Construct validation of the dietary inflammatory index among postmenopausal women

Diet quality and a traditional dietary pattern predict lean mass in Australian women: Longitudinal data from the Geelong Osteoporosis Study

Low muscle mass is associated with reduced independence and increased risk for falls and fractures. Identification of modifiable risk factors for low muscle mass is thus imperative. This study aimed to examine the longitudinal relationship between both diet quality and patterns and lean mass in Australian women. Data from n = 494 participants of the Geelong Osteoporosis Study's 10- and 15-year women's follow-ups were used (conducted in 2004-08 and 2011-14, respectively), and participants were aged 21-89 years. Self-reported lifestyle and demographics were collected, and food frequency questionnaire data informed the dietary exposure variables: the Australian Recommended Food Score (ARFS); the Dietary Inflammatory Index (DII); and a posteriori dietary patterns. The outcome, Skeletal Muscle Index (SMI), was calculated from DXA-derived appendicular lean mass (ALM) relative to height (ALM kg/m2). Analyses employed Generalised Estimating Equations. A higher ARFS score positively predicted SMI over 5-years, and adjustments for age and physical activity did not attenuate this relationship (B:0.044, (95%CI 0.004, 0.084) kg/m2). Following adjustment, both an anti-inflammatory diet (B:-0.034, (95%CI -0.070, -0.002) kg/m2) and a 'traditional' dietary pattern predicted higher SMI (B:0.081, (95%CI 0.004, 0.158) kg/m2). No other associations were observed. Our study reinforces the importance of diet quality for healthy, aging muscle mass. Furthermore, a less inflammatory diet and a diet comprising a wide variety of plant and animal foods may be conducive to maintenance of muscle mass in women. Further studies investigating diet quality's impact on various muscle health measures over longer time periods are warranted.

Association between dietary inflammatory index and gestational diabetes mellitus risk in a prospective birth cohort study

OBJECTIVE

Information is limited regarding the possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM). This study investigated the association between the inflammatory potential of the diet, measured by the dietary inflammatory index (DII), and GDM risk in pregnant Chinese women.

METHODS

This study included 2639 eligible women from the Tongji Maternal and Child Health Cohort. Dietary intake was assessed by a validated semiquantitative food frequency questionnaire and was used to calculate the DII score. The DII was then validated using C-reactive protein measurements in a subsample of 133 pregnant women. GDM diagnoses were collected from medical records based on the results of a 75 g oral glucose tolerance test at 24 to 28 wk gestation. Multivariable-adjusted logistic regression models were performed to estimate the odds ratios (ORs) for GDM risk by DII score, modeled continuously and in tertiles.

RESULTS

Of the 2639 participants, 13.1% were diagnosed with GDM. DII scores ranged from -4.45 to 3.15 and were positively associated with C-reactive protein (adjusted β : 1.28, 95% confidence interval [CI]: 0.16, 2.40; P trend = 0.023) when comparing DII tertile 3 (most pro-inflammatory) to tertile 1 (most anti-inflammatory). A significant and positive association was observed between DII scores and GDM risk (adjusted OR: 1.43; 95% CI: 1.05, 1.95; P trend = 0.022) comparing the highest versus lowest tertiles. The stratified analysis showed that this association was stronger in pregnant women who were overweight or obese before pregnancy (adjusted OR: 2.20; 95% CI: 1.03, 4.69).

CONCLUSIONS

These findings suggest that a higher DII score, corresponding to a more proinflammatory diet, is associated with a higher risk of GDM, particularly in pregnant women who were overweight or obese before pregnancy.

Association Between Inflammatory Potential of the Diet and Ulcerative Colitis: A Case-Control Study

Background/Aim: Despite the inflammatory nature of inflammatory bowel disease (IBD), limited data are available on the association of inflammatory potential of the diet and risk of ulcerative colitis (UC). We aimed to investigate the association of inflammatory potential of the diet (IPD) score and odds of UC in a case-control study. Methods: Patients with UC were enrolled from Iranian IBD registry, whose disease was confirmed by a gastroenterologist. Controls were selected randomly from the Study of the Epidemiology of Psycho Alimentary Health and Nutrition (SEPAHAN) study, a large population-based study on more than 8,000 apparently healthy individuals. Dietary intakes of 28 food items obtained from a validated dish-based food frequency questionnaire (FFQ), were used to compute IPD score. Results: This case-control study was carried out among 109 cases and 218 randomly chosen controls. Mean age of cases and controls was 39.5 ± 10.0 and 41.5 ± 11.8 y, respectively. Totally, 52% of study participants were female and 48% were male. After controlling for age, sex, and body mass index (BMI), we found that the patients with UC were more likely to be in the highest quartile of IPD score compared with controls (OR: 2.83; 95% CI: 1.41-5.69, P-trend < 0.001). This association strengthened after additional adjustment for education, smoking, medical history, and physical activity (OR: 3.48; 95% CI: 1.32-9.10, P-trend = 0.003). When we took dietary habits into account, the association was slightly attenuated (OR: 3.33; 95% CI: 1.20-9.20, P-trend = 0.005). Conclusions: We found that adherence to a pro-inflammatory diet was positively associated with greater odds of UC. Further studies are required to confirm these findings.

Associations Between the Dietary Inflammatory Index, Brain Volume, Small Vessel Disease, and Global Cognitive Function

BACKGROUND

An inflammatory diet is related to poorer cognition, but the underlying brain pathways are unknown.

OBJECTIVE

The aim of this study was to examine associations between the Energy-Adjusted Dietary Inflammatory Index (E-DII) and brain volume, small vessel disease, and cognition in people with and without type 2 diabetes mellitus (T2DM).

DESIGN

This is a secondary cross-sectional analysis of data from the Cognition and Diabetes in Older Tasmanians study.

PARTICIPANTS/SETTINGS

This study included 641 participants (n = 326 with T2DM) enrolled between 2005 and 2011 from Tasmania, Australia.

MAIN OUTCOME MEASURES

The E-DII was computed from the 80-item Dietary Questionnaire for Epidemiological Studies, version 2. Brain volumes (gray matter, white matter, and white matter hyperintensities), infarcts, and microbleeds were obtained from magnetic resonance imaging. Global cognition was derived from a comprehensive battery of neuropsychological tests.

STATISTICAL ANALYSIS

Logistic and linear regressions were performed to examine associations between E-DII and brain measures and a global cognitive score, adjusting for demographics, energy, T2DM, mood, ambulatory activity, and cardiovascular risk factors. An E-DII × T2DM interaction term was tested in each model.

RESULTS

The mean (standard deviation) age of participants was 69.8 (7.4) years. There were no associations between the E-DII and any of the brain structural measures or global cognitive function in fully adjusted models. There was a modification effect for T2DM on the association between E-DII and gray matter volume (T2DM: β = 1.38, 95% CI -3.03 to 5.79; without T2DM: β = -4.34, 95% CI, -8.52 to -0.16), but not with any of the other outcome measures.

CONCLUSIONS

In this cross-sectional study, E-DII was not associated with brain structure or global cognition. In 1 of the 7 outcomes, a significant modification effect for T2DM was found for the associations between E-DII and gray matter. Future prospective studies are needed to clarify the associations between diet-related inflammation and brain health.

Dietary inflammatory potential and risk of sarcopenia: data from national health and nutrition examination surveys

This study used National Health and Nutrition Examination Surveys data from 1999 to 2006 to investigate the association between dietary inflammatory potential, represented by dietary inflammatory index (DII) scores, and the risk of sarcopenia in U.S. adults. A total of 25,781 participants were included in the study. The DII scores were calculated based on dietary information collected from 24-hour recalls. Men and women were classified as sarcopenic if appendicular lean mass (ALM) adjusted for BMI (ALM_BMI) was <0.789 or <0.512, respectively. The covariates included comorbidities, dietary data, demographic data, and physical examination data. In a full-adjusted model, each unit of increase in DII score was associated with a 12% increase in risk of sarcopenia. When categorizing sarcopenia into tertiles, the adjusted effect size (relative to Tertile1) was 1.26 (95% CI, 1.07, 1.47) for Tertile 2 and 1.55 (95% CI, 1.31, 1.83) for Tertile 3. The trend test showed that the risk of sarcopenia increased with increasing DII tertiles, (P <0.0001). These findings demonstrate that dietary inflammatory potential correlates positively with the risk of sarcopenia and suggest that making ones diet inflammatory may reduce the incidence of sarcopenia and its associated negative health outcomes.

Dietary Inflammatory Index and Epithelial Ovarian Cancer in Southern Chinese Women: A Case-Control Study

The association between inflammatory properties of diet and ovarian cancer risk has been investigated in some Western populations. However, little evidence is available from Asian women whose ovarian cancer incidence rates are low and dietary and lifestyle patterns are very different from their Western counterparts. We aimed to examine whether more pro-inflammatory diets, as indicated by higher dietary inflammatory index (DII®) scores, are associated with increased odds of epithelial ovarian cancer in southern China. A case-control study was conducted during 2006-2008 in Guangzhou, Guangdong Province. Energy-adjusted DII (E-DII) scores were calculated based on dietary intake assessed by a validated food frequency questionnaire administered to 500 incident epithelial ovarian cancer patients and 500 hospital-based controls. Logistic regression models were used to assess the relationship between E-DII scores and odds of ovarian cancer. Positive associations were observed between higher E-DII scores and ovarian cancer odds, using both continuous DII scores (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.65, 2.13) and by DII tertiles (OR_tertile3vs1 7.04, 95% CI: 4.70, 10.54, p for trend < 0.001). Likewise, a more pro-inflammatory diet was associated with a higher chance of serous and mucinous ovarian tumors. Our results suggest that a pro-inflammatory diet was associated with increased odds of developing epithelial ovarian cancer in southern Chinese women. The findings add to epidemiological evidence for the role of dietary inflammatory potential in ovarian cancer development.

