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

Diet Quality Mediates the Relationship Between Chronic Stress and Inflammation in Patients With Metabolic Syndrome

BACKGROUND

Chronic stress is associated with promotion of inflammation and development of metabolic syndrome, as well as deterioration of diet quality. Inflammation can be modified by changes in dietary intake.

OBJECTIVE

The aim of this study was to test the hypothesis that diet quality mediates the relationship of chronic stress with inflammation in patients with metabolic syndrome.

METHODS

Participants with metabolic syndrome (n = 73, 62 ± 12 years old, 71% female) completed questionnaires on chronic stress (Perceived Stress Scale-10) and diet quality (Healthy Eating Index-2020). The Perceived Stress Scale-10 was dichotomized. The Healthy Eating Index-2020 score was used as a continuous variable, and higher scores indicate better diet quality. Inflammation was assessed using plasma high-sensitivity C-reactive protein (log-transformed). We used PROCESS in SPSS to test the hypothesis.

RESULTS

Patients in the higher stress group had lower Healthy Eating Index-2020 scores (worse diet quality) than those in the lower stress group (57 ± 13 vs 64 ± 10, P = .01). Diet quality mediated the relationship between chronic stress and inflammation (indirect effect, 0.211; 95% bootstrap confidence interval, 0.006-0.496). Higher stress was associated with lower diet quality (effect, -7.152; 95% confidence interval, -13.168 to -1.137) that was associated with increased inflammation (effect, -0.030; 95% confidence interval, -0.052 to -0.007).

CONCLUSIONS

Our findings show the important role of diet quality in the relationship of chronic stress with inflammation in patients with metabolic syndrome. Healthcare providers should encourage patients with higher stress to improve diet quality, which can decrease inflammation.

Association between the dietary inflammatory index and gout in the National Health and Nutrition Examination Survey 2007-2018

Objective

The aim of our study was to investigate whether the Dietary Inflammatory Index (DII) correlated with gout in American adults.

Method

The study used data from the 2007-2018 National Health and Nutrition Examination Survey, with 27,710 adults participating. Initially, multivariable analysis was performed, with controls for covariates, to assess the link of DII and gout. Then, restricted cubic splines (RCS) were applied to model the nonlinear relationship of DII and gout. Furthermore, propensity score matching (PSM) as a further study of potential relationships was established. Eventually, subgroup analysis was performed.

Result

Participants within the highest DII quartile would be more susceptible to increased risk of gout in the univariate regression model (Q4 vs. Q1, OR = 1.31, CI: 1.05-1.63). Additionally, a positive correlation was detected between gout risk and DII after adjusting on drinking, smoking, gender, race, age, and BMI. Based on RCS analysis, we observed that the risk of gout raised sharply as DII values increased, then flattened, and increased sharply again when the DII was greater than approximately 2.5. After performing the PSM, it was observed that DII correlated in a positive way to the presence of gout on a fully adjusted multivariable model. Subgroup analysis revealed that the link of DII and gout showed no statistical significance in females, blacks, Mexicans, nor in the population that smoked.

Conclusion

Greater degrees of pro-inflammation correlate with a higher risk of gout and might be a predisposing factor for gout. Hence, tactics fostering an anti-inflammatory diet for preventing and improving gout in adults should be regarded.

Association of Higher Intake of Plant-Based Foods and Protein With Slower Kidney Function Decline in Women With HIV

BACKGROUND

We investigated whether there exists an association between dietary acid load and kidney function decline in women living with HIV (WLWH) receiving antiretroviral therapy (ART).

SETTING

One thousand six hundred eight WLWH receiving ART in the WIHS cohort with available diet data and a baseline estimated glomerular filtration rate (eGFR) ≥15 mL/minute/1.73 m2.

METHODS

A brief dietary instrument conducted from 2013 to 2016 under the Food Insecurity Sub-Study was used for assessing fruits and vegetables (FV) and protein intake. A mixed-effects model with random intercept and slope was used to estimate subjects' annual decline rate in eGFR and the association between FV intake and eGFR decline, adjusting for sociodemographics, serum albumin, comorbidities, time on ART, ART drugs, HIV markers, and baseline eGFR. We evaluated whether markers of inflammation mediated the effect of FV intake on decline in eGFR, using causal mediation analysis.

RESULTS

We found a dose-response relationship for the association of FV intake and eGFR decline, with lesser annual decline in eGFR in the middle and highest tertiles of FV intake. An increase of 5 servings of FV intake per day was associated with a lower annual eGFR decline (-1.18 [-1.43, -0.94]). On average, 39% of the association between higher FV intake and slower eGFR decline was explained by decreased levels of inflammation.

CONCLUSIONS

Plant-rich diet was associated with slower decline in kidney function. Inflammation is a potential path through which diet may affect kidney function. The findings support an emerging body of literature on the potential benefits of plant-rich diets for prevention of chronic kidney disease.

The Possible Effect of Dietary Fiber Intake on the Metabolic Patterns of Dyslipidemia Subjects: Cross-Sectional Research Using Nontargeted Metabolomics

BACKGROUND

Dyslipidemia is important because of its association with various metabolic complications. Numerous studies have sought to obtain scientific evidence for managing dyslipidemia patients.

OBJECTIVES

This study aims to identify differences in the nutritional traits of dyslipidemia subjects based on metabolite patterns.

METHODS

Dyslipidemia (n = 73) and control (n = 80) subjects were included. Dyslipidemia was defined as triglycerides ≥200 mg/dL, total cholesterol ≥240 mg/dL, low density lipoprotein cholesterol ≥160 mg/dL, high-density lipoprotein cholesterol <40 mg/dL (men) or 50 mg/dL (women), or lipid-lowering medicine use. Nontargeted metabolomics based on ultra-high performance liquid chromatography-mass spectrometry identified plasma metabolites, and K-means clustering was used to reconstitute groups based on the similarity of metabolomic patterns across all subjects. Then, with eXtreme Gradient Boosting, metabolites significantly contributing to the new grouping were selected. Statistical analysis was conducted to analyze traits demonstrating appreciable differences between the groups.

RESULTS

Dyslipidemia subjects were divided into 2 groups based on whether they were (n = 24) or were not (n = 56) in a similar metabolic state as the controls by K-means clustering. The considerable contribution of 4 metabolites (3-hydroxybutyrylcarnitine, 2-octenal, 1,3,5-heptatriene, and 5β-cholanic acid) to this new subset of dyslipidemia was confirmed by eXtreme Gradient Boosting. Furthermore, fiber intake was significantly higher in dyslipidemia subjects whose metabolic state was similar to that of the control than in the dissimilar group (P = 0.002). Moreover, significant correlations were observed between the 4 metabolites and fiber intake. Regression analysis determined that the ideal cutoff for fiber intake was 17.28 g/d.

CONCLUSIONS

Dyslipidemia patients who consume 17.28 g/d or more of dietary fiber may maintain similar metabolic patterns to healthy individuals, with substantial effects on the changes in the concentrations of 4 metabolites. Our findings could be applied to developing dietary guidelines for dyslipidemia patients.

The associations between dietary fibers intake and systemic immune and inflammatory biomarkers, a multi-cycle study of NHANES 2015-2020

Background

In recent years, there has been considerable growth in abnormal inflammatory reactions and immune system dysfunction, which are implicated in chronic inflammatory illnesses and a variety of other conditions. Dietary fibers have emerged as potential regulators of the human immune and inflammatory response. Therefore, this study aims to investigate the associations between dietary fibers intake and systemic immune and inflammatory biomarkers.

Methods

This cross-sectional study used data from the National Health and Nutrition Examination Survey (2015-2020). Dietary fibers intake was defined as the mean of two 24-h dietary recall interviews. The systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), red blood cell distribution width-to-albumin ratio (RA), ferritin, high-sensitivity C-reactive protein (hs-CRP), and white blood cell (WBC) count were measured to evaluate systemic immune and inflammatory states of the body. The statistical software packages R and EmpowerStats were used to examine the associations between dietary fibers intake and systemic immune and inflammatory biomarkers.

