Search

Background: Since the first version of the dietary inflammatory index (DII®) developed in the past decade, several other versions have been developed. However, to date no study has attempted to compare these versions with respect to their associations with biomarkers of inflammation., Objective: We aimed to investigate the relationship between four dietary inflammatory scores [DII, two energy-adjusted derivatives (E-DII and E-DII r ), and the Inflammatory Score of the Diet (ISD)], and circulating levels of several inflammatory markers and adipokines., Methods: This study included 17 637 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort with at least one marker of inflammation measured in blood. Associations between the four scores and C-reactive protein (CRP), interleukin (IL)6, IL10, IL1RA, tumor necrosis factor-α (TNFα), soluble tumor necrosis factor receptor-1 (sTNFR1), sTNFR2, leptin, soluble leptin receptor (sLeptin R), adiponectin, and High Molecular Weight (HMW) adiponectin were evaluated using multivariable linear regressions adjusted for potential confounders., Results: Positive associations were observed between the four dietary inflammatory scores and levels of CRP, IL6, sTNFR1, sTNFR2 and leptin. However, only the DII and the ISD were positively associated with IL1RA levels and only the DII and the E-DII r were positively associated with TNFα levels. The proportion of variance of each biomarker explained by the scores was lower than 2%, which was equivalent to the variance explained by smoking status but much lower than that explained by body mass index., Conclusions: Our results suggest that the four dietary inflammatory scores were associated with some biomarkers of inflammation and could be used to assess the inflammatory potential of diet in European adults but are not sufficient to capture the inflammatory status of an individual. These findings can help to better understand the inflammatory potential of diet, but they need to be replicated in studies with repeated dietary measurements., Competing Interests: Conflicts of Interest Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smartphone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has CHI-related activity exerted any influence on this project., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Background & Aims: Inflammatory potential of diet may contribute to poor health outcomes in individuals with metabolic disorders. In a representative sample of the U.S. population, we investigated the association between consuming a pro-inflammatory diet and mortality risk in adults with normal range of body mass index (BMI) but with central obesity., Methods: This prospective cohort study included 3521 adults 20-90 years of age with normal BMI who participated in the National Health and Nutrition Examination Survey III, 1988-1994 and did not have a history of cardiovascular disease (CVD) or cancer and did not change their dietary intake in the year preceding baseline measurements. Mortality from all causes, CVD, and cancer was ascertained from the National Death Index. Normal-weight central obesity (NWCO, n = 1777) was defined as those with BMI 18.5 to <25 kg/m 2 and waist-to-hip ratio (WHR) ≥0.85 in women and ≥0.90 in men. Severe central obesity was defined as WHR ≥0.92 in women and ≥1.00 in men. The dietary inflammatory index (DII®) was computed based on baseline dietary intake using 24-h dietary recalls, and associations with mortality were estimated using multivariable Cox proportional hazards regression., Results: In individuals with NWCO, DII score (i.e., more pro-inflammatory diet) was associated with increased risk of CVD mortality (HR T3 vs T1 , 1.89 [95% CI, 1.01-3.53], P trend = 0.04; HR 1 SD increase 1.29 [95% CI, 1.06-1.57]). This association was stronger with more severe central obesity (HR T3 vs T1 , 2.79 [95% CI, 1.10-7.03], P trend = 0.03; HR 1 SD increase 1.52 [95% CI, 1.05-2.21]). DII score was not associated with increased risk of mortality in normal-weight individuals without central obesity or with risk of cancer mortality in either group., Conclusion: Among individuals in the normal-weight range of BMI, a pro-inflammatory diet assessed by high DII scores was associated with increased risk of CVD mortality in those with central obesity., (Copyright © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Food processing may adversely affect human health through a variety of mechanisms, including the development of a chronic pro-inflammatory state. In this study we aimed to test the hypothesis that an increasing degree of food processing is directly associated