Inflammatory potential of the diet and risk of sarcopenia and its components

BACKGROUND

Despite a large body of evidence on the link between dietary inflammatory index (DII) and several chronic conditions, limited data are available about the association of DII and sarcopenia. This study aimed to examine the relationship between inflammatory potential of the diet (as measured by DII) and sarcopenia and its components among community-dwelling elderly population.

METHODS

This population-based cross-sectional study was performed in 2011 among 300 elderly people (150 men and 150 women) aged ≥55 years, who were selected using cluster random sampling method. Dietary assessment was done using a pre-tested food frequency questionnaire. Energy-adjusted DII was calculated based on earlier studies. Sarcopenia and its components were determined based on the European Working Group on Sarcopenia (EWGSOP) definition.

RESULTS

Mean age of study participants was 66.7 ± 7.7 y. Subjects in the highest tertile of DII score (i.e. those with a more pro-inflammatory diet) were more likely to be older (P = 0.02). The prevalence of sarcopenia (P = 0.016) and low muscle mass (P = 0.041) was significantly higher among subjects in the top tertile compared with those in the bottom tertile of DII. After adjustment for potential confounders, those with the highest DII were 2.18 times (95% CI: 1.01-4.74) more likely to have sarcopenia than those with the lowest DII. With regard to components of sarcopenia, subjects in the top tertile of DII had not significantly greater odds of low muscle mass (OR: 1.38; 95% CI: 0.72-2.63), abnormal handgrip strength (OR: 0.97; 95% CI: 0.49-1.89), and abnormal gait speed (OR: 1.61; 95% CI: 0.84-3.08) than those in the bottom tertile.

CONCLUSIONS

In conclusion, a diet with more pro-inflammatory potential was associated with a greater odds of sarcopenia. Further studies are required to confirm these findings.

Pro-Inflammatory Diet Is Associated with Adiposity during Childhood and with Adipokines and Inflammatory Markers at 11 Years in Mexican Children

There is limited evidence about the inflammatory potential of diet in children. The aim of this study was to evaluate the association between the Children's Dietary Inflammatory Index (C-DII) from 5 to 11 years with adiposity and inflammatory biomarkers in Mexican children. We analyzed 726 children from a birth cohort study with complete dietary information and measurements to evaluate adiposity at 5, 7 and 11 y and 286 children with IL-6, hsCRP, leptin and adiponectin information at 11 y. C-DII trajectories were estimated using latent class linear mixed models. We used linear mixed models for adiposity and logistic and multinomial regression for biomarkers. In girls, each one-point increase in C-DII score was associated with greater adiposity (abdominal-circumference 0.41%, p = 0.03; skinfold-sum 1.76%, p = 0.01; and BMI Z-score 0.05, p = 0.01). At 11 y the C-DII was associated with greater leptin (34% ≥ 13.0 ng/mL, p = 0.03) and hsCRP concentrations (29% ≥ 3.00 mg/L, p = 0.06) and lower adiponectin/leptin ratio (75% < 2.45, p = 0.02). C-DII trajectory 3 in boys was associated with a 75.2% (p < 0.01) increase in leptin concentrations and a 37.9% decrease (p = 0.02) in the adiponectin/leptin ratio. This study suggests that the inflammatory potential of diet may influence adiposity in girls and the homeostasis of adipose tissue and chronic subclinical inflammation in 11-year-old children.

Dietary inflammatory potential in relation to the gut microbiome: results from a cross-sectional study

Diet has direct and indirect effects on health through inflammation and the gut microbiome. We investigated total dietary inflammatory potential via the literature-derived index (Dietary Inflammatory Index (DII®)) with gut microbiota diversity, composition and function. In cancer-free patient volunteers initially approached at colonoscopy and healthy volunteers recruited from the medical centre community, we assessed 16S ribosomal DNA in all subjects who provided dietary assessments and stool samples (n 101) and the gut metagenome in a subset of patients with residual fasting blood samples (n 34). Associations of energy-adjusted DII scores with microbial diversity and composition were examined using linear regression, permutational multivariate ANOVA and linear discriminant analysis. Spearman correlation was used to evaluate associations of species and pathways with DII and circulating inflammatory markers. Across DII levels, α- and β-diversity did not significantly differ; however, Ruminococcus torques, Eubacterium nodatum, Acidaminococcus intestini and Clostridium leptum were more abundant in the most pro-inflammatory diet group, while Akkermansia muciniphila was enriched in the most anti-inflammatory diet group. With adjustment for age and BMI, R. torques, E. nodatum and A. intestini remained significantly associated with a more pro-inflammatory diet. In the metagenomic and fasting blood subset, A. intestini was correlated with circulating plasminogen activator inhibitor-1, a pro-inflammatory marker (rho = 0·40), but no associations remained significant upon correction for multiple testing. An index reflecting overall inflammatory potential of the diet was associated with specific microbes, but not overall diversity of the gut microbiome in our study. Findings from this preliminary study warrant further research in larger samples and prospective cohorts.

Associations between dietary inflammatory index and sleep problems among adults in the United States, NHANES 2005-2016

OBJECTIVES

To examine the associations between Dietary Inflammatory Index (DII) scores and sleep measures of sleep duration and self-reported sleep disturbance.

DESIGN

Cross-sectional study.

SETTING

The United States.

PARTICIPANTS

Participants from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) who were 20 years old or older (n = 30,121).

MEASUREMENTS

Sleep duration, classified as short (≤6 hours), long (≥9 hours) and recommended (6-9 hours) duration, and the presence of self-reported sleep disturbance were the outcome variables. The energy-adjusted DII (E-DII) was computed based on the dietary intake data using a single-day 24-hour dietary recall. Multinomial logistic regression was used to examine the associations.

RESULTS

After adjusting for confounders, participants in the highest quintile (most proinflammatory E-DII) had a 40% increase in the odds of short sleep duration compared to the lowest quintile (most anti-inflammatory E-DII)(OR_quintile5vs1 = 1.40 [95% confidence interval {CI}, 1.21, 1.61]). The odds of short sleep duration was increased by 26% in quintile 4 compared to quintile 1 (OR _quintile4vs1 = 1.26 [95% CI, 1.10, 1.43]). Similarly, the odds of long sleep duration was increased in higher E-DII quintiles (OR_quintile5vs1 = 1.23 [95% CI, 1.03, 1.46] and OR_quintile4vs1 = 1.24 [95% CI, 1.03, 1.49]). Participants in the highest E-DII quintile also were more likely to report sleep disturbances (OR_quintile5vs1 = 1.14 [95% CI, 1.02, 1.27]).

CONCLUSIONS

Adults consuming proinflammatory diets were more likely to have short sleep duration, long sleep duration, and/or self-reported sleep disturbances. Future, especially longitudinal, studies need to examine the impact of anti-inflammatory diets in mitigating extreme sleep durations and sleep disturbances.

Dietary inflammatory index score, glucose control and cardiovascular risk factors profile in people with type 2 diabetes

We examined the relationships between the dietary inflammatory index (DII^®), dietary habits and cardiovascular risk factor profiles in people with type 2 diabetes mellitus (T2DM). Energy-adjusted DII (E-DII™) scores were calculated from a Food Frequency Questionnaire in 2568 T2DM patients from different parts of Italy. Analyses were conducted according to quartiles of sex-specific E-DII scores. Higher, more pro-inflammatory, (quartile 4) E-DII scores were associated with overall poor quality of the diet characterised by higher content of refined carbohydrates, added sugars, saturated fat and cholesterol and lower unsaturated fat, fibre and polyphenols compared to quartile 1. Higher E-DII scores also were associated with higher waist circumference (105.4 vs. 103.5 cm; p = 0.002), triglycerides (154.6 vs. 146.1 mg/dL; p = 0.005), diastolic blood pressure (80.05 vs. 78.6 mmHg; p = 0.04) and lower HDL-cholesterol (45.3 vs. 47.4 mg/dL; p = 0.04). In conclusion, E-DII is a potent marker of overall quality of the diet and is associated with an unfavourable cardiovascular risk factor profile.

Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study)

Metabolic syndrome (MetS) is one of the risk factors for all causes of mortality. Inflammation is an important risk factor for MetS. The present cross-sectional study aimed to investigate the relationship between MetS and pro-inflammatory diet by using the food inflammation index (DII). This study consists of 10,017 participants with an age range of 35 to 70 years. The Fasa Cohort Study (FACS) population (Fars Province, Iran) was used to collect data. The DII was estimated according to Shivappa et al. method using a validated 125-item FFQ. To determine the association between MetS components and DII Logistic regression was used (P > 0.05). The overall mean of DII was - 0.89 ± 1.74. However, adjusted multinomial logistic regression indicates each unit increase in waist circumference (WC) (OR 0.98, 95% CI 0.96-0.99) and HDL-C (OR 0.99, 95% CI 0.98-0.99) was associated with significantly decreased odds of being in the 4th DII quartile in men and all participations respectively, there is no statistically significant relationship between MetS and DII. Overall, although people in the highest quartile of inflammatory food consumption had more likely to develop MetS, this relationship was not statistically significant among males and females.