Results

Overall, 14,392 participants were included in this study. After adjusting for age, gender, race, family monthly poverty level index, alcohol consumption, smoking status, vigorous recreational activity, body mass index, hyperlipidemia, hypertension, diabetes, and dietary inflammatory index, dietary fibers intake was inversely associated with SII (β = -2.19885, 95% CI: -3.21476 to -1.18294, p = 0.000248), SIRI (β = -0.00642, 95% CI: -0.01021 to -0.00263, p = 0.001738), NLR (β = -0.00803, 95% CI: -0.01179 to -0.00427, p = 0.000284), RA (β = -0.00266, 95% CI: -0.00401 to -0.00131, p = 0.000644), ferritin (β = -0.73086, 95% CI: -1.31385 to -0.14787, p = 0.020716), hs-CRP (β = -0.04629, 95% CI: -0.0743 to -0.01829, p = 0.002119), WBC (β = -0.01624, 95% CI: -0.02685 to -0.00563, p = 0.004066), neutrophils (β = -0.01346, 95% CI: -0.01929 to -0.00764, p = 0.000064). An inverse association between dietary fibers and PLR was observed in the middle (β = -3.11979, 95% CI: -5.74119 to -0.4984, p = 0.028014) and the highest tertile (β = -4.48801, 95% CI: -7.92369 to -1.05234, p = 0.016881) and the trend test (βtrend = -2.2626, 95% CI: -3.9648 to -0.5604, Ptrend = 0.0150). The observed associations between dietary fibers intake and SII, SIRI, NLR, RA, ferritin, hs-CRP, WBC, and neutrophils remained robust and consistent in the sensitivity analysis. No significant interaction by race was found.

Conclusion

Dietary fibers intake is associated with the improvement of the parameters of the immune response and inflammatory biomarkers, supporting recommendations to increase dietary fibers intake for enhanced immune health.

Prospective network analysis of proinflammatory proteins, lipid markers, and depression components in midlife community women

BACKGROUND

Vulnerability theories propose that suboptimal levels of lipid markers and proinflammatory proteins predict future heightened depression. Scar models posit the reverse association. However, most studies that tested relationships between non-specific immune/endocrine markers and depression did not separate temporal inferences between people and within-person and how different immunometabolism markers related to unique depression symptoms. We thus used cross-lagged prospective network analyses (CLPN) to investigate this topic.

METHODS

Community midlife women (n = 2224) completed the Center for Epidemiologic Studies-Depression scale and provided biomarker samples across five time-points spanning 9 years. CLPN identified significant relations (edges) among components (nodes) of depression (depressed mood, somatic symptoms, interpersonal issues), lipid markers [insulin, fasting glucose, triglycerides, low-density lipoprotein-cholesterol (LDL), high-density lipoprotein-cholesterol (HDL)], and proinflammatory proteins [C-reactive protein (CRP), fibrinogen], within and across time-points. All models adjusted for age, estradiol, follicle-stimulating hormone, and menopausal status.

RESULTS

In within-person temporal networks, higher CRP and HDL predicted all three depression components (d = 0.131-2.112). Increased LDL preceded higher depressed mood and interpersonal issues (v. somatic symptoms) (d = 0.251-0.327). Elevated triglycerides predicted more somatic symptoms (v. depressed mood and interpersonal problems) (d = 0.131). More interpersonal problems forecasted elevated fibrinogen and LDL levels (d = 0.129-0.331), and stronger somatic symptoms preceded higher fibrinogen levels (d = 0.188).

CONCLUSIONS

Results supported both vulnerability and scar models. Long-term dysregulated immunometabolism systems, social disengagement, and related patterns are possible mechanistic accounts. Cognitive-behavioral therapies that optimize nutrition and physical activity may effectively target depression.

Oral health and 10-year cardiovascular risk in US adults: mediating role of inflammatory diet and vitamin D

OBJECTIVE

To investigate whether E-DII or vitamin D mediates the relationship between oral health and cardiovascular disease (CVD) risk.

METHODS

This study involved 6616 participants aged over 30 years old from the National Health and Nutrition Examination Survey (NHANES) in 2009-2014. Dietary inflammation and 10-year CVD risk were evaluated via the Energy-adjusted Dietary Inflammatory Index (E-DII) and the Framingham Risk Score (FRS), respectively. We used correlation analysis and mediation analysis to investigate the role of dietary inflammation and vitamin D in the relationship between oral health and CVD risk.

RESULTS

Oral health indicators and CVD risk were positively correlated with E-DII (r > 0, P < 0.001) and negatively correlated with vitamin D levels (r < 0, P < 0.001). The estimated mediating role of E-DII and vitamin D in the overall association between oral health and 10-year risk of CVD ranged from 4.9 to 7.5% and 6.6 to 11.6%, respectively. Furthermore, the mediation proportion of E-DII and vitamin D levels in the total association between oral health indicators and FRS were increased in participants without periodontitis.

CONCLUSION

Both E-DII and serum vitamin D were mediated the association between oral problems and 10-year CVD risk, especially in participants without periodontitis. Among them, E-DII played a positive mediating role, and serum vitamin D levels was a negative mediator.

CLINICAL RELEVANCE

Anti-inflammatory diet and prevention of vitamin D deficiency might reduce the impact of oral problems on cardiovascular disease risk to some extent. The study highlights the important role of oral health and dietary inflammation and vitamin D in primary prevention of cardiovascular disease.

Changes in Dietary Inflammatory Index Score over Time and Cancer Development in Rural Post-Menopausal Women

Inflammation plays a key role in cancer development. As an important modulator of inflammation, the role of diet should be explored. The purpose of this study was to determine the association between diets with a higher inflammatory potential, as measured by the Dietary Inflammatory Index (DII^®), and cancer development in a cohort of rural post-menopausal women. Dietary intake from a randomized controlled trial cohort of rural, post-menopausal women in Nebraska was used to compute energy-adjusted DII (E-DII^TM) scores at baseline and four years later (visit 9). A linear mixed model analysis and multivariate logistic regression evaluated the association between E-DII scores (baseline, visit 9, change score) and cancer status. Of 1977 eligible participants, those who developed cancer (n = 91, 4.6%) had a significantly larger, pro-inflammatory change in E-DII scores (Non-cancer: Δ 0.19 ± 1.43 vs. Cancer: Δ 0.55 ± 1.43, p = 0.02). After adjustment, odds of cancer development were over 20% higher in those with a larger change (more pro-inflammatory) in E-DII scores than those with smaller E-DII changes (OR = 1.21, 95% CI [1.02, 1.42], p = 0.02). Shifting to a more pro-inflammatory diet pattern over four years was associated with increased odds of cancer development, but not with E-DII at baseline or visit 9 alone.

The Relationship between the Dietary Inflammatory Index (DII) and Metabolic Syndrome (MetS) in Middle-Aged and Elderly Individuals in the United States

(1) Background: With the aging demographic shift in society, there is a growing number of middle-aged and elderly individuals affected by metabolic syndrome (MetS), a risk factor contributing to all causes of mortality. Inflammation plays a crucial role in the development of MetS. This study aims to examine the correlation between MetS and pro-inflammatory diets in middle-aged and elderly individuals, utilizing the Dietary Inflammation Index (DII) as a measure. (2) Methods: Data were extracted from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) database for individuals who were 45 years of age or older. The DII was determined for each participant through 24-h dietary recall interviews. The relationship between DII and MetS was assessed using binary logistic regression analysis, and the association between DII and MetS-related indicators was further explored through generalized linear model (GLM) and quantile regression analysis. (3) Results: A total of 3843 middle-aged and elderly individuals were included in the study. After controlling for confounding factors, the highest quartile of DII was associated with a higher risk of MetS (ORQ4:Q1 = 1.339; 95% CI: 1.013, 1.769; p for trend = 0.018). The top DII quartile also increased the risk of reduced HDL-C (ORQ4:Q1 = 1.499; 95% CI: 1.005, 2.234; p for trend = 0.048) and raised FG (ORQ4:Q1 = 1.432; 95% CI: 1.095, 1.873; p for trend = 0.010) compared to the lowest DII quartile. The levels of DII were found to be positively correlated with BMI (β = 0.258, p = 0.001), FPG (β = 0.019, p = 0.049), TG (β = 2.043, p = 0.013), waistline (β = 0.580, p = 0.002), and negatively correlated with HDL-C (β = -0.672, p = 0.003). (4) Conclusions: In middle-aged and elderly individuals in the United States, a high DII score has been linked to the presence of MetS, low HDL-C, and hyperglycemia. Therefore, dietary recommendations for the middle-aged and elderly should focus on reducing the DII by choosing foods rich in antioxidants, dietary fiber, and unsaturated fatty acids.