with low-grade inflammation, and evaluate to what extent this association is mediated by the inflammatory potential of highly processed foods., Methods: Cross-sectional analysis on 21,315 subjects (mean age 55 ± 3 y) from the Moli-sani Study with complete dietary data collected by a validated 188-item food frequency questionnaire. The NOVA classification was used to categorize foods on the basis of industrial processing as: 1) unprocessed/minimally processed foods; 2) processed culinary ingredients; 3) processed foods; 4) ultra-processed foods (UPF). The inflammatory potential of the diet was evaluated through the Energy-adjusted Dietary Inflammatory Index (E-DII™). Low-grade inflammation was assessed by a composite INFLA-score including C-reactive protein, leukocyte and platelet counts and the granulocyte to lymphocyte ratio., Results: In multivariable-adjusted linear regression models, the INFLA-score was positively associated with E-DII (β = 0.15; 0.10, 0.19), processed foods (β = 0.04; 0.01, 0.08) and UPF (β = 0.13; 0.07, 0.19), but inversely associated with minimally processed foods (β = -0.09; -0.13, -0.06). The E-DII score was inversely associated with minimally processed food (β = -0.40; 95%CI -0.41, -0.39 for 5% increment in the weight ratio) but directly with either processed culinary ingredients (β = 0.18; 0.15, 0.21 for 1% increment), processed food (β = 0.28; 0.27, 0.29 for 5% increment) or UPF (β = 0.34; 0.32, 0.36 for 5% increment). The inclusion of the E-DII into the multivariable model explained 88.5% of the association of processed food with the INFLA-score (p < 0.0001) and mitigated by 32.6% (p < 0.0001) the association with UPF., Conclusions: The association of UPF with low-grade inflammation is only partially explained by the high pro-inflammatory potential of these foods. Further studies are warranted to test whether the observed adverse relationship of UPF with low-grade inflammation could be triggered by mechanisms that are not directly related to the pro-inflammatory potential of highly processed food products., Competing Interests: Conflicts of interest Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project. The other authors declare no conflict of interest., (Copyright © 2022 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Maternal diet during pregnancy is a modifiable behaviour which plays an important role in maternal, neonatal and child health outcomes. Thus, knowledge of predictors of dietary quality and dietary inflammatory potential in European countries may contribute to developing maternal diet-related public health policies that target specific at-risk populations in Europe., Methods: We used harmonised data from >26,000 pregnant women enrolled in the ALSPAC, EDEN, Generation R, Lifeways, REPRO&#95;PL, ROLO and SWS cohorts, as part of the ALPHABET consortium. Maternal dietary quality and inflammatory potential were assessed using the Dietary Approaches to Stop Hypertension (DASH) and the energy-adjusted Dietary Inflammatory Index (E-DII). We conducted an individual participant data meta-analysis to investigate the maternal sociodemographic, health and behavioural predictors of maternal diet before and during pregnancy., Results: DASH and E-DII scores were moderately correlated: from -0.63 (95% CI: -0.66, -0.59) to -0.48 (95% CI: -0.49, -0.47) across cohorts. Higher maternal age, education, household income, and physical activity during pregnancy were associated with a better dietary quality and a more anti-inflammatory diet. Conversely, multiparity and smoking during pregnancy were associated with a poorer dietary quality and a more proinflammatory diet. Women with obesity had a poorer pregnancy dietary quality than women with a normal body mass index range., Conclusions: The results will help identify population subgroups who may benefit from targeted public health strategies and interventions aimed at improving women's dietary quality during pregnancy., Competing Interests: Conflicts of interest Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina in order to develop computer and smartphone applications for patient counselling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. All other authors declare no support from any organisation for the submitted work other than those described above; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: Lipoprotein particle concentrations and size are associated with increased risk for atherosclerosis and premature cardiovascular disease. Studies also suggest that certain dietary behaviours may be cardioprotective. Limited comparative data regarding any dietary