Association of Dietary Inflammatory Index with Serum IL-6, IL-10, and CRP Concentration during Pregnancy

Background: The mother’s diet has a direct impact on fetal development and pregnancy, and can also be important in the course of the body’s inflammatory response. An anti-inflammatory diet can be a promising way to counter an excessive inflammatory response in pregnancy. Objective: The aim of the study was to examine the association between the dietary inflammatory index (DII) and the pregnant women’s serum interleukin 6 (IL-6) and 10 (IL-10) and C-reactive protein (CRP) concentration in the course of normal and complicated pregnancy. Research Methods and Procedures: The study included 45 Polish pregnant women recruited to the study. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a seven-day 24-h recall and an food frequency questionnaire (FFQ) in each trimester of pregnancy. At the same time as the nutritional interviews, blood samples were collected for the determination of IL-6, IL-10, and CRP concentrations. The studied group was divided into subgroups with normal and complicated pregnancy and depending on the DII median. Results: With the development of pregnancy, the DII score slightly decreased in subsequent trimesters: −1.78 in the first trimester, −2.43 in the second trimester, and −2.71 in the third trimester (p = 0.092). Independent of the trimester of pregnancy and the occurrence of pregnancy complications, the DII score did not affect the differences in the serum concentrations of IL-6, IL-10, and CRP, with the exception of CRP level in the second trimester in women with complicated pregnancy (subgroup with DII < median had a lower CRP level than subgroup with DII > median). In the first and third trimesters, there was a weak but significant positive correlation between the DII score and CRP concentration. During the second trimester, in the group with normal pregnancy and DII below the median, a significant negative correlation between the DII score and the serum IL-6 and IL-10 concentration was noted as well as in the third trimester for IL-6. Conclusion: The anti-inflammatory potential of a pregnant woman’s diet increases slightly with pregnancy development; however, its value has no permanent significant association with the level of CRP, IL-6, and IL-10.

Inflammatory potential of diet and risk of incident knee osteoarthritis: a prospective cohort study

Background

To examine the relation between inflammatory potential of diet and incident knee osteoarthritis (OA) and the role of BMI in the association of interest.

Methods

In the Osteoarthritis Initiative, the energy-adjusted dietary inflammatory index (E-DII™) scores were calculated based on the Block Brief 2000 Food Frequency Questionnaire and categorized into sex-specific quartiles. Outcomes were incident (1) radiographic knee OA (ROA) (i.e., a KL grade ≥ 2) and (2) symptomatic knee OA (SxOA) (i.e., a combination of frequent knee pain and ROA). We fitted generalized estimating equation models to examine the association between E-DII scores and incident knee OA. We performed mediation analyses to assess the potential mediation by BMI in the DII-OA relation.

Results

Over a 48-month follow-up period, 232 and 978 knees developed ROA and SxOA, respectively. Compared with the lowest (most anti-inflammatory) E-DII quartile, the odds ratio (OR) of incident ROA for the highest (most pro-inflammatory) E-DII quartile was 1.73 (95% confidence interval (CI) 1.15 to 2.62, P_trend = 0.007). The corresponding OR for SxOA was 1.43 (95% CI 1.16 to 1.76, P_trend = 0.001). The DII-OA association was significantly mediated via BMI with an indirect effect of 1.08 (95% CI 1.04, 1.13) for ROA and 1.13 (95% CI 1.09, 1.16) for SxOA, accounting for 20.4% and 44.5% of the total effect, respectively.

Conclusions

A higher inflammatory potential of diet increased the risk of knee OA. The association was significantly mediated via BMI. Targeting the inflammatory potential of diet may be beneficial to reduce the risk of knee OA.

Resistance Training Associated with Dietetic Advice Reduces Inflammatory Biomarkers in the Elderly

Aging is a biological process during which chronic low-grade inflammation is present due to changes in the immune system of the elderly. The main objective of this study is to evaluate the effects of resistance training associated with dietary advice on chronic inflammation in the elderly. We conducted a prospective intervention study in which we evaluated anthropometric parameters and inflammatory biomarkers (CRP, IL-8, CCL-2, and leptin) in 40 elderly people before and after long-term progressive resistance training (19 weeks) associated with dietary advice. The participants trained twice a week on nonconsecutive days, and the training lasted one hour with an intensity of 60-85% of 1-MR. Dietary advice was explained in person and individually focusing on foods rich in compounds with anti-inflammatory and antioxidant properties. Participants were instructed at the beginning of the training program, and dietary advice was reinforced verbally weekly. There was an improvement in body composition evidenced by a reduction in waist circumference and body fat percentage and by the increase in arm circumference, calf circumference, and corrected arm muscle area. In addition, there was a reduction in the inflammatory biomarkers CCL-2 (p = 0.01) and leptin (p < 0.01). Resistance training associated with dietary guidance can contribute to a healthy aging due to observed improvements in body composition and in the inflammatory profile of the elderly.

TNF genetic polymorphism (rs1799964) may modify the effect of the dietary inflammatory index on gastric cancer in a case-control study

The inflammatory process is known to increase the risk of gastric carcinogenesis, and both genetic and dietary factors are associated with inflammation. In the present study of 1,125 participants (373 cases and 752 controls), we determined whether the dietary inflammatory index (DII) is associated with the risk of gastric cancer (GC) and investigated whether a TNF polymorphism (rs1799964) modifies this association. Semi-quantitative food frequency questionnaire derived data were used to calculate the DII scores. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic models adjusted for confounders. When we stratified the data by sex, the association between GC and the DII was significant only among the women (OR, 2.27; 95% CI 1.25-4.19), and the DII effect on the risk of GC differed depending on the TNF genotype (OR, 2.30; 95% CI 1.27-4.24 in TT genotype; OR, 0.78; 95% CI 0.37-1.65 in CC + CT, p for interaction = 0.035). Furthermore, the association between the DII and GC was significant in the Helicobacter pylori-positive group; similarly, the effect differed based on the TNF genotype (OR, 1.76; 95% CI 1.13-2.73 in TT genotype; OR,0.98; 95% CI 0.54-1.77 in CT + CC, p for interaction = 0.034). In conclusion, rs1799964 may modify the effect of the DII on GC.

Changes in Dietary Inflammatory Index Patterns with Weight Loss in Women: A Randomized Controlled Trial

Dietary composition can influence systemic inflammation; higher levels of circulating inflammatory biomarkers are associated with increased risk of breast and other cancers. A total of 438 overweight/obese, healthy, postmenopausal women were randomized to a caloric-restriction diet (goal: 10% weight-loss), aerobic-exercise (225 min/week moderate-to-vigorous activity), combined diet+exercise, or control. Dietary inflammatory index (DII) and energy-adjusted (E-DII) scores were derived from food frequency questionnaires (FFQ) and could be calculated for 365 participants with complete FFQs at baseline and 12 months. Changes from baseline to 12 months in E-DII scores in the intervention arms versus controls were analyzed using generalized estimating equations, adjusted for confounders. We examined associations between changes in previously measured biomarkers and E-DII at 12 months. Participants randomized to diet and diet+exercise arms had greater reductions in E-DII (-104.4% and -84.4%), versus controls (-34.8%, both P < 0.001). Weight change had a more marked effect than E-DII change on biomarkers at 12-months; associations between E-DII and biomarker changes were reduced after adjustment by weight change. Changes in E-DII at 12 months, adjusted for weight change, were negatively associated with changes in ghrelin [r = -0.19; P = 0.05 (diet), r = -0.29; P = 0.02 (diet+exercise)], and positively with VEGF [r = 0.22; P = 0.03 (diet+exercise)], and red blood cell counts [r = 0.30; P = 0.004 (exercise)]. C-reactive protein (CRP) and IL6 levels were not associated with E-DII changes at 12 months. In conclusion, a behavior change of low-calorie, low-fat diet significantly reduces dietary inflammatory potential, modulating biomarkers that are associated with tumorigenesis, such as VEGF, but not CRP or IL6. PREVENTION RELEVANCE: Diets high in saturated fats and low in fruit and vegetable intake are associated with increased inflammation, which increases cancer risk. This study showed that changes in diet quality had effects on factors associated with cancer; however, the majority of beneficial effects were associated with weight loss rather than diet quality.

Long-term anti-inflammatory diet in relation to improved breast cancer prognosis: a prospective cohort study

Inflammation-modulating nutrients and inflammatory markers are established cancer risk factors, however, evidence regarding the association between post-diagnosis diet-associated inflammation and breast cancer survival is relatively sparse. We aimed to examine the association between post-diagnosis dietary inflammatory index (DII®) and risks of all-cause and breast cancer-specific mortality. A total of 1064 female breast cancer survivors in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) Trial prospective cohort, were included in this analysis if they had completed the diet history questionnaire (DHQ). Energy-adjusted DII (E-DIITM) scores were calculated based on food and supplement intake. Cox regression and competing risk models were used to estimate multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (95% CIs) by E-DII tertile (T) for all-cause and breast cancer-specific mortality. With median follow-up of 14.6 years, there were 296 (27.8%) deaths from all causes and 100 (9.4%) breast cancer-specific death. The E-DII was associated with all-cause mortality (HR T3 vs T1, 1.34; 95% CI, 1.01-1.81; P trend, 0.049, Table 2) and breast cancer mortality (HR T3 vs T1, 1.47; 95% CI, 0.89-2.43; P trend, 0.13; multivariable-adjusted HR for 1-unit increment: 1.10; 95% CI: 1.00-1.22). Non-linear positive dose-response associations with mortality from all causes were identified for E-DII scores (P non-linearity < 0.05). The post-diagnosis E-DII was statistically significantly associated with mortality risk among breast cancer survivors. Long-term anti-inflammatory diet might be a means of improving survival of breast cancer survivors.