Mediation of 10-Year Cardiovascular Disease Risk between Inflammatory Diet and Handgrip Strength: Base on NHANES 2011-2014

OBJECTIVE

Dietary inflammatory index (DII) and handgrip strength (HGS) were correlated, and both were associated with cardiovascular disease (CVD). However, the role of the 10-year CVD risk in the relationship between DII and grip strength remains uncertain.

METHODS

This study involved 5691 adults from the National Health and Nutrition Examination Survey (NHANES) in 2011-2014. Dietary inflammation, 10-year CVD risk and relative grip strength were assessed by the Dietary Inflammation Index, the Framingham Risk Score (FRS) and handgrip strength adjusted BMI. Linear regression analyses and mediation analysis were used to explore these associations.

RESULTS

Both DII and 10-year CVD risk were negatively associated with relative handgrip strength, and DII was positively associated with 10-year CVD risk. Additionally, 10-year CVD risk partially mediated the association between DII and relative handgrip strength by a 11.8% proportion. Specifically, the mediating effect of the 10-year risk of CVD varied by gender and age.

CONCLUSIONS

Reducing the 10-year risk of CVD attenuates the effect of an inflammatory diet on relative grip strength impairment. Therefore, we recommend reducing the effect of inflammatory diet on grip strength impairment by controlling any of the FRS parameters, such as lowering blood pressure and smoking cessation, especially with targeted measures for different populations.

Chronic Sub-Clinical Systemic Metabolic Acidosis - A Review with Implications for Clinical Practice

When arterial serum pH remains near the lower pH limit of 7.35 for protracted periods of time, a low-grade, sub-clinical form of acidosis results, referred to in this review as chronic, sub-clinical, systemic metabolic acidosis (CSSMA). This narrative review explores the scientific basis for CSSMA, its consequences for health, and potential therapeutic interventions. The major etiology of CSSMA is the shift away from the ancestral, alkaline diet which was rich in fruit and vegetables, toward the contemporary, acidogenic 'Westernized' diet characterized by higher animal protein consumption and lack of base forming minerals. Urine pH is reduced with high dietary acid load and may be a convenient marker of CSSMA. Evidence suggests further that CSSMA negatively influences cortisol levels potentially contributing significantly to the pathophysiology thereof. Both CSSMA and high dietary acid load are associated with the risk and prognosis of various chronic diseases. Clinical trials show that CSSMA can be addressed successfully through alkalizing the diet by increasing fruit and vegetable intake and/or supplementing with alkaline minerals. This review confirms the existence of a significant body of evidence regarding this low-grade form of acidosis as well as evidence to support its diverse negative implications for health, and concludes that CSSMA is a condition warranting further research.

Proinflammatory Diets and Risk of ESKD in US Adults with CKD

Background

Inflammation may affect long-term kidney function. Diet may play a role in chronic inflammation. We hypothesized that proinflammatory diets increase the risk of progression to kidney failure with replacement therapy (KFRT), and systemic inflammation is a mediator of the effect of diet on progression to KFRT.

Methods

In the 1988-1994 National Health and Nutrition Examination Survey linked to the national ESKD registry, in adults with CKD (eGFR 15-59 ml/min per 1.73 m²), aged ≥20 years, we calculated the Adapted Dietary Inflammatory Index (ADII) at baseline from a 24-hour dietary recall and an inflammation score (IS) using average of z scores of four inflammation biomarkers. We explored the association of the ADII and IS with risk of incident KFRT using Cox proportional model, adjusting for sociodemographics, physical activity, Framingham risk score, eGFR, and urinary ACR. We evaluated whether, and to what extent, IS mediated the effect of the ADII on KFRT incidence, using causal mediation analysis.

Results

Of 1084 adults with CKD, 109 (10%) developed KFRT. The ADII was associated with increased risk of KFRT (relative hazard [RH] per SD increase (2.56): 1.4 [1.04-1.78]). IS was also associated with KFRT (RH: 1.12; 95% CI, 1.02 to 1.25). Approximately 36% of the association between the ADII and KFRT was explained by IS.

Conclusions

Among adults with CKD, a proinflammatory diet was associated with risk of KFRT, and that association was partially explained by an increase in inflammatory markers. Dietary interventions that reduce inflammation may offer an approach for preventing KFRT.

Effect of oat supplementation interventions on cardiovascular disease risk markers: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Oat supplementation interventions (OSIs) may have a beneficial effect on cardiovascular disease (CVD) risk. However, dietary background can modulate such effect. This systematic review assesses the effects of OSIs on CVD risk markers among adults, accounting for different dietary backgrounds or control arms.

METHODS

We included randomized clinical trials (RCTs) that assessed the effect of oat, oat beta-glucan-rich extracts or avenanthramides on CVD risk markers.

RESULTS

Seventy-four RCTs, including 4937 predominantly hypercholesterolemic, obese subjects, with mild metabolic disturbances, were included in the systematic review. Of these, 59 RCTs contributed to the meta-analyses. Subjects receiving an OSI, compared to control arms without oats, had improved levels of total cholesterol (TC) [weighted mean difference and (95% CI) - 0.42 mmol/L, (- 0.61; - 0.22)], LDL cholesterol [- 0.29 mmol/L, (- 0.37; - 0.20)], glucose [- 0.25 nmol/L, (- 0.36; - 0.14)], body mass index [- 0.13 kg/m2, (- 0.26; - 0.01)], weight [- 0.94 kg, (- 1.84: - 0.05)], and waist circumference [- 1.06 cm, (- 1.85; - 0.27)]. RCTs on inflammation and/or oxidative stress markers were scarce and with inconsistent findings. RCTs comparing an OSI to heterogeneous interventions (e.g., wheat, eggs, rice, etc.), showed lowered levels of glycated haemoglobin, diastolic blood pressure, HDL cholesterol and apolipoprotein B. The majority of included RCTs (81.1%) had some concerns for risk of bias.

CONCLUSION

Dietary OSIs resulted in lowered levels of blood lipids and improvements in anthropometric parameters among participants with predominantly mild metabolic disturbances, regardless of dietary background or control. Further high-quality trials are warranted to establish the role of OSIs on blood pressure, glucose homeostasis and inflammation markers.

DNA methylation signature of chronic low-grade inflammation and its role in cardio-respiratory diseases

We performed a multi-ethnic Epigenome Wide Association study on 22,774 individuals to describe the DNA methylation signature of chronic low-grade inflammation as measured by C-Reactive protein (CRP). We find 1,511 independent differentially methylated loci associated with CRP. These CpG sites show correlation structures across chromosomes, and are primarily situated in euchromatin, depleted in CpG islands. These genomic loci are predominantly situated in transcription factor binding sites and genomic enhancer regions. Mendelian randomization analysis suggests altered CpG methylation is a consequence of increased blood CRP levels. Mediation analysis reveals obesity and smoking as important underlying driving factors for changed CpG methylation. Finally, we find that an activated CpG signature significantly increases the risk for cardiometabolic diseases and COPD.

Association of Dietary and Lifestyle Inflammation Score With Cardiorespiratory Fitness

Objective

We aimed to assess the potential association of dietary (DIS) and lifestyle inflammation score (LIS) and their joint association (DLIS) with cardiorespiratory fitness (CRF) in Tehranian adults.

Design

The present study was designed cross-sectional.

Participants

A total of 265 males and females aged 18–70 years (mean ± SD: 36.9 ± 13.3) were entered in the present cross-sectional study. Eligible participants were healthy men and women who were free of medications and had no acute or chronic infection or inflammatory disease.

Measures

The DIS was calculated by the use of data from 18 anti- and pro-inflammatory dietary components, and the LIS by three non-dietary components including physical activity, smoking status, and general adiposity, with higher scores indicating a more pro-inflammatory diet and lifestyle, respectively. The DLIS was calculated by summing the DIS and LIS. CRF was assessed by the Bruce protocol and VO₂ max was measuredas the main variable of CRF. The odds ratio (OR) and 95% confidence interval (CI) of CRF across tertiles of the DIS, LIS, and DLIS were estimated by logistic regression analysis with considering age, gender, energy intake, marital and education status, and occupation as confounders.

Results

The DLIS ranged from −2.10 to 0.38 (mean ± SD: −1.25 ± 0.64). In the model that controlled for all variables, the ORs of CRF for the second and third tertiles of the DLIS as compared to the first tertile were 0.42 (95%CI: 0.20, 0.90) and 0.12 (95%CI: 0.05, 0.32), respectively (P-trend < 0.001). There was a strong inverse association between the LIS and CRF (OR_{thirdvs.firsttertile}: 0.12, 95%CI: 0.05, 0.32). There was no association between DIS and CRF.

