Elsevier

Primary Care Diabetes

Volume 12, Issue 5, October 2018, Pages 467-472
Primary Care Diabetes

Original research
The association between dietary inflammatory index and metabolic syndrome components in Iranian adults

https://doi.org/10.1016/j.pcd.2018.07.008Get rights and content

Highlights

  • •
    Association between the dietary inflammatory index (DII) and metabolic syndrome (MetS) was investigated cross-sectionally.
  • •
    Higher DII score was significantly associated with MetS.
  • •
    After adjustment, participants in the highest quartile of DII score had significantly higher FBG.
  • •
    There were not significant association between DII and liver enzymes level.

Abstract

Aims

Investigating the association between the dietary inflammatory index (DII®) and metabolic syndrome (MetS) components and liver enzymes in Iranian population.

Methods

The present cross-sectional study consist of 606 participants from East-Azarbaijan-Iran. The MetS status was determined using ATPIII NCEP criteria. Moreover, liver enzymes including alanine aminotransferase and aspartate aminotransferase were measured. The DII was calculated according to Shivappa et al. method using a validated quantitative FFQ. Logistic regression was used to determine the association between DII and MetS.

Results

About 34.3% of the participants had metabolic syndrome. Higher DII score was significantly associated with MetS [OR: 2.26 (95% CI: 1.03, 4.92)] after adjusting for covariates. After adjustment, participants in the highest quartile of DII score had significantly higher FBG [OR: 2.56 (95% CI: 1.00, 7.05)] compared with the participants in the lowest quartile of DII score. No other significant association was observed between DII and liver enzymes level and other MetS components (P > 0.05).

Conclusions

The results showed that the DII score was associated with overall MetS and FBG, after adjusting for all covariates. For precise conclusion there is a need for longitudinal studies with larger sample size and considering more food parameters.

Introduction

Metabolic syndrome has become one of the major public health problem worldwide [1]. In addition to the traditional components of the MetS including abdominal obesity, dyslipidemia, hyperglycemia and hypertension, other disorders such as nonalcoholic fatty liver disease (NAFLD) [2] are also thought to be part of the cluster. Studies had shown that the prevalence of MetS in Middle Eastern societies is high [1], [3], [4]. Iran as a Middle Eastern country is also shown the high prevalence of this syndrome. According to the result of recent a meta-analysis study, the prevalence of MetS in Iran was about 36.5% [5]. The exact pathogenesis of MetS is not clear; however, the genetic/ethnic predisposition, life style and environmental factors such as dietary habits and sedentary lifestyles, increasing age and body mass index are shown to be associated with increased prevalence of MetS [6]. Moreover, inflammation is also considered as a risk factor for MetS[7]. Studies have shown that obesity is associated with increasing inflammatory factors and can serve as a precursor to metabolic disorder [8]. Moreover, dietary patterns have been shown to be associated with inflammation like Mediterranean diet decreases inflammation [9], [10] while western dietary pattern increase inflammation [10]. In this regard, the dietary inflammatory index (DII) was developed to assess the pro-inflammatory and anti-inflammatory properties of the individuals‘ diet and it was hypothesized that this index could predict inflammation-related outcomes in any population. In this regard, different studies assessed the association of DII and MetS in different populations and yielded mainly inconsistent results [11], [12], [13], [14], [15]. Although some earlier studies reported the significant association between DII and MetS components [13], [14], [15], the association between pro-inflammatory DII score and overall MetS has been reported in only one study conducted in France [11]. To the best of our knowledge, there is no study that assesses the association between DII score and MetS and liver enzymes in Iranian population. So, in the present study, we hypothesized that there may be association between dietary inflammatory index, metabolic syndrome and liver enzymes level in Iranian population.

Section snippets

Method

In the cross-sectional analysis of lifestyle promotion project (LPP) data set, probability proportional to size multistage stratified cluster sampling was used as a sampling method. The method of sampling is described in detail elsewhere [16]. In brief, the updated postal code was used as the sampling frame and the clusters were selected based on postal code. 150 clusters were selected. After determining the cluster start point, enrollment and data collection was started. In each cluster, 5

Results

The mean age of the participants was 42.24 ± 12.00 years. About 45.5% of participants were male. About 34.3% of the participants had metabolic syndrome. Respectively 48.2%, 44.1%, 16.6%, 29.6% and 25.2% of participants had high waist circumference, serum TG, FBS, systolic blood pressure and diastolic blood pressure levels. The median of DII was 1.81 and ranged from −4.38 to 4.85. The baseline characteristics of study population according to DII score is presented in Table 1. There were not

Discussion

According to the previous studies, inflammation is associated with obesity, CVD and insulin resistance [20] and diet have central role in the regulation of chronic inflammation. Previously, it has been shown that diets high in fat specially saturated and trans-fatty acids, refined carbohydrates and sugar and low in fiber and omega-3 fatty acids shift the balance of inflammation to more pro-inflammatory state and lead to innate immune system activation which predisposes at-risk people to

Conclusion

In conclusion, the results of the present study showed that the DII® score was associated with overall MetS and FBS, after adjusting for all covariates. However, we did not observe any association between DII and other metabolic syndrome components and also ALT and AST levels. More longitudinal researches with larger sample size and considering more food parameters in calculation of DII are needed to confirm the association of dietary inflammatory index and MetS.

Acknowledgements

The authors wish to thanks East Azerbaijan Provincial Health Center, Tabriz Health Services Management Research Center at Tabriz University of Medical Sciences and Eastern-Azerbaijan Governor General for financial support.

Conflict of interest

The authors state that they have no conflict of interest.

Compliance with ethical standards

All procedures performed in the present study were in accordance with the ethical standards of the ethics committee of Tabriz University of medical sciences (registration number: 1394.383) and with the 1964 Helsinki declaration and its later amendments. All participants have signed the written informed consent.

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