Examining Regional Differences of Dietary Inflammatory Index and Its Association with Depression and Depressive Symptoms in Korean Adults

The relationship between the dietary inflammatory index (DII^®) and depression and depressive symptoms in South Korean adults remains unclear. This study aimed to examine the overall relationship between the DII and depression in South Korea and to evaluate the association between the DII and depressive symptoms and depression across regions among Korean adults aged ≥19 years. A total of 15,929 study participants were selected from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014–2017. Energy-adjusted (E-DII) scores were calculated using 24-h dietary recall data. Depression and depressive symptoms were measured on the basis of the Korean version of the Patient Health Questionnaire 9-item scale, a doctor’s diagnosis of depression, and self-reported depressive symptom-related questionnaire. Overall, 4.2% of the participants had depression, with notable gender differences (i.e., 2.4% in men and 6.2% in women). Korean adults residing in the Capital area, Chungcheong-do and Jeju-do, and with diets in the highest tertile of the E-DII (most pro-inflammatory diet) had significantly increased odds of having depression and depressive symptoms compared with those in the lowest tertile of the E-DII (most anti-inflammatory diet) after controlling for covariates (adjusted odds ratio (AOR): 1.44, 95% confidence interval (CI): 1.04–1.99; AOR 2.97, 95% CI 1.36–6.52; AOR 4.06, 95% CI 1.56–10.53, respectively). No association between the E-DII and depression/depressive symptoms was found in other regions of South Korea. A pro-inflammatory diet is associated with greater odds of depression and depressive symptoms, with distinct regional differences. The present study provides evidence regarding existing regional differences in the association of the E-DII with depression and depressive symptoms.

Dietary inflammatory index and cardiovascular risk and mortality: A meta-analysis of cohort studies

BACKGROUND

The role of dietary inflammatory index (DII) in cardiovascular disease (CVD) risk and mortality is still controversial. This systematic review and meta-analysis of cohort studies aimed to evaluate the effect of DII, indicating a pro-inflammatory diet, on the incidence and mortality of CVD.

METHODS

A comprehensive literature search of articles published through August 2019 was performed in Medline, EMBASE, and Web of Science. The pooled relative risks (RRs) and 95% confidence intervals (CIs) for highest vs lowest DII in relation to CVD risk or mortality were estimated using a DerSimonian and Laird random effects model. The heterogeneity among studies was tested using Cochran's Q test and I statistic.

RESULTS

A total of 15 cohort studies were finally included in this meta-analysis. The highest DII score was significantly associated with a higher risk of CVD incidence (RR = 1.41, 95% CI 1.12-1.78) or mortality (RR = 1.31, 95% CI 1.19-1.44), compared with the lowest DII score. There was statistically significant heterogeneity among the studies on the association between DII and CVD mortality (P < .001; I = 70.8%). No obvious heterogeneity was observed among the studies on the association between DII and CVD risk (P = .160; I = 37.0%). In the sensitivity analysis, exclusion of any single study did not materially alter the pooled RRs.

CONCLUSION

The present systematic review and meta-analysis indicates that a higher DII score is related to a higher risk of CVD. Further well-designed prospective cohort or trials are warranted to validate our preliminary findings.

Is there a relationship between the dietary inflammatory index and metabolic syndrome among adolescents?

Background Dietary patterns have a crucial role in modulating chronic inflammation. This study aimed to determine the relationship between the Dietary Inflammatory Index (DII) and inflammation markers and metabolic syndrome components in adolescents (n = 343). Methods Fasting glucose, fasting insulin and lipid profile were analyzed and blood pressures were measured. Analysis of inflammation markers such as sedimentation, leukocyte, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) was also performed. The DII scores were calculated based on the adolescent's 3-day food consumption records. Results The dietary inflammatory score varied between 1.04 and 5.11 (3.6 ± 0.82). There was no significant difference in leukocyte and CRP levels between quartiles (p > 0.05). Those in the fourth quartile were observed to have higher levels of TNF-α and IL-6 compared to the others (p < 0.05). In the multiple regression analysis, a positive correlation existed only between IL-6 and DII, independent of other inflammatory markers (β = 0.272; p < 0.05). The DII was associated with glucose intolerance (odds ratio [OR] for DII quartile 4 compared to 1 = 3.5, 95% confidence interval [CI] = 1.2-10.4) and dyslipidemia (OR for DII quartile 4 compared to 1 = 5.3, 95% CI = 1.7-16.8). Conclusions These data suggest that a higher DII score was significantly associated with an increased risk of metabolic syndrome and some metabolic syndrome components in adolescents. Hence, DII can be used to determine the inflammatory potential of a diet and a healthy diet with anti-inflammatory properties that may be conducive to the prevention of metabolic disorders.

Proinflammatory Dietary Intake is Associated with Increased Risk of Metabolic Syndrome and Its Components: Results from the Population-Based Prospective Study

Metabolic syndrome (MetS) is a major public health challenge throughout the world, although studies on its association with the inflammatory potential of diet are inconsistent. The aim of this prospective study was to assess the association between the Dietary Inflammatory Index (DII^®) and the risk of MetS and its components in a Korean population. Data from 157,812 Korean adults (mean age 52.8 years; 53,304 men and 104,508 women with mean follow-up of 7.4 years) collected by members of the Korean Genome and Epidemiology Study form the basis for this report. DII scores were calculated based on Semi-Quantitative Food-Frequency Questionnaire data. Multivariable-adjusted Cox proportional hazard models were used to estimate the association between DII scores and MetS. In women, higher DII scores (pro-inflammatory diet) increased the risk of MetS (hazard ratio [HR]_{quintile5 v. 1} 1.43; 95% confidence interval (CI) 1.21–1.69; p for trend ≤ 0.0001) and its five components. A positive association was observed for postmenopausal women, with a 50% higher risk of developing MetS (HR_{quintile5 v. 1} 1.50; 95% CI 1.23–1.83; p for trend = 0.0008) after fully adjusting for potential confounders. Irrespective of the menopausal status of women, higher DII (=Q5) scores were positively associated with all 5 components of MetS (p < 0.05). In men, higher DII scores significantly increased the risk of low HDL cholesterol [HR]_{quintile5 v. 1} 1.59 (1.27–1.99); p for trend = 0.0001], elevated waist circumferences [HR]_{quintile5 v. 1} 1.28 (1.08–1.52); p for trend = 0.01], and high blood pressure [HR]_{quintile5 v. 1} 1.17 (1.03–1.32); p for trend = 0.05]. These results indicate that diet with pro-inflammatory potential, as represented by higher DII scores, is prospectively associated with increased risk of MetS, and the relationship is stronger in women than in men.

Association Between Change in Inflammatory Aspects of Diet and Change in IBD-related Inflammation and Symptoms Over 1 Year: The Manitoba Living With IBD Study

BACKGROUND

We aimed to investigate (1) the stability of inflammatory aspects of diet over 1 year among persons with inflammatory bowel disease (IBD) and (2) the impact of change in diet on changes in inflammation and IBD symptoms over 1 year.

METHODS

Participants were recruited to the Manitoba Living with IBD Study and completed the Harvard Food Frequency Questionnaire (FFQ). The Dietary Inflammatory Index (DII) and the Empirical Dietary Inflammatory Index (EDII) were used to calculate the inflammatory potential of the diet. Inflammation was measured by fecal calprotectin (≥250 µg/g). Symptoms were measured by the IBD Symptom Inventory (IBDSI). All measures were obtained at baseline and 1 year. Dietary Inflammatory Index and Empirical Dietary Inflammatory Index scores >0 and <0 reflect pro- and anti-inflammatory diet, respectively. Variance components analyses were used to describe diet stability. Associations between changes in diet and changes in active inflammation and symptoms were assessed using ordinal logistic regression and multilevel linear regression modeling.

RESULTS

One hundred thirty-five participants (66% CD) were included. Approximately one third of the variance in EDII (36%) and DII (33%) scores was explained by changes in diet over time. Each unit increase in the change in EDII (baseline to follow-up) was associated with a greater odds of FCAL, indicating active inflammation (>250 µg/g; odds ratio, 3.1; 95% confidence interval [CI], 1.02-9.93; P = 0.04) and with a rise in IBDSI of 6.7 (95% CI, 1.0-12.4; P = 0.022; theoretical IBDSI range, 0-81). There was no association between changes in DII and changes in FCAL or IBDSI.

CONCLUSION

The EDII, but not the DII, may have utility to identify the inflammatory potential of diet. This inflammatory potential can contribute to inflammation and/or disease symptoms in persons with IBD.

Intergenerational associations of dietary inflammatory index with birth outcomes and weight status at age 5 and 9: Results from the Lifeways cross-generation cohort study

BACKGROUND

Maternal diet and chronic inflammation may influence early-life offspring health. No comparative data regarding intergenerational associations between dietary inflammation and offspring growth exist.

OBJECTIVE

To investigate potential associations between parental and grandparental dietary inflammatory index (DII®) scores with offspring birth outcomes and childhood adiposity.

METHODS

This analysis of the Lifeways Study includes 1082 mother-child pairs, 333 index-child's fathers and 707 grandparents. Energy-adjusted DII (E-DII) scores were derived from a validated FFQ for all adults. Birth outcomes were abstracted from hospital records. Childhood BMI was determined at age 5 and 9. Logistic regression and mediation analyses using the PROCESS macro for SPSS were performed.