Conclusion

The present study examined the joint association of inflammation-related lifestyle behaviors with CRF and found a strong inverse association between a pro-inflammatory lifestyle with CRF. We did not find any association between dietary inflammatory properties with CRF. Future studies should address the relationship between the inflammatory potential of the diet and CRF.

Genesis and Mechanism of Some Cancer Types and an Overview on the Role of Diet and Nutrition in Cancer Prevention

Cancer is a major disease with a high mortality rate worldwide. In many countries, cancer is considered to be the second most common cause of death after cardiovascular disease. The clinical management of cancer continues to be a challenge as conventional treatments, such as chemotherapy and radiation therapy, have limitations due to their toxicity profiles. Unhealthy lifestyle and poor dietary habits are the key risk factors for cancer; having a healthy diet and lifestyle may minimize the risk. Epidemiological studies have shown that a high fruit and vegetable intake in our regular diet can effectively reduce the risk of developing certain types of cancers due to the high contents of antioxidants and phytochemicals. In vitro and in vivo studies have shown that phytochemicals exert significant anticancer effects due to their free radical scavenging capacity potential. There has been extensive research on the protective effects of phytochemicals in different types of cancers. This review attempts to give an overview of the etiology of different types of cancers and assesses the role of phytonutrients in the prevention of cancers, which makes the present review distinct from the others available.

Food as medicine? Exploring the impact of providing healthy foods on adherence and clinical and economic outcomes

Background

Methods

Results

Conclusion

The Role of Dietary Inflammatory Index on the Association Between Sleep Quality and Long-Term Cardiovascular Risk: A Mediation Analysis Based on NHANES (2005-2008)

OBJECTIVE

People with poor sleep quality have higher risk of cardiovascular disease (CVD), and one potential mechanism of CVD is chronic inflammation. The aim of this study was to investigate the role of dietary inflammation in the relationship between sleep quality and CVD risk.

METHODS

This study involved 5594 participants from the National Health and Nutrition Examination Survey (NHANES) in 2005-2008. Sleep quality, dietary inflammation, and 10-year CVD risk were evaluated via the Pittsburgh Sleep Quality Index (PSQI), the Energy-adjusted Dietary Inflammatory Index (E-DII), and the Framingham Risk Score (FRS), respectively. We used generalized additive model (GAM) and mediation analysis to investigate the relationship among sleep quality, 10-year CVD risk, and E-DII.

RESULTS

PSQI had a non-linear relationship with 10-year CVD risk (P < 0.001). Meanwhile, among the participants with poor sleep quality, PSQI was positively associated with increased 10-year CVD risk (P < 0.001) and E-DII (P < 0.001). Furthermore, the association between sleep quality and CVD risk was partially mediated by E-DII, and the mediated proportion was 14.6%, and the mediating effect of E-DII varied in different gender and age groups. However, in the subjects with good sleep quality, the association among PSQI, E-DII, and 10-year CVD risk was not existed.

CONCLUSION

Ten-year CVD risk could be reduced by controlling the intake of inflammatory food, especially for whom with sleep disorders. In general, the reduction of inflammatory diet could weaken the effect of sleep disorders on the CVD risk.

Dietary Inflammatory Index and the Risk of Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents

Background: Dietary Inflammatory Index (DII) scores have been consistently associated with several chronic diseases. This study explored the correlation between the DII and hyperuricemia in Chinese adult residents. Methods: The study included 7880 participants from the China Health and Nutrition Survey (CHNS), which was taken in in 2009. A 3-day 24 h meal review method was used to collect diet data and to calculate the DII score. Serum uric acid was obtained to determine hyperuricemia levels. Subjects were divided into a hyperuricemia group and a non-hyperuricemia group, according to their serum uric acid level. Multilevel logistic regression models were used to examine the association between DII scores and hyperuricemia. Results: After adjusting for covariates, a higher DII score was determined to be associated with a higher risk of hyperuricemia. Compared to those in the highest DII score group, the lower DII score group had an inverse association with hyperuricemia risk (Q2: 0.83, 95% CI: 0.70–0.99; Q3: 0.72, 95% CI: 0.60–0.86; Q4: 0.73, 95% CI: 0.61–0.88). The intake of energy-adjusted protein, total fat, MUFAs, PUFAs and saturated fatty acid was higher in the hyperuricemia group. Conclusions: A higher DII score is significantly associated with a higher risk of hyperuricemia. Controlling the intake of pro-inflammatory food may be beneficial to reduce the risk of hyperuricemia.

Dietary Inflammatory Index and Risk of Asthenozoospermia: A Hospital-Based Case-Controlled Study in China

Background: Evidence of associations between a pro-inflammatory diet and asthenozoospermia risk is limited. We therefore performed a case-controlled study to investigate associations between pro-inflammatory diet using dietary inflammatory index (DII) scores and asthenozoospermia risk in China.

Methods: Our hospital-based case-controlled study comprised 549 incident asthenozoospermia men and 581 healthy controls. All were interviewed at the infertility clinic in Shengjing Hospital of China Medical University from June 2020 to December 2020. DII scores were calculated based on dietary intake which were assessed using a validated food frequency questionnaire. Semen parameters were analyzed according to World Health Organization guidelines. An unconditional logistic regression model was used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for asthenozoospermia risk. The lowest tertile served as the reference category for regression analyses.

Results: After adjustment for age in the primary multivariable model, we failed to determine a significant negative association between DII and asthenozoospermia risk (for the highest tertile of DII scores compared to the lowest tertile) (OR = 0.77, 95% CI: 0.57–1.03). Similarly, non-significant associations were also identified in the multivariable model after adjusting for more potential confounders (OR = 0.86; 95% CI: 0.58–1.27). Additionally, in subgroup analyses stratified by age, body mass index, and smoking status, non-significant results were consistent with the main findings.

Conclusions: To our knowledge, this is the first study exploring this particular topic. Our research does not support an association between DII scores and asthenozoospermia risk. Further prospective studies with more DII relevant foods and nutrients are warranted to confirm our findings.

Inflammation, hippocampal volume, and cognition in schizophrenia: results from the Northern Finland Birth Cohort 1966

Increased blood interleukin-6 (IL-6) levels are a replicated abnormality in schizophrenia, and may be associated with smaller hippocampal volumes and greater cognitive impairment. These findings have not been investigated in a population-based birth cohort. The general population Northern Finland Birth Cohort 1966 was followed until age 43. Subjects with schizophrenia were identified through the national Finnish Care Register. Blood IL-6 levels were measured in n = 82 subjects with schizophrenia and n = 5373 controls at age 31. Additionally, 31 patients with schizophrenia and 63 healthy controls underwent brain structural MRI at age 34, and cognitive testing at ages 34 and 43. Patients with schizophrenia had significantly higher median (interquartile range) blood IL-6 levels than controls (5.31, 0.85-17.20, versus 2.42, 0.54-9.36, p = 0.02) after controlling for potential confounding factors. In both schizophrenia and controls, higher blood IL-6 levels were predictors of smaller hippocampal volumes, but not cognitive performance at age 34. We found evidence for increased IL-6 levels in patients with midlife schizophrenia from a population-based birth cohort, and replicated associations between IL-6 levels and hippocampal volumes. Our results complement and extend the previous findings, providing additional evidence that IL-6 may play a role in the pathophysiology of schizophrenia and associated brain alterations.

Association between dietary inflammatory index and inflammatory biomarkers with outcomes of in vitro fertilization treatment

AIM

To investigate associations between dietary inflammatory index (DII), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) with outcomes of in vitro fertilization treatment.

METHODS

This observational prospective study included 144 women undergoing fresh in vitro fertilization cycles who attended infertility center of Al-Zahra Hospital in Tabriz, Iran. DII was computed based on dietary intake assessed using a 3-day 24-h food record diary. Outcomes of in vitro fertilization in this study were considered fertilization rate, embryo quality and positive pregnancy test. Inflammatory biomarkers were measured on the day of embryo transfer.

