet expressed through an index of separate foods and nutrients3 and; a. the presence of MetS using different sets of criteria to define it, b. the 10-year incidence of diabetes mellitus, hypertension, dyslipidemia, and transition from healthy –defined by Lavie et colleagues as absence of all MetS traits excluding waist circumference– to unhealthy metabolic status [18]. In this study we have proposed that dietary patterns with increased anti-inflammatory potential (D-AII) are inversely associated with MetS as well as the 10-year transition to unhealthy metabolic status and separate intermediate cardiometabolic risk factors.