RESULTS

Higher maternal E-DII scores, reflecting a more pro-inflammatory diet, were associated with increased risk of low birthweight (LBW), BW < 2500 g (OR:1.20, 95%CI:1.02-1.47, p = 0.03). Higher maternal grandmothers' (MGM) E-DII scores were associated with increased risk of macrosomia (OR:1.35, 95% CI:1.02-1.79, p = 0.03) and with increased risk of an overweight grandchild at age 9 (OR:1.47, 95% CI:1.26-1.72, p = 0.02). Results from the mediation analyses revealed a significant total effect between MGMs' E-DII scores and grandchild's BW. Higher father's and paternal grandmothers' (PGM) E-DII scores were associated with greater risk of childhood overweight/obesity at 5 years (OR:1.03, 95%CI:1.01-1.19, p = 0.04 and OR:1.07, 95%CI:1.05-1.09, p = 0.01, respectively). The association with the PGMs' E-DII persisted at age 9 (OR:1.13, 95%CI:1.01-1.90, p = 0.04).

CONCLUSIONS

Dietary inflammation is associated with adverse offspring birth outcomes and childhood adiposity. A more pro-inflammatory maternal line diet appears to influence early-life growth, whereas paternal line dietary inflammation appears to influence childhood obesity.

Dietary Inflammatory Index and Differentiated Thyroid Carcinoma Risk: A Population-Based Case-Control Study in New Caledonia

Despite research efforts, current knowledge of the etiology of thyroid carcinoma remains limited. To explore the potential role of diet-induced inflammation, we examined the association between differentiated thyroid cancer risk and the energy-adjusted Dietary Inflammatory Index (E-DII) in a population-based case-control study conducted in New Caledonia, a Pacific archipelago with one of the highest recorded thyroid cancer incidence rates in the world. The E-DII was computed from food frequency questionnaire information on usual dietary intake. Logistic regression analyses were performed on data from 324 histologically confirmed cases of papillary or follicular carcinoma, diagnosed from 1993 to 1999, and 402 controls. Positive associations between E-DII and thyroid cancer risk were observed (comparing extreme tertiles, odds ratio = 1.67, 95% confidence interval: 1.08, 2.58; P for trend = 0.002), with stronger associations found for larger carcinomas (P for trend = 0.0005). Stratified analyses showed an increased risk of thyroid cancer associated with the E-DII among Southern province residents (P for trend = 0.003), Melanesian women (P for trend = 0.02), obese participants (P for trend = 0.006), and ever-smokers (P for trend = 0.0005). Our results suggest that a proinflammatory diet-especially when concomitant with other inflammation-inducing conditions or habits (e.g., obesity, smoking)-is associated with increased risk of thyroid carcinoma.

Higher Dietary Inflammatory Index Scores are Associated with Increased Odds of Benign Breast Diseases in a Case-Control Study

Purpose

Dietary inflammatory index (DII) is a new tool for assessing the inflammatory potential of diet. Since there is no study that has investigated the association of DII and benign breast diseases (BBD), the aim of our study was to compare DII scores in patients with and without BBD.

Methods

One hundred and eleven (111) subjects with BBD and 104 healthy women attending the Iranian Center for Breast Cancer affiliated with the Academic Center for Education, Culture and Research were enrolled in a case–control study. Dietary data collected using a 168‑item validated food frequency questionnaire (FFQ). Energy-adjusted DII was calculated based on FFQ. Socio demographic data were collected by interview. In addition, physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Weight, height and waist circumference were also measured.

Results

After adjustment for multiple confounding variables, participants at the highest tertile of DII had increased OR for BBD (OR=1.7, 95% CI=0.75–3.95) (P-trend =0.04).

Conclusion

The increased chance of BBD was suggested with a higher consumption of diets with inflammatory potential. However, this result should be interpreted with caution as OR was not statistically significant. Interventional studies are warranted to elucidate the role of inflammatory diets in the development of BBD.

Proinflammatory Diet Increases Circulating Inflammatory Biomarkers and Falls Risk in Community-Dwelling Older Men

BACKGROUND

The relations between diet, chronic inflammation, and musculoskeletal health are unclear, especially among older men.

OBJECTIVE

This study aimed to determine associations of the Dietary Inflammatory Index (DII) with inflammatory biomarkers, musculoskeletal health, and falls risk in community-dwelling older men.

METHODS

The cross-sectional analysis included 794 community-dwelling men, mean age 81.1 ± 4.5 y, who participated in the 5-y follow-up of the Concord Health and Aging in Men Project. Of these, 616 were seen again 3 y later for the longitudinal analysis. Energy-adjusted DII (E-DII) was calculated from a validated diet history questionnaire. Bone mineral density (BMD) was measured using DXA. Twenty-four inflammatory biomarkers were analyzed. Incident falls over 3 y were determined through telephone interviews every 4 mo. Multiple regression, linear mixed effects models, negative binomial regression, and mediation analysis were utilized in this study.

RESULTS

A higher E-DII score (indicating a more proinflammatory diet) was associated with higher concentrations of IL-6 (β: 0.028 pg/mL; 95% CI: 0.003, 0.053), IL-7 (β: 0.020 pg/mL; 95% CI: 0.002, 0.037), and TNF-α (β: 0.027 pg/mL; 95% CI: 0.003, 0.051). A higher E-DII score was also associated with lower appendicular lean mass adjusted for BMI (ALMBMI) (β: -0.006 kg/m2; 95% CI: -0.010, -0.001). For every unit increase in E-DII (range: -4.91 to +3.66 units), incident falls rates increased by 13% (incidence rate ratio: 1.13; 95% CI: 1.05, 1.21) over 3 y. Mediation analysis showed that the association between E-DII and 3-y incident falls was influenced by the concentrations of IL-7 by 24%. There was no association between E-DII and BMD.

CONCLUSIONS

Consumption of a proinflammatory diet was associated with increased concentrations of IL-6, IL-7, and TNF-α; increased falls risk; and lower ALMBMI in community-dwelling older men. The association between incident falls and E-DII was partly mediated by concentrations of IL-7.

Impact of a 3-Month Anti-inflammatory Dietary Intervention Focusing on Watermelon on Body Habitus, Inflammation, and Metabolic Markers: A Pilot Study

An anti-inflammatory dietary intervention called the Inflammation Management Intervention (IMAGINE) was adapted to emphasize watermelon due to its anti-inflammatory properties. This pilot study (n = 23) tested the effect of a watermelon-enhanced IMAGINE intervention (n = 15) on body habitus and markers of inflammation and metabolism. This 3-month self-selection trial, consisting of weekly in-person classes and online education for 12 weeks, focused on incorporating watermelon into an already anti-inflammatory diet. Controls (n = 8) received basic health education via email and blogs. Measurements, including diet, anthropometrics, actigraphy, and a blood draw, were made at baseline and immediately postintervention. Linear regression analyses were conducted using intervention status as the main exposure. Post hoc analyses then ignored intervention assignment and grouped participants based on their change in their energy-adjusted Dietary Inflammatory Index (E-DIITM) score. There were no group-by-time interactions for any of the studied outcomes. However, some intervention participants' diets became more proinflammatory, and several control participants' diets became more anti-inflammatory. Those participants below the median of E-DII change (ie, more anti-inflammatory changes) showed reductions in body fat percent (-1.27% vs +0.90%, respectively, P = .01), body mass index (-0.66 vs +0.38 kg/m2, respectively, P = .06) and body weight (-0.99 vs +0.54 kg, respectively, P = .08) compared to those above the median of E-DII change. This study demonstrates that individuals who adopt a more anti-inflammatory diet containing watermelon will have improvements in body anthropometrics. Future studies should focus on increasing adherence and compliance to intervention prescriptions, exploring options to extend interventions to evaluate long-term changes, and further examining changes in inflammatory biomarkers. Clinical Trials Registration: NCT03158740.

A pro-inflammatory diet increases the likelihood of obesity and overweight in adolescent boys: a case-control study

BACKGROUND

Obesity and Overweight at an early age can contribute with many chronic diseases such as cancers, diabetes and cardiovascular diseases. Diet-related inflammation is one of the most important underlying mechanisms that may has a key role in obesity and overweight. This paper aimed to compare the dietary inflammatory index (DII^®) in normal weight and overweight adolescent boys.

METHODS

A total of 535 adolescent boys (214 cases were overweight and obese and 321 controls with normal weight) participated in this study from two schools in Tehran, Iran. The student's weight and body composition were measured using a Bio-Impedance Analyzer (BIA) scale. A validated semi-quantitative Food Frequency Questionnaire (FFQ) was used to assess dietary inflammatory index.

RESULTS

Results obtained from modeling DII^® as a continuous variable identified a positive association between DII^® and obesity (OR = 1.08, CI 1.01-1.16). After multivariable adjustment, subjects with DII^® > 0.02 had at 1.5 times higher odds of obesity and overweight compared to subjects with DII^® ≤ 0.02 (OR = 1.52; CI 1.04-2.22).

CONCLUSION

Our study indicated the importance of dietary-induced inflammation in the obesity and overweight during adolescence. Therefore, advising adolescent to consume diet with lower DII^® with more fruits and vegetables, rich sources of fiber, flavonoids, zinc, magnesium and selenium and avoiding the consumption of saturated fatty acids (SFA), trans-fatty acids, and cholesterol may support a healthy weight.

Association between dietary inflammatory index and components of metabolic syndrome

Introduction: Limited data are available on the association of Dietary Inflammatory Index (DII) with metabolic syndrome (MetS) and its components. The present study was conducted to investigate the association of DII with MetS and its components among Iranian adults.

Methods: A total of 404 subjects, aged 18 years or older, were included in the current cross-sectional study. We used a validated and reliable 147-item food frequency questionnaire (FFQ) to assess dietary intakes. Fasting blood sample was obtained to quantify glycemic indicators and lipid profile. MetS was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III).