RESULTS

There was no statistically significant difference between pregnant and nonpregnant women in terms of infertility and demographic characteristics, quantity of retrieved and fertilized oocytes, fertilization rate and number of transferred embryos (P > 0.05). The mean quality scores of resultant embryos (P < 0.001) and transferred embryos (P = 0.019) were significantly lower in the group of pregnant women, indicating the better quality among them. Median (percentile 25-75th) DII in the pregnant women was 1.8 (0.5-2.7) and in the nonpregnant women was 1.6 (0.3-2.6). DII was significantly related to hs-CRP (r = 0.198, P = 0.017) but not to IL-6. There were no significant relationships between DII, serum hs-CRP, IL-6 and in vitro fertilization outcomes (P > 0.05).

CONCLUSION

These findings demonstrate that serum hs-CRP and IL-6 concentration and DII are not predictive markers of in vitro fertilization cycle outcomes in women undergoing in vitro fertilization.

Analysis of the intricate effects of polyunsaturated fatty acids and polyphenols on inflammatory pathways in health and disease

Prevention and treatment of non-communicable diseases (NCDs), including cardiovascular disease, diabetes, obesity, cancer, Alzheimer's and Parkinson's disease, arthritis, non-alcoholic fatty liver disease and various infectious diseases; lately most notably COVID-19 have been in the front line of research worldwide. Although targeting different organs, these pathologies have common biochemical impairments - redox disparity and, prominently, dysregulation of the inflammatory pathways. Research data have shown that diet components like polyphenols, poly-unsaturated fatty acids (PUFAs), fibres as well as lifestyle (fasting, physical exercise) are important factors influencing signalling pathways with a significant potential to improve metabolic homeostasis and immune cells' functions. In the present manuscript we have reviewed scientific data from recent publications regarding the beneficial cellular and molecular effects induced by dietary plant products, mainly polyphenolic compounds and PUFAs, and summarize the clinical outcomes expected from these types of interventions, in a search for effective long-term approaches to improve the immune system response.

Dietary Inflammatory Index is associated with Healthy Eating Index, Alternative Healthy Eating Index, and dietary patterns among Iranian adults

Background

Recent investigations have evaluated the effect of the inflammatory potential of diet in several populations by calculating the Dietary Inflammatory Index (DII) score. We aimed to evaluate the association of the DII with the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), and dietary pattern (DP) among healthy Iranian adults.

Methods

A cross‐sectional study was conducted among 4365 middle‐aged adults. Major DPs and DII score were identified using a validated semi‐quantitative food frequency questionnaire (FFQ). Poisson regression was used to evaluate the association of DPs, HEI, and AHEI across tertiles of DII.

Results

After adjustment for confounding variables, a low HEI (HEI < 55) and AHEI (AHEI < 56.5) were more prevalent among the participants in the highest tertile of DII compared to the first tertile (PR: 1.13, P‐value <.05; PR: 1.10, P‐value <.05; respectively). Adherence to a balanced healthy dietary pattern was significantly lower in subjects with a diet that was more pro‐inflammatory compared to those with anti‐inflammatory diet (PR: 0.85, P‐value P < .01). No significant association was found between the DII and a western DP. High levels of HDL and hip and waist circumference were observed in the highest tertile of DII, and high levels of dietary intake of protein and fiber, minerals, fasting blood glucose, and monounsaturated fat were reported in the lowest tertile of DII.

Conclusion

The highest tertile of the DII (a pro‐inflammatory diet) was associated with a lower HEI, AHEI, and lower adherence to balanced DP in a representative sample of adults in Iran.

Chronic Inflammation in the Context of Everyday Life: Dietary Changes as Mitigating Factors

The lifestyle adopted by most people in Western societies has an important impact on the propensity to metabolic disorders (e.g., diabetes, cancer, cardiovascular disease, neurodegenerative diseases). This is often accompanied by chronic low-grade inflammation, driven by the activation of various molecular pathways such as STAT3 (signal transducer and activator of transcription 3), IKK (IκB kinase), MMP9 (matrix metallopeptidase 9), MAPK (mitogen-activated protein kinases), COX2 (cyclooxigenase 2), and NF-Kβ (nuclear factor kappa-light-chain-enhancer of activated B cells). Multiple intervention studies have demonstrated that lifestyle changes can lead to reduced inflammation and improved health. This can be linked to the concept of real-life risk simulation, since humans are continuously exposed to dietary factors in small doses and complex combinations (e.g., polyphenols, fibers, polyunsaturated fatty acids, etc.). Inflammation biomarkers improve in patients who consume a certain amount of fiber per day; some even losing weight. Fasting in combination with calorie restriction modulates molecular mechanisms such as m-TOR, FOXO, NRF2, AMPK, and sirtuins, ultimately leads to significantly reduced inflammatory marker levels, as well as improved metabolic markers. Moving toward healthier dietary habits at the individual level and in publicly-funded institutions, such as schools or hospitals, could help improving public health, reducing healthcare costs and improving community resilience to epidemics (such as COVID-19), which predominantly affects individuals with metabolic diseases.

Potential Markers of Dietary Glycemic Exposures for Sustained Dietary Interventions in Populations without Diabetes

There is considerable interest in dietary and other approaches to maintaining blood glucose concentrations within the normal range and minimizing exposure to postprandial hyperglycemic excursions. The accepted marker to evaluate the sustained maintenance of normal blood glucose concentrations is glycated hemoglobin A1c (HbA1c). However, although this is used in clinical practice to monitor glycemic control in patients with diabetes, it has a number of drawbacks as a marker of efficacy of dietary interventions that might beneficially affect glycemic control in people without diabetes. Other markers that reflect shorter-term glycemic exposures have been studied and proposed, but consensus on the use and relevance of these markers is lacking. We have carried out a systematic search for studies that have tested the responsiveness of 6 possible alternatives to HbA1c as markers of sustained variation in glycemic exposures and thus their potential applicability for use in dietary intervention trials in subjects without diabetes: 1,5-anhydroglucitol (1,5-AG), dicarbonyl stress, fructosamine, glycated albumin (GA), advanced glycated end products (AGEs), and metabolomic profiles. The results suggest that GA may be the most promising for this purpose, but values may be confounded by effects of fat mass. 1,5-AG and fructosamine are probably not sensitive enough to the range of variation in glycemic exposures observed in healthy individuals. Use of measures based on dicarbonyls, AGEs, or metabolomic profiles would require further research into possible specific molecular species of interest. At present, none of the markers considered here is sufficiently validated and sensitive for routine use in substantiating the effects of sustained variation in dietary glycemic exposures in people without diabetes.

The Effect of Isolated and Synthetic Dietary Fibers on Markers of Metabolic Diseases in Human Intervention Studies: A Systematic Review

Observational studies provide strong evidence for the health benefits of dietary fiber (DF) intake; however, human intervention studies that supplement isolated and synthetic DFs have shown inconsistent results. Therefore, we conducted a systematic review to summarize the effects of DF supplementation on immunometabolic disease markers in intervention studies in healthy adults, and considered the role of DF dose, DF physicochemical properties, intervention duration, and the placebo used. Five databases were searched for studies published from 1990 to 2018 that assessed the effect of DF on immunometabolic markers. Eligible studies were those that supplemented isolated or synthetic DFs for ≥2 wk and reported baseline data to assess the effect of the placebo. In total, 77 publications were included. DF supplementation reduced total cholesterol (TC), LDL cholesterol, HOMA-IR, and insulin AUC in 36-49% of interventions. In contrast, <20% of the interventions reduced C-reactive protein (CRP), IL-6, glucose, glucose AUC, insulin, HDL cholesterol, and triglycerides. A higher proportion of interventions showed an effect if they used higher DF doses for CRP, TC, and LDL cholesterol (40-63%), viscous and mixed plant cell wall DFs for TC and LDL cholesterol (>50%), and longer intervention durations for CRP and glucose (50%). Half of the placebo-controlled studies used digestible carbohydrates as the placebo, which confounded findings for IL-6, glucose AUC, and insulin AUC. In conclusion, interventions with isolated and synthetic DFs resulted mainly in improved cholesterol concentrations and an attenuation of insulin resistance, whereas markers of dysglycemia and inflammation were largely unaffected. Although more research is needed to make reliable recommendations, a more targeted supplementation of DF with specific physicochemical properties at higher doses and for longer durations shows promise in enhancing several of its health effects.

Inflammatory properties of diet mediate the effect of depressive symptoms on Framingham risk score in men and women: Results from the National Health and Nutrition Examination Survey (2007-2014)

Depression is common in patients with cardiovascular disease (CVD) and associated with inflammation. Inflammation contributes to the development of CVD and can be modulated by diet. However, the role of inflammatory properties of diet in the relationship between depressive symptoms and CVD risk is not well understood. We hypothesized that the inflammatory properties of diet mediate the relationship between depressive symptoms and CVD risk in men and women. Cross-sectional data collected by the National Health and Nutrition Examination Survey (2007-2014) were used for the study. Depressive symptoms scores, inflammatory properties of diet, and CVD risk were measured by the Patient Health Questionnaire-9 (PHQ-9), the Dietary Inflammatory Index (DII), and the Framingham risk score (FRS), respectively. Generalized linear models were used for the mediation analysis. There were significant differences in the proportions of men and women in the depressed group (PHQ-9 ≥ 10; 5.24 ± 0.65% vs 9.36 ± 0.87%, P < .001) and high CVD risk group (FRS >20%; 16.47 ± 0.79% vs 6.03 ± 0.32%, P < .001). The DII partially mediated the relationship between depressive symptoms and CVD risk in men (indirect effect: 0.06, P = .010) but fully mediated the relationship between depressive symptoms and CVD risk in women (indirect effect: 0.10, P < .001). These findings confirmed our hypothesis that inflammatory properties of diet at least partially mediate the relationship between depressive symptoms and CVD risk in men and women. Our findings suggest that interventions designed to reduce depressive symptoms should contain strategies to reduce pro-inflammatory and increase anti-inflammatory properties of diet to decrease CVD risk.

Dietary inflammatory index and the aging kidney in older women: a 10-year prospective cohort study

PURPOSE

Chronic inflammation plays a role in the pathogenesis of age-related renal disease and the diet can moderate systemic inflammation. The primary objective of this study was to examine the associations between a dietary inflammatory index (DII^®) score and renal function, the trajectory of renal function decline, and renal disease-related hospitalizations and/or mortality over 10 years.

METHODS

The study was conducted in 1422 Western Australian women without prevalent chronic kidney disease and aged ≥ 70 years. Baseline dietary data, obtained from a validated food frequency questionnaire, were used to calculate a DII score for each individual.

RESULTS

In this cohort, the mean [range] DII score was 0.19 [- 6.14 to 6.39]. A higher DII score was associated with poorer renal function at baseline and a greater renal function decline over 10 years; after multivariable adjustments, a one-unit higher DII score was associated with a 0.55 mL/min/1.73 m² lower eGFR at baseline (p = 0.01) and a 0.06 mL/min/1.73 m² greater annual decline in eGFR over 10 years (p = 0.05). Restricted cubic splines provide evidence of a non-linear association between baseline DII score and risk of a renal disease-related event. Compared to participants in the lowest quintile, those in the highest quintile of DII score were at a higher risk of experiencing a renal disease-related event (adjusted HR 2.06, 95% CI 0.97, 4.37).

CONCLUSION

Recommending an increased consumption of foods with a higher anti-inflammatory potential could form part of a multifaceted approach to reduce the risk of renal disease through diet and lifestyle changes.

Diet and Chronic Kidney Disease

Kidney disease affects almost 15% of the US population, and prevalence is anticipated to grow as the population ages and the obesity epidemic continues due to Western dietary practices. The densely caloric Western diet, characterized by high animal protein and low fruit and vegetable content, has fueled the growth of chronic diseases, including chronic kidney disease. The glomerulus or filtering unit of the kidney is very susceptible to barotrauma, and diets high in animal protein impede the glomerulus' ability to protect itself from hemodynamic injury. High animal protein intake combined with low intake of fruits and vegetables also leads to a high net endogenous acid production requiring augmentation of ammonium excretion in order to prevent acidosis. This higher workload of the kidney to maintain a normal serum bicarbonate level may further exacerbate kidney disease progression. This article reviews the potential mechanisms whereby several key characteristics of the typical Western diet may impact kidney disease incidence and progression. Reducing animal protein intake and egg yolk and increasing intake of fruits and vegetables and fiber may prevent or delay end-stage renal disease, but few clinical trials have examined vegetarian diets for management of chronic kidney disease. More research is needed to determine optimal dietary patterns for the prevention of kidney disease and its progression.

Development of a food-based index of dietary inflammatory potential for Koreans and its relationship with metabolic syndrome

BACKGROUND/OBJECTIVES

Inflammation is known to be a risk factor for metabolic diseases. This study aimed to develop a Food-based Index of Dietary Inflammatory Potential (FBDI) and examine its association with metabolic biomarkers.

SUBJECTS/METHODS

This study analyzed the raw data from the 2012-2014 Korean Genome and Epidemiology Study data of 17,771 people. To analyze the relationship between foods consumed by Koreans and inflammation, we conducted a correlation analysis between 51 food groups and hs-CRP levels. The FBDI was developed from 17 food groups selected by multiple regression method. We examined whether FBDI was associated with metabolic markers (waist circumference, blood pressure, fasting glucose, triglyceride, and HDL-cholesterol) in the 6th Korea National Health and Nutrition Examination Survey (KNHANES). We used binary logistic regression analysis to examine the association.

RESULTS

The FBDI model included seven of the anti-inflammatory food groups and three of the pro-inflammatory food groups. The FBDI formula was calculated by multiplying the intake of food group by β-coefficients derived from the multiple regression model based on the correlation analysis. The FBDI was significantly associated with waist circumference (P < 0.001), blood pressure (P < 0.001), triglyceride level (P < 0.001), and HDL-cholesterol (P < 0.001) level among adults aged 20-64 years in the KNHANES. The prevalence of metabolic syndrome was 2.618 times higher in the group with the highest FBDI than in the group with the lowest one (95% confidence interval: 1.778-3.856, P for trend < 0.001).

CONCLUSIONS

This study established an FBDI reflecting food intake patterns of Koreans, which showed a significant relationship with the prevalence of metabolic syndrome.

Decreased serum total cholesterol is associated with a history of childhood physical violence in depressed outpatients

Associations between adverse childhood experiences (ACEs) and cholesterol in depressed patients are unclear. Therefore, we compared 78 adult outpatients with major depressive disorder (MDD) with (n = 24) or without (n = 54) experiences of physical violence in childhood. Background data were collected with questionnaires, and total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured from fasting blood samples. Patients with a history of childhood physical violence had lower levels of TC than the control group. No differences were observed in HDL-C, LDL-C, or low-grade inflammation levels between the two groups. In multivariate models, decreased levels of TC were associated with childhood physical violence, and these associations remained significant after adjustments for age, gender, lifestyle, metabolic condition, socioeconomic situation, psychiatric status, suicidality, low-grade inflammation, the chronicity of depression, medications used and somatic diseases. At the 8-month follow-up, the results were essentially the same when the Trauma and Distress Scale (TADS) was used as the measure of ACEs. The specific mechanisms underlying cholesterol alterations associated with ACEs are a topic for future studies. Better understanding of these mechanisms might lead to possible new interventions in the prevention of adverse health effects resulting from ACEs.

Dietary inflammatory index and acute myocardial infarction in a large Italian case-control study

Background

Diet and inflammation have been implicated to play a role in the incidence of acute myocardial infarction (AMI).

Methods

In this Italian case-control study conducted between 1995 and 2003, we explored the association between the dietary inflammatory index (DIITM) and AMI. Cases were 760 patients, below age 79 years, with a first episode of nonfatal AMI and controls were 682 patients admitted to hospital for acute conditions unrelated to diet. The DII was computed based on dietary intake assessed using a reproducible and validated 78-item food frequency questionnaire. Odds ratios (OR) were estimated through logistic regression models adjusting for age, sex, total energy intake, tobacco, body mass index, hypertension, hyperlipidemia and other recognized confounding factors.

Results

Higher DII scores (i.e., indicating a more pro-inflammatory diet) were associated with increased likelihood of AMI when expressed both as continuous (ORcontinuous=1.14, 95% confidence interval, CI:1.05, 1.24; one-unit increase in DII score corresponding to ≈9% of the range of DII) and as quartiles (ORQuartile4vs1= 1.60, 95%, CI 1.06, 2.41; P-trend = 0.02). Stratified analyses produced slightly stronger associations between DII and AMI among women, ≥60 years, never smokers, subjects with history of hypertension and subjects with no family history of AMI, however, in the absence of heterogeneity across strata.

Conclusion

A pro-inflammatory diet as indicated by higher DII scores is associated with increased likelihood of AMI.