Results: Mean age of study participants was 38.20 ± 9.55 years. No significant association was found between DII and odds of MetS (odds ratio [OR]: 0.92, 95% CI: 0.48-1.76). In terms of MetS components, a significant positive association was seen between DII scores and reduced levels of high-density lipoprotein cholesterol (HDL-C) (OR: 2.29, 95% CI: 1.32-3.97); such that after controlling for energy intake, demographic variables and BMI, participants in the highest category of DII had 2.71 times greater odds for having reduced levels of HDL-C (OR: 2.71, 95% CIs: 1.34, 5.47). There was no other significant association between other components of MetS and DII scores either before or after adjusting for confounding variables.

Conclusion: We observed no significant association between DII and odds of MetS. However, higher score of DII was associated with lower levels of HDL.

Dietary inflammatory index, risk and survival among women with endometrial cancer

PURPOSE

Chronic inflammation has been implicated in endometrial carcinogenesis yet the impact of potentially modifiable exposures that might affect inflammation, like diet, has been understudied. This study examined the association between the dietary inflammatory index (DII®), a literature-derived tool to assess the inflammatory potential of diet, and risk of developing, and survival after a diagnosis of endometrial cancer (EC).

METHODS

This study included data from 1,287 women with EC and 1,435 population controls who participated in the Australian National Endometrial Cancer Study. Energy-adjusted DII (E-DII) scores were calculated from pre-diagnostic dietary intake obtained using a semi-quantitative food frequency questionnaire. Logistic regression was used to assess the association between E-DII scores and risk of EC and proportional-hazards models were used for survival analyses.

RESULTS

Higher E-DII scores, reflecting a more pro-inflammatory diet, were not associated with risk of EC [adjusted odds ratio (OR) 0.98, 95% CI 0.77-1.24, p-trend = 0.7]. However, in stratified analyses, higher E-DII scores were associated with increased risk of EC among very obese (BMI 35 + kg/m²) women (OR 1.60, 95% CI 0.80-3.21, p-trend = 0.049, p-interaction = 0.045). After a median follow-up of 7.2 years there were 160 deaths, of which 110 (69%) were from EC. We found no association between E-DII score and survival.

CONCLUSION

Greater inflammatory potential of pre-diagnostic diet was not associated with EC risk or survival. Secondary stratified analysis suggested greater inflammatory potential may be associated with EC risk in very obese women.

Dietary inflammatory index and mortality: a cohort longitudinal study in a Mediterranean area

BACKGROUND

Higher Dietary Inflammatory Index (DII®) scores are associated with increased morbidity and mortality. However, little is known about the effects of DII on mortality in Mediterranean countries. Therefore, in the present study, we aimed to investigate the potential association between DII scores and overall, cancer and cardiovascular disease (CVD) mortality in people living in a Mediterranean area.

METHODS

DII scores were calculated using a validated food-frequency questionnaire. DII scores were then categorised into tertiles. Mortality was ascertained via death certificates. The association between DII scores with overall and cause-specific mortality was assessed via a multivariable Cox's regression analysis and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs).

RESULTS

The study included 1565 participants (mean age 65.5 years; females 44.7%). After a median follow-up of 12 years (2005-2017), 366 (23.4%) participants died. After adjusting for 17 potential confounders, people with higher DII scores had an increased risk of death compared to those in the lowest (most anti-inflammatory) tertile (HR = 1.38; 95% CI = 1.04-1.82 for the second tertile; HR = 1.38; 95% CI = 1.03-1.86 for the third tertile). Each 1 SD increase in DII score increased the risk of death by 13%. No association was found between DII scores and cancer or CVD death when considered separately.

CONCLUSIONS

Higher DII scores were associated with a significantly higher mortality risk, whereas the association with cause-specific mortality was less clear. These findings highlight the potential importance of diet in modulating inflammation and preventing death.

Development and Validation of Novel Dietary and Lifestyle Inflammation Scores

BACKGROUND

Chronically higher inflammation, which may partly result from diet and lifestyle, is implicated in risk for multiple chronic diseases. The dietary inflammatory index (DII) and empirical dietary inflammatory pattern (EDIP), developed to characterize dietary contributions to systemic inflammation, have several limitations. There are no scores to characterize contributions of lifestyle to inflammation.

OBJECTIVES

To reflect dietary/lifestyle contributions to inflammation, we developed novel, inflammation biomarker panel-weighted, dietary (DIS) and lifestyle (LIS) inflammation scores in a subset (n = 639) of the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) cohort.

METHODS

We selected a priori 19 food groups and 4 lifestyle characteristics to comprise the DIS and LIS, respectively. We calculated the components' weights based on their strengths of association with an inflammation biomarker score [comprising high-sensitivity C-reactive protein (hsCRP), IL-6, IL-8, and IL-10] using multivariable linear regression. The sums of the weighted components constitute the scores, such that higher scores reflect, on balance, more proinflammatory exposures. We calculated the DIS, LIS, DII, and EDIP with cross-sectional data from the remaining REGARDS cohort (  n = 14,210 with hsCRP measurements) and 2 other study populations with hsCRP and/or an 8-component inflammation biomarker panel, and investigated their associations with circulating inflammation biomarker concentrations using multivariable logistic regression.

RESULTS

In REGARDS, those in the highest relative to the lowest DIS, LIS, DII, and EDIP quintiles had statistically significant 1.66-, 4.29-, 1.56-, and 1.32-fold higher odds of a high hsCRP concentration (>3 mg/dL), respectively (all P-trend < 0.001). Those in the highest relative to the lowest joint DIS/LIS quintile had a statistically significant 7.26-fold higher odds of a high hsCRP concentration. Similar findings were noted in the other 2 validation populations.

CONCLUSION

Our results support that dietary and lifestyle exposures collectively contribute substantially to systemic inflammation, and support the use of our novel DIS and LIS.

Pancreatic cancer risk is modulated by inflammatory potential of diet and ABO genotype: a consortia-based evaluation and replication study

Diets with high inflammatory potential are suspected to increase risk for pancreatic cancer (PC). Using pooled analyses, we examined whether this association applies to populations from different geographic regions and population subgroups with varying risks for PC, including variation in ABO blood type. Data from six case-control studies (cases, n = 2414; controls, n = 4528) in the Pancreatic Cancer Case-Control Consortium (PanC4) were analyzed, followed by replication in five nested case-control studies (cases, n = 1268; controls, n = 4215) from the Pancreatic Cancer Cohort Consortium (PanScan). Two polymorphisms in the ABO locus (rs505922 and rs8176746) were used to infer participants' blood types. Dietary questionnaire-derived nutrient/food intake was used to compute energy-adjusted dietary inflammatory index (E-DII®) scores to assess inflammatory potential of diet. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable-adjusted logistic regression. Higher E-DII scores, reflecting greater inflammatory potential of diet, were associated with increased PC risk in PanC4 [ORQ5 versus Q1=2.20, 95% confidence interval (CI) = 1.85-2.61, Ptrend < 0.0001; ORcontinuous = 1.20, 95% CI = 1.17-1.24], and PanScan (ORQ5 versus Q1 = 1.23, 95% CI = 0.92-1.66, Ptrend = 0.008; ORcontinuous = 1.09, 95% CI = 1.02-1.15). As expected, genotype-derived non-O blood type was associated with increased PC risk in both the PanC4 and PanScan studies. Stratified analyses of associations between E-DII quintiles and PC by genotype-derived ABO blood type did not show interaction by blood type (Pinteraction = 0.10 in PanC4 and Pinteraction=0.13 in PanScan). The results show that consuming a pro-inflammatory diet and carrying non-O blood type are each individually, but not interactively, associated with increased PC risk.

Inflammatory Potential of Diet and the Risk of Prostate Cancer: A Casecontrol Study in the West of Iran

Background:

Prostate cancer is one of the most common cancer in worldwide and inflammatory reactions may be the major risk factors for it. Diet has a potential role in the running of inflammatory reactions. Dietary Inflammatory Index (DII) is a tool that can assess the inflammatory potential of a diet.

Objective:

Study of the effect of Dietary Inflammatory Index (DII) and body composition on the risk of prostate cancer was the aim of this research.

Methods:

We assessed the ability of Dietary Inflammatory Index (DII) to predict prostate cancer in a case-control study conducted in Kermanshah, Iran in 2016. The study included 50 cases with primary prostate cancer and 150 healthy controls. Anthropometric indices were measured by Bioelectric Impedance Analysis (BIA). The DII was computed based on the intake of 32 nutrients assessed using a 147-items food frequency questionnaire. The multivariate logistic regression was used to evaluate the odds ratio, with DII expressed as a dichotomous variable.

Results:

There were no statistically significant differences in body composition between case and control groups, but participants with DII > 0.80 had significant differences in BMI, LBM, SLM, MBF and TBW versus participant with DII ≤ 0.80. Also, men with higher DII scores were at increased risk of prostate cancer [OR: 1.77; 95% confidence interval 1.28-2.44] and categorical variable [OR DII>0.80 vs ≤ 0.80: 3.81; 95% confidence interval: 1.49-9.75].

Conclusion:

These findings suggest that a pro-inflammatory diet is a risk factor for prostate cancer and also can have the impact on body composition.

Adherence to the pro-inflammatory diet in relation to prevalence of irritable bowel syndrome

Objective

There is no prior study that examined the association between nutrient-based dietary inflammatory index (DII) and odds of Irritable Bowel Syndrome (IBS). We examined the association between DII score and odds of IBS and its severity among Iranian adults.

Methods

In this cross-sectional study, dietary intakes of 3363 Iranian adults were examined using a validated Dish-based 106-item Semi-quantitative Food Frequency Questionnaire (DS-FFQ). DII was calculated based on dietary intakes derived from DS-FFQ. IBS was assessed using a modified Persian version of Rome III questionnaire.

Results

After adjustment for potential confounders, we found that participants in the highest quintile of DII score had greater chance for IBS compared with those in the lowest quintile (OR: 1.36; 95% CI: 1.03–1.80). By gender, we found a significant association between DII score and IBS among women (OR: 1.41; 95% CI: 1.00–2.00). By BMI status, overweight or obese (BMI ≥ 25 kg/m²) individuals in top quintile of DII score had greater odds for IBS than those in the bottom quintile (OR: 1.64; 95% CI: 1.07–2.53). No significant association was observed between a pro-inflammatory diet and severity of IBS symptoms.

Conclusions

Consumption of a pro-inflammatory diet was associated with increased odds of IBS, in particular among women and those with BMI ≥ 25 kg/m².

A proinflammatory diet is associated with inflammatory gene expression among healthy, non-obese adults: Can social ties protect against the risks?

The Western diet, characterized by high intake of saturated fat, sugar, and salt, is associated with elevated inflammation and chronic disease risk. Few studies have investigated molecular mechanisms linking diet and inflammation; however, a small number of randomized controlled trials suggest that consuming an anti-inflammatory diet (i.e., a primarily plant-based diet rich in monounsaturated fat and lean protein) decreases proinflammatory gene expression. The current study investigated the association between everyday diet and proinflammatory gene expression, as well as the extent to which central adiposity and social involvement modulate risk. Participants were healthy middle-aged and older adults (N = 105) who completed a food frequency questionnaire and reported how many close social roles they have. Anthropometric measurements and blood samples also were collected; gene expression data were analyzed from LPS-stimulated peripheral blood mononuclear cells for interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α. The inflammatory potential of each participant's diet was calculated using the Dietary Inflammatory Index (DII®). Participants with higher DII® scores, indicating a more proinflammatory diet, had greater IL-6 (b = -0.02, SE = 0.008, p = .01), IL-1β (b = -0.01, SE = 0.006, p = .03), and TNF-α (b = -0.01, SE = 0.005, p = .04) gene expression if they had a smaller sagittal abdominal diameter (SAD); effects were not seen among those with higher SADs. Social involvement served a protective role, such that participants with smaller SADs had greater IL-6 (b = 0.01, SE = 0.004, p = .049) and IL-1β (b = 0.01, SE = 0.003, p = .045) gene expression only if they had less social involvement; there was no effect of diet on gene expression among those who reported greater social participation. Results are the first to demonstrate a link between self-reported diet and proinflammatory gene expression. Importantly, the effect of diet on gene expression depended upon both body fat composition and social participation, both of which have previously been linked directly with proinflammatory gene expression and inflammation.

Association between inflammatory potential of diet and odds of gestational diabetes mellitus among Iranian women

Background: The possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM) requires further investigation, especially in non-Western populations. We examined the association between dietary inflammatory index (DII) scores and GDM in a case-control study conducted in Iran. Methods: This study included 122 GDM cases and 266 controls hospitalized for acute non-neoplastic diseases. Cases were pregnant women aged 18-40 years, who visited major general hospitals in different regions of Tehran. Pregnant women were screened for gestational diabetes between the 24th and 28th week of gestation with a 50-g, 1-hour glucose challenge test (GCT). Cases were diagnosed positive for GDM. Controls were pregnant women who had normal GCT test. DII scores were computed from dietary intake assessed by a previously validated 147-item food frequency questionnaire. Logistic regression models adjusted age, gestational age, energy, exercise, BMI, smoking exposure, family history of diabetes, and history of multivitamin intake were used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Results: Subjects with higher DII scores (i.e. indicating a more proinflammatory diet) had a higher odd of GDM with the DII being used as both a continuous (OR = 1.20; 95% CI = 0.94-1.54) and as categorical (ORtertile 3vs1 = 2.10; 95% CI = 1.02-4.34, p-trend = .03). Conclusions: These results indicate that a proinflammatory diet, as evidenced by higher DII scores, is associated with increased odds of GDM among Iranian women.

Imaging inflammation and its resolution in health and disease: current status, clinical needs, challenges, and opportunities

Inflammation is a normal process in our body; acute inflammation acts to suppress infections and support wound healing. Chronic inflammation likely leads to a wide range of diseases, including cancer. Tools to locate and monitor inflammation are critical for developing effective interventions to arrest inflammation and promote its resolution. To identify current clinical needs, challenges, and opportunities in advancing imaging-based evaluations of inflammatory status in patients, the U.S. National Institutes of Health convened a workshop on imaging inflammation and its resolution in health and disease. Clinical speakers described their needs for image-based capabilities that could help determine the extent of inflammatory conditions in patients to guide treatment planning and undertake necessary interventions. The imaging speakers showcased the state-of-the-art in vivo imaging techniques for detecting inflammation in different disease areas. Many imaging capabilities developed for 1 organ or disease can be adapted for other diseases and organs, whereas some have promise for clinical utility within the next 5-10 yr. Several speakers demonstrated that multimodal imaging measurements integrated with serum-based measures could improve in robustness for clinical utility. All speakers agreed that multiple inflammatory measures should be acquired longitudinally to comprehend the dynamics of unresolved inflammation that leads to disease development. They also agreed that the best strategies for accelerating clinical translation of imaging inflammation capabilities are through integration between new imaging techniques and biofluid-based biomarkers of inflammation as well as already established imaging measurements.-Liu, C. H., Abrams, N. D., Carrick, D. M., Chander, P., Dwyer, J., Hamlet, M. R. J., Kindzelski, A. L., PrabhuDas, M., Tsai, S.-Y. A., Vedamony, M. M., Wang, C., Tandon, P. Imaging inflammation and its resolution in health and disease: current status, clinical needs, challenges, and opportunities.

Secular trends in Dietary Inflammatory Index among adults in the United States, 1999-2014

OBJECTIVE

The objective of this study was to evaluate secular trends in Dietary Inflammatory Index (DII) scores in the United States between 1999 and 2014.

METHODS

Data from adults over 19 years from the 1999 to 2014 National Health and Nutrition Examination Survey (N = 39,191) were used. DII scores, at each 2-year cycle, were evaluated from a 24-h recall, including 26 food parameters for DII calculation. Analyses were conducted in 2018.

RESULTS

For the entire sample, there was a quadratic trend (Ptrend < 0.001), with the DII scores peaking in 2003-2004, and then decreasing during the cycles from 2005 to 2014. Similar quadratic trends (Ptrend < 0.001) were observed by age, gender, race-ethnicity, and education.

CONCLUSION

Males, non-Hispanic Blacks, younger adults, and those with less education adults had the highest DII scores (i.e., indicating the greatest inflammatory potential). The overall DII scores of the US population showed a quadratic trend from 1999 to 2014. Continued monitoring of DII changes is needed to better understand changes in the inflammatory potential of diet of American adults, and how they relate to changes in the risk of chronic disease.

Dietary Inflammatory Index Scores Are Associated with Pressure Pain Hypersensitivity in Women with Fibromyalgia

Objective

Pain hypersensitivity has been described as one of the most disabling symptoms of fibromyalgia syndrome (FMS). Here we analyzed the relationship between an anti-inflammatory diet profile and the pressure pain thresholds (PPTs) of tender point sites and other fibromyalgia-related symptoms in patients with FMS.

Methods

This cross-sectional study included 95 women diagnosed with FMS and 98 menopause-status matched controls. The Dietary Inflammatory Index (DII) was calculated by conducting a 24-hour diet recall interview. The PPTs of tender point sites and self-reported global pain levels were evaluated by algometry and the visual analog scale, respectively. Disease severity, fatigue, sleep anxiety, and central sensitization were also evaluated.

Results

Linear regression analysis revealed that the PPTs of tender point sites including the occiput (β = 0.234, 95% confidence interval [CI] = 0.016–0.452, P = 0.036), trapezius (β = 0.299, 95% CI = 0.083–0.515, P = 0.007), zygapophyseal joint (β = 0.291, 95% CI = 0.022–0.559, P = 0.035), second rib (β = 0.204, 95% CI = 0.060–0.348, P = 0.006), gluteus (β = 0.591, 95% CI = 0.110–1.072, P = 0.017), greater trochanter (β = 0.379, 95% CI = 0.016–0.742, P = 0.041), and knee (β = 0.482, 95% CI = 0.117–0.850, P = 0.011) were associated with DII score after adjustments for the age, menopausal status, and global energy levels reported by the patients with FMS. No significant differences were found for the cases or controls between the DII score and the remaining clinical symptoms. Analyses of covariance showed that the PPTs of the aforementioned tender point sites were also significantly associated (P &lt; 0.05) with the DII score quartiles in patients with FMS, but no significant differences were found between these quartiles and the other clinical symptoms.

Conclusions

A pro-inflammatory diet was associated with pain hypersensitivity in patients with FMS.

Predictors of the dietary inflammatory index in children and associations with childhood weight status: A longitudinal analysis in the Lifeways Cross-Generation Cohort Study

BACKGROUND & AIMS

The family environment can influence offspring diet and weight status. Obesity is a pro-inflammatory state, which is associated with the dietary inflammatory index (DII®). Predictors of the DII in children (C-DII™) and its associations with childhood obesity are relatively unknown. We evaluated the intergenerational relationships between the energy-adjusted DII (E-DII) scores in adults, predictors of C-DII and associations with childhood weight status.