Associations between Dietary Inflammatory Index Scores and Inflammatory Biomarkers among Older Adults in the Lothian Birth Cohort 1936 Study

OBJECTIVES

Chronic low-grade inflammation is a key underlying mechanism in several age-related chronic conditions and previous studies have shown that diet can modulate the inflammatory process. We investigated the ability of the Dietary Inflammatory Index (DII®), a summary measure of dietary inflammatory potential, to predict concentrations of plasma inflammatory markers in a sample of older people.

DESIGN

Cross-sectional and 3-year follow-up analysis of Lothian Birth Cohort 1936 (LBC1936) study data.

SETTING

Baseline data collection occurred between 2004 and 2007 in Edinburgh, Scotland.

PARTICIPANTS

Men and women (n 928, age ~70 at baseline) living in Edinburgh and surrounding regions who are surviving participants of the Scottish Mental Survey of 1947.

MEASUREMENTS

Energy-adjusted DII (E-DII) scores at age 70 (derived from a food-frequency questionnaire), plasma concentrations of inflammatory biomarkers at age 70 (C-reactive protein (CRP), fibrinogen) and age 73 (CRP, fibrinogen, hs-CRP, Interleukin-6 (IL-6)). Analyses were performed using multivariable logistic regression adjusting for age, sex, smoking, body mass index, physical activity, and hypercholesterolaemia.

RESULTS

Higher E-DII scores (pro-inflammatory diet) were associated with increased odds of elevated CRP (>3mg/L) at age 70 (OR 1.12; 95% CI: 1.02, 1.24, P = 0.02), and elevated IL-6 (>1.6pg/ml) at age 73 (OR 1.11; 95% CI: 1.00, 1.23, P = 0.04), but not with fibrinogen.

CONCLUSION

These results are consistent with the ability of the DII to predict inflammatory biomarker concentrations and suggest that diet plays a role in the regulation of inflammation, even after controlling for potential confounders. This validation study provides support for using the DII in research among older populations.

Association of Dietary Inflammatory Index with anthropometric indices in children and adolescents: the weight disorder survey of the Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN)-IV study

This study aimed to assess the relationship between the Dietary Inflammatory Index (DII®), a validated tool for evaluating diet-associated inflammation, and anthropometric indices in children and adolescents. This multicentre survey was conducted on 5427 school students selected via multistage cluster sampling from thirty provinces of Iran. This survey was conducted under the framework of the weight disorders survey, which is part of a national surveillance programme entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases-IV. For calculating the DII scores, twenty-five dietary factors were obtained from a validated 168-item FFQ. Height, weight, wrist circumference, neck circumference (NC), waist circumference (WC) and hip circumference (HC) were measured. BMI z-score, waist circumference:hip circumference ratio (WHR), waist circumference:height ratio (WHtR) and parental BMI were computed. Linear regression models were used to evaluate the association of DII and anthropometric indices. Significant trends were observed across quartiles of DII score for all anthropometric indices in all participants (P &lt;0·05), except for WHR and WHtR. After adjustment for potential confounders, the multiple linear regression analysis for each anthropometric index revealed that participants in the highest DII quartile had higher BMI z-score, WC, HC and parental BMI compared with those in the first (or lowest) quartile. In summary, we found that a pro-inflammatory diet was associated with higher BMI z-score, wrist circumference, NC, WC, HC and parental BMI. The large sample size of the present study may influence the statistical significance of observed associations. Hence, the findings should be clinically interpreted with caution.

Impact of Diet-Modulated Butyrate Production on Intestinal Barrier Function and Inflammation

A major challenge in affluent societies is the increase in disorders related to gut and metabolic health. Chronic over nutrition by unhealthy foods high in energy, fat, and sugar, and low in dietary fibre is a key environmental factor responsible for this development, which may cause local and systemic inflammation. A low intake of dietary fibre is a limiting factor for maintaining a viable and diverse microbiota and production of short-chain fatty acids in the gut. A suppressed production of butyrate is crucial, as this short-chain fatty acid (SCFA) can play a key role not only in colonic health and function but also at the systemic level. At both sites, the mode of action is through mediation of signalling pathways involving nuclear NF-κB and inhibition of histone deacetylase. The intake and composition of dietary fibre modulate production of butyrate in the large intestine. While butyrate production is easily adjustable it is more variable how it influences gut barrier function and inflammatory markers in the gut and periphery. The effect of butyrate seems generally to be more consistent and positive on inflammatory markers related to the gut than on inflammatory markers in the peripheral tissue. This discrepancy may be explained by differences in butyrate concentrations in the gut compared with the much lower concentration at more remote sites.

Diet Quality and High-Sensitivity C-Reactive Protein in Patients With Systemic Lupus Erythematosus

Background and Aims:

C-reactive protein (CRP) is commonly used as a biomarker for inflammation. Mild elevations of CRP have been seen in chronic autoimmune diseases like systemic lupus erythematosus (SLE), and CRP has been linked to an increased risk of cardiovascular events. Diet quality and certain dietary factors seem to influence CRP levels in healthy subjects. To date, the effect of diet on serum CRP in SLE has not been studied. Our aim was to investigate the relationship between dietary nutrients, antioxidant intake, and serum CRP in SLE.

Design and Method:

A cross-sectional study was conducted among 91 patients with SLE. High-sensitivity hsCRP values were determined using an immuno-turbidimetry assay in a Beckman Coulter analyzer (AU5800). Dietary intake of macro- and micronutrients was assessed through a 24-hr diet recall. Antioxidant nutrient intake was evaluated using the dietary antioxidant quality score (DAQs). Linear regression models were used to investigate the relationships between serum hsCRP levels, dietary nutrient intake, and DAQs.

Results:

The mean serum hsCRP level observed (3.76 ± 6.68 mg/L) was above the established normal range. However, participating SLE patients had low-quality diets, and we found no significant correlations between dietary intake of macro- or micronutrients or antioxidant nutrient intake (DAQs) and serum CRP levels.

Conclusion:

Our study reveals that participating SLE patients had a low-quality diet that did not influence inflammatory status measured using serum CRP levels. Further interventional studies with high-quality diets in this population are necessary to dissect the role of diet on CRP levels in SLE.

Meta-analysis of the association between the inflammatory potential of diet and urologic cancer risk

BACKGROUND

The inflammatory potential of diet has been shown to have an association with the risk of several cancer types, but the evidence is inconsistent regarding the related risk of urologic cancer (UC). Therefore, we conducted the present meta-analysis to investigate the association between the inflammatory potential of diet and UC.

METHODS

PubMed, Embase and Web of Science were searched up to July 31, 2018. Two reviewers independently selected the studies and extracted the data. The pooled risk ratio (RR) and its 95% confidence interval (CI) were calculated using the Stata12.0 software package.

RESULTS

Nine case-control studies and three cohort studies including 83,197 subjects met the inclusion criteria. The overall meta-analysis results showed that individuals with the highest category of DII (dietary inflammatory index) were associated with an increased risk of prostate cancer (RR = 1.62, 95% CI: 1.30-2.02); subgroup analysis showed consistent results. For kidney and bladder cancer, significant positive associations were found in individuals with the highest category of DII score; however, no significant association was found between DII and the risk of urothelial cell carcinoma (UCC).

CONCLUSION

Available data suggest that more pro-inflammatory diets are associated with an increased risk of prostate cancer, kidney cancer and bladder cancer. However, further well designed large-scaled cohort studies are warranted to provide more conclusive evidence.

Association between inflammatory potential of diet and risk of lung cancer among smokers in a prospective study in Singapore

BACKGROUND

Diet and inflammation have been suggested to be important risk factors for lung cancer. We examined the ability of the dietary inflammatory index (DII^®) to predict lung cancer in the Singapore Chinese Health Study (SCHS). The DII is a diet quality index based on the literature linking foods and nutrients with inflammatory biomarkers.

PATIENTS AND METHODS

Using data from the SCHS for 60,232 participants, including 1851 lung cancer cases, we investigated the associations of baseline DII scores calculated from a food frequency questionnaire with risk of developing lung cancer over an average of 17.6 years of follow-up. Hazard ratios (HR) were estimated using Cox regression, adjusting for smoking status and other risk factors.

RESULTS

After excluding cancers diagnosed in the first 2 years of follow-up, the DII was non-significantly associated with risk of lung cancer (HR_Q5vsQ1 = 1.13; 95% CI 0.94-1.35; P-trend = 0.24) after adjusting for age, dialect group, sex, interview year, education, body mass index, total calorie intake, physical activity and various smoking variables. In stratified analysis, stronger, statistically significant associations were evident in current smokers (HR 1.44; 95% CI 1.11-1.86; P_trend = 0.03, P for interaction = 0.003) and in male ever-smokers (HR_Q5vsQ1 = 1.37; 95% CI 1.07-1.77; P-trend = 0.03).