METHODS

The study comprises 551 children and index-child's mothers, fathers and grandparents in the Lifeways Cross-Generation Cohort Study. E-DII scores were generated at baseline for expectant mothers, fathers, and grandparents, and at 5-year follow-up for the mothers and children, using a validated food frequency questionnaire. Body mass index (BMI) and waist circumference were determined at age 5 and 9 years. Associations were assessed by logistic regression and mediation analysis.

RESULTS

Higher C-DII scores indicating a more pro-inflammatory diet among children, were associated with greater risk of childhood obesity at age 5 (OR:1.09; 95%CI:1.00-1.37; P = 0.02) and overweight/obese status at 5 and 9 years (OR:1.06; 95%CI:1.01-1.09; P = 0.01 and OR:1.12; 95%CI:1.07-1.18; P = 0.01, respectively). Maternal and paternal smoking during pregnancy (OR:1.98; 95%CI:1.19-3.03; P = 0.001 and OR:1.64; 95%CI:1.12-2.49; P = 0.006, respectively) increased likelihood of higher C-DII at age 5. Child BMI, TV watching and all meals given by the childcare provider were associated with a more pro-inflammatory diet (P < 0.05), whereas breastfeeding and family meals at home were associated with a more anti-inflammatory diet (P < 0.04). Higher maternal, but not paternal, E-DII scores during pregnancy (P < 0.001) and at 5-year follow-up (P = 0.008) were associated with more pro-inflammatory diet at age 5. Results from the mediation analysis suggest that maternal grandmothers E-DII scores may influence C-DII indirectly via the mothers E-DII scores.

CONCLUSIONS

A more pro-inflammatory dietary score was associated with childhood overweight and obesity. Parental, familial and personal factors independently influenced the C-DII score.

Association of Dietary Inflammatory Potential With Colorectal Cancer Risk in Men and Women

Importance

Inflammation is important in colorectal cancer development. Diet modulates inflammation and may thus be a crucial modifiable factor in colorectal cancer prevention.

Objective

To examine whether proinflammatory diets are associated with increased colorectal cancer risk by using an empirical dietary inflammatory pattern (EDIP) score based on a weighted sum of 18 food groups that characterizes dietary inflammatory potential based on circulating levels of inflammation biomarkers.

Design, Settings, and Participants

Cohort study of 46 804 men (Health Professionals Follow-up Study: 1986-2012) and 74 246 women (Nurses' Health Study: 1984-2012) followed for 26 years to examine associations between EDIP scores and colorectal cancer risk using Cox regression. We also examined associations in categories of alcohol intake and body weight. Data analysis began January 17, 2017, and was completed August 9, 2017.

Exposures

EDIP scores calculated from food frequency questionnaires administered every 4 years.

Main Outcomes and Measures

Incident colorectal cancer.

Results

We documented 2699 incident colorectal cancer cases over 2 571 831 person-years of follow-up. Compared with participants in the lowest EDIP quintile (Q) who had a colorectal cancer incidence rate (per 100 000 person-years) of 113 (men) and 80 (women), those in the highest Q had an incidence rate of 151 (men) and 92 (women), leading to an unadjusted rate difference of 38 and 12 more colorectal cancer cases, respectively, among those consuming highly proinflammatory diets. Comparing participants in the highest vs lowest EDIP Qs in multivariable-adjusted analyses, higher EDIP scores were associated with 44% (men: hazard ratio [HR], 1.44; 95% CI, 1.19-1.74; P < .001 for trend), 22% (women: HR, 1.22; 95% CI, 1.02-1.45; P = .007 for trend), and 32% (men and women: pooled HR, 1.32; 95% CI, 1.12-1.55; P < .001 for trend) higher risk of developing colorectal cancer. In both men and women, associations were observed in all anatomic subsites except for the rectum in women. In subgroups (P ≤ .02 for all interactions), associations differed by alcohol intake level, with stronger associations among men (Q5 vs Q1 HR, 1.62; 95% CI, 1.05-2.49; P = .002 for trend) and women (Q5 vs Q1 HR, 1.33; 95% CI, 0.97-1.81; P = .03 for trend) not consuming alcohol; and by body weight, with stronger associations among overweight/obese men (Q5 vs Q1 HR, 1.48; 95% CI, 1.12-1.94; P = .008 for trend) and lean women (Q5 vs Q1 HR, 1.31; 95% CI, 0.99-1.74; P = .01 for trend).

Conclusions and Relevance

Findings suggest that inflammation is a potential mechanism linking dietary patterns and colorectal cancer development. Interventions to reduce the adverse role of proinflammatory diets may be more effective among overweight/obese men and lean women or men and women who do not consume alcohol.

Dietary Inflammatory Index Score and Cardiovascular Disease Risk Markers in Women with Systemic Lupus Erythematosus

BACKGROUND

Patients with systemic lupus erythematosus (SLE), a chronic inflammatory autoimmune disease, have an increased risk of developing cardiovascular diseases. Environmental factors like diet and nutrition are known to play a key role in modulating inflammation and the prognosis of cardiovascular diseases.

OBJECTIVE

To investigate the relationship between Dietary Inflammatory Index score and cardiovascular disease risk markers in a population of women with SLE.

DESIGN

A cross-sectional study was conducted in women with SLE recruited from 2016 through 2017.

PARTICIPANTS/SETTINGS

Clinically stable women with SLE were enrolled from three public hospitals in the Andalusian region of Spain. Participants with chronic renal failure, active infections, recent trauma, pregnancy, and/or other autoimmune diseases were excluded.

MAIN OUTCOME MEASURES

A 24-hour diet recall was used to estimate Dietary Inflammatory Index score and physical activity was assessed through the International Physical Activity Questionnaires. Cardiovascular disease risk markers included blood lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels), high-sensitivity C-reactive protein levels, and homocysteine levels, along with diagnosis of obesity, diabetes mellitus, hypertension, dyslipidemia, and ankle-brachial index measurement.

STATISTICAL ANALYSIS

Comparisons of cardiovascular disease risk markers across Dietary Inflammatory Index score tertiles were analyzed through a one-way analysis of variance and linear regressions adjusting for age, physical activity level, and medical treatment.

RESULTS

A total of 105 women (aged 45.4±12.8 years) were included. Linear regression analysis revealed that Dietary Inflammatory Index score was significantly associated with total cholesterol levels (β=.26, 95% CI 1.66 to 14.28; P=0.014) after adjusting for age, physical activity, and the use of medical treatment. No significant associations were observed between Dietary Inflammatory Index score and the other cardiovascular markers considered.

CONCLUSIONS

Higher inflammatory potential of the diet was positively associated with higher total cholesterol levels in women with SLE. These findings suggest that the inflammatory potential of a person's diet may play a role in lipid profiles in this population. Future intervention studies are needed to build on these results and explore the effect of anti-inflammatory diets on health outcomes in individuals with SLE.

Prediagnostic Proinflammatory Dietary Potential Is Associated with All-Cause Mortality among African-American Women with High-Grade Serous Ovarian Carcinoma

BACKGROUND

Chronic inflammation is associated with ovarian carcinogenesis; yet, the impact of inflammatory-related exposures on outcomes has been understudied.

OBJECTIVE

Given the poor survival of women diagnosed with ovarian cancer, especially African-Americans, we examined whether diet-associated inflammation, a modifiable source of chronic systemic inflammation measured by the dietary inflammatory index (DII), was associated with all-cause mortality among African-American women with ovarian carcinoma.

METHODS

Data were available from 490 ovarian carcinoma patients enrolled in a population-based case-control study of African-American women with ovarian cancer, the African-American Cancer Epidemiology Study. Energy-adjusted DII (E-DII) scores were calculated based on prediagnostic dietary intake of foods alone or foods and supplements, which was self-reported using the 2005 Block Food Frequency Questionnaire. Cox proportional hazards regression was used to estimate risk of mortality overall and for the most common histotype, high-grade serous carcinoma. Additionally, we assessed interaction by age at diagnosis and smoking status.

RESULTS

Women included in this study had a median age of 57 y, and the majority of women were obese (58%), had late-stage disease (Stage III or IV, 66%), and had high-grade serous carcinoma (64%). Greater E-DII scores including supplements (indicating greater inflammatory potential) were associated with an increased risk of mortality among women with high-grade serous carcinoma (HR1-unit change: 1.08; 95% CI: 1.01, 1.17). Similar associations were observed for the E-DII excluding supplements, although not statistically significant (HR1-unit change: 1.07; 95% CI: 0.97, 1.17). There was an interaction by smoking status, where the positive association with mortality was present only among ever smokers (HRQuartile 4/Quartile 1: 2.36; 95% CI: 1.21, 4.60) but not among never smokers.

CONCLUSIONS

Greater inflammatory potential of prediagnostic diet may adversely impact prognosis among African-American women with high-grade serous carcinoma, and specifically among ever smokers.

Altered immune system in frailty: Genetics and diet may influence inflammation

Frailty is a complex geriatric syndrome associated with biological vulnerability to stressors and decreased physiological reserve. Its etiology and pathogenesis are not completely understood, although various causes and complex pathways have been proposed. Immune system alterations (immunosenescence and "InflammAging") have been suggested to contribute to frailty, but a precise causative role of such alterations remains to be determined. Genetic studies support the suggestion of immune system involvement in frailty: genetic variants in genes involved in immune system function have been associated with the syndrome. Interestingly, nutritional status, through its effects on cellular metabolism, may also influence the immune system, i.e. hormone and cytokine (mainly adipocytokine) levels, and immune cell populations and function, increasing inflammation and contributing to frailty. This review aims to discuss the role of immune system alterations in frailty, analyzing the role of genetic factors in frailty onset and the impact of diet on inflammation and, in turn, on frailty.