CONCLUSION

A pro-inflammatory diet, as shown by higher DII scores, is associated with an elevated risk of lung cancer for subjects with a history of smoking. Public health measures should be adopted to promote consumption of a healthy, anti-inflammatory diet to reduce the risk of lung cancer, especially in current and former smokers.

Association of proinflammatory diet with low-grade inflammation: results from the Moli-sani study

OBJECTIVES

The association between diet and inflammation is well documented. Yet, no evidence exists on the relationship between the inflammatory potential of the diet and low-grade inflammation (LGI) as measured by a composite score of plasma and cellular biomarkers. The aim of this study was to assess the association between the Dietary Inflammatory Index (DII^®) and LGI in a large population-based cohort.

METHODS

Cross-sectional analyses were conducted on data from 20 823 adults (age ≥35 y; 48% male) without acute inflammation, who were recruited within the general population of the Moli-sani study from 2005 to 2010. LGI was measured by using a composite score (INFLA-score) including platelet and leukocyte counts, the granulocyte to lymphocyte ratio, and C-reactive protein. DII scores were computed based on dietary intake assessed by the EPIC food frequency questionnaire. Multivariable linear regression models were fit to produce adjusted regression coefficients and 95% confidence intervals (CIs).

RESULTS

Higher DII scores were associated with increased LGI (β = 0.131; 95% CI, 0.089-0.174 for the highest versus lowest quintile of DII) after adjusting for age, sex, lifestyle, prevalence of chronic diseases, and health conditions. A higher DII score also was positively associated with each single biomarker of inflammation included in the INFLA-score, unhealthy behaviors (smoking, sedentary lifestyle), and insulin.

CONCLUSIONS

Higher DII scores, indicating greater inflammatory potential of the diet, were directly associated with LGI, as measured by a composite score of plasma and cellular biomarkers of inflammation. These findings are consistent with the contributing role of diet-mediated inflammation in increasing risk for inflammation-related chronic diseases.

Dietary Fiber Intake and Type 2 Diabetes Mellitus: An Umbrella Review of Meta-analyses

Objective

The purpose of this study was to review previously published meta-analyses on the effectiveness of dietary fiber on type 2 diabetes.

Methods

An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to April 30, 2017, was conducted using the following search strategy: (fiber OR glucan OR psyllium) AND (meta-analysis OR systematic review). Only English-language publications that provided quantitative statistical analysis on type 2 diabetes, fasting blood glucose concentrations, or glycosylated hemoglobin were retrieved.

Results

Sixteen meta-analyses were retrieved for inclusion in this umbrella review. In the meta-analyses comparing highest versus lowest dietary fiber intake, there was a statistically significant reduction in the relative risk (RR) of type 2 diabetes (RR = 0.81-0.85), with the greatest benefit coming from cereal fibers (RR = 0.67-0.87). However, statistically significant heterogeneity was observed in all of these meta-analyses. In the meta-analyses of supplementation studies using β-glucan or psyllium fibers on type 2 diabetic participants, statistically significant reductions were identified in both fasting blood glucose concentrations and glycosylated hemoglobin percentages.

Conclusion

This review suggests that those consuming the highest amounts of dietary fiber, especially cereal fiber, may benefit from a reduction in the incidence of developing type 2 diabetes. There also appears to be a small reduction in fasting blood glucose concentration, as well as a small reduction in glycosylated hemoglobin percentage for individuals with type 2 diabetes who add β-glucan or psyllium to their daily dietary intake.

Dietary inflammatory index and cardiometabolic risk in US adults

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Dietary Fiber, C-Reactive Protein, and Leisure-Time Physical Activity Among U.S. Adults

BACKGROUND

Some evidence suggests an inverse association between increased fiber intake and C-reactive protein (CRP). However, few studies have examined the associations among CRP, dietary fiber, and leisure-time physical activity (LTPA) in a nationally representative sample of U.S. adults.

METHODS

Sample (n = 8372) included adults (≥20 years of age) who participated in the 2007-2010 National Health and Nutrition Examination Survey. Tertiles of reported fiber intake were created. The dependent variable was elevated CRP (>3-10 mg/L). Logistic regression models were stratified by LTPA participation and adjusted for age, gender, race, waist circumference (WC), and standing height.

RESULTS

In adults reporting any volume of LTPA participation, increased fiber intake was significantly (P < 0.05 for the upper tertile of fiber intake) associated with lower odds of having an elevated CRP concentration when compared with the lowest tertile. Similar associations were not revealed in analyses limited to adults reporting no LTPA participation. After additional adjustment for WC and standing height, this protective association was no longer statistically significant.

CONCLUSIONS

Results suggest that WC and standing height may mediate the beneficial association between increased fiber intake and lower odds of elevated CRP in adults reporting LTPA participation.

Dietary inflammatory index and its relationship with high-sensitivity C-reactive protein in Korean: data from the health examinee cohort

Inflammation is associated with chronic disease. High-sensitivity C-reactive protein (hs-CRP) is a predictor of chronic disease. The dietary inflammatory index (DII) is used to determine the overall inflammatory potential of diet. A cross-sectional analysis of Health Examinee cohort data (2012–2014) from Korea was performed. Subjects were 40–79 years of age (8,332 males; 19,754 females). The DII was used to analyze the relationship between subject characteristics, nutrient intake, and the hs-CRP. Additionally, the relationship between DII and hs-CRP as a predictor of chronic disease was examined. The DII was divided into 4 quartile: Q1 = −7.21 to −1.88 (median: −3.020), Q2 = −1.87 to −0.02 (median: −0.410), Q3 = −0.01 to 1.87 (median = 0.870) and Q4 = 1.88 to 7.34 (median = 3.040). For each group, the carbohydrate/protein/fat intake ratio was Q1 = 66.7:16.6:19.2, Q2 = 67.2:15.6:18.7, Q3 = 67.3:15.1:18.4 and Q4 = 67.3:14.0:17.9. The odds of elevated hs-CRP were 1.241 times higher in participants with the most proinflammatory diets than those with the most anti-inflammatory diets [hs-CRP; odds ratio (95% confidence interval) for Q4 vs Q1: 1.241 (1.071, 1.438); p for trend = 0.002]. An association was found between a high DII and high levels of hs-CRP. The DII may be applied to measure the association between diet and chronic diseases.

Short-chain fatty acids, prebiotics, synbiotics, and systemic inflammation: a systematic review and meta-analysis

BACKGROUND

Prebiotic soluble fibers are fermented by beneficial bacteria in the colon to produce short-chain fatty acids (SCFAs), which are proposed to have systemic anti-inflammatory effects.

OBJECTIVE

This review examines the effect of SCFAs, prebiotics, and pre- and probiotic combinations (synbiotics) on systemic inflammation.

DESIGN

Relevant English language studies from 1947 to May 2017 were identified with the use of online databases. Studies were considered eligible if they examined the effects of SCFAs, prebiotics, or synbiotics; were delivered orally, intravenously, or per rectum; were on biomarkers of systemic inflammation in humans; and performed meta-analysis where possible.

RESULTS

Sixty-eight studies were included. Fourteen of 29 prebiotic studies and 13 of 26 synbiotic studies reported a significant decrease in ≥1 marker of systemic inflammation. Eight studies compared prebiotic and synbiotic supplementation, 2 of which reported a decrease in inflammation with synbiotics only, with 1 reporting a greater anti-inflammatory effect with synbiotics than with prebiotics alone. Meta-analyses indicated that prebiotics reduce C-reactive protein (CRP) [standardized mean difference (SMD): -0.60; 95% CI: -0.98, -0.23], and synbiotics reduce CRP (SMD: -0.40; 95% CI: -0.73, -0.06) and tumor necrosis factor-α (SMD -0.90; 95% CI: -1.50, -0.30).

CONCLUSIONS

There is significant heterogeneity of outcomes in studies examining the effect of prebiotics and synbiotics on systemic inflammation. Approximately 50% of included studies reported a decrease in ≥1 inflammatory biomarker. The inconsistency in reported outcomes may be due to heterogeneity in study design, supplement formulation, dosage, duration, and subject population. Nonetheless, meta-analyses provide evidence to support the systemic anti-inflammatory effects of prebiotic and synbiotic supplementation.