score/index-lipoprotein particle subclass associations exist. Thus, our objective was to assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Health Eating Index-2015 (HEI-2015), Mediterranean Diet (MD) and Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and plasma lipids and lipoprotein profiles to test the hypothesis that healthier diet (better quality and more anti-inflammatory) would be associated with a more favourable lipoprotein profile., Materials and Methods: This was a cross-sectional study of 1862 men and women aged 46-73 years, randomly selected from a large primary care centre in Ireland. DASH, HEI-2015, MD and E-DII scores were derived from food frequency questionnaires. Lipoprotein subclass particle concentrations and size were determined using nuclear magnetic resonance spectroscopy. Correlation and multivariate-adjusted linear regression analyses with correction for multiple testing were performed to examine dietary score relationships with lipoprotein particle subclasses., Results: In fully adjusted models, higher diet quality or a more anti-inflammatory diet was associated with less large and medium very low-density lipoprotein (VLDL) (DASH and HEI-2015), intermediate-density lipoprotein (IDL) (DASH, MD and E-DII) and small high-density lipoprotein (HDL) (DASH, HEI-2015 and E-DII) particles. After accounting for multiple testing, relationships with large VLDL (DASH: β = -0.102, p = .037), IDL (DASH: β = -0.089, p = .037) and small HDL (DASH: β = -0.551, p = .014 and E-DII: β = 0.483, p = .019) concentrations persisted., Conclusions: These findings provide evidence that better diet quality, determined by the DASH score, may be more closely associated with a more favourable lipoprotein particle subclass profile in middle-to older-aged adults than the HEI-2015, MD and E-DII scores. A less pro-atherogenic lipoprotein status may be a potential mechanism underlying the cardioprotective effects of higher dietary quality., Competing Interests: Conflicts of interest We wish to disclose that Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina in order to develop computer and smart phone applications for patient counselling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background & Aims: Findings from observational studies investigating the association between Dietary Inflammatory Index (DII®) scores and depression symptoms (DepS) are inconsistent. This study aims to assess the association between energy-adjusted DII (E-DII™) and DepS using the North West Adelaide Health Study (NWAHS) cohort as well as update a previous meta-analysis., Methods: A total of 1743 (mean ± SD age: 56.6 ± 13.6 years, 51% female) study participants from NWAHS were included in the cross-sectional study and 859 (mean ± SD age: 58.4 ± 12.1 years, 52.6% female) in the longitudinal analyses. The Center for Epidemiological Studies Depression Scale (CES-D) was used for the measurement of DepS. E-DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Data from two stages [Stage 3 (2008-10) and North West 15 (NW15) (2015)] were used. Log- and negative binomial regression were used to assess the association between quartiles of E-DII and DepS. A recent meta-analysis was updated by including 12 publications (six cross-sectional and six cohort studies) on the association between DII and DepS., Results: In the cross-sectional analysis, a higher E-DII score (i.e., more pro-inflammatory diet) was associated with a 79% increase in odds of reporting DepS [OR Quartile4vs1 : 1.79; 95% CI: 1.14-2.81; p = 0.01; p for trend (p trend ) = 0.03]. Males with higher E-DII had a more than two-fold higher odds of DepS (OR Quartile4vs1 : 2.27; 95% CI: 1.02-5.06; p = 0.045; p trend  = 0.09). Females with higher E-DII had an 81% increase in odds of DepS (OR Quartile4vs1 : 1.81; 95% CI: 1.01-3.26; p = 0.046; p trend  = 0.07). These associations were consistent in the longitudinal analysis. Comparing highest to lowest quintiles of E-DII, the updated meta-analysis showed that a pro-inflammatory diet is associated with a 45% increase in odds of having DepS (OR: 1.45; 95% CI: 1.20-1.74; p < 0.01) with higher odds in females (OR: 1.53; 95% CI: 1.16-2.01; p = 0.01) compared to their male counterparts (OR: 1.29; 95% CI: 0.98-1.69; p = 0.15)., Conclusion: The data from the NWAHS and the updated meta-analysis of observational studies provide further evidence that a pro-inflammatory diet is positively associated with increased risk of DepS. These findings support the current recommendation on consuming a less inflammatory diet to improve DepS., Competing Interests: Conflict of interest All authors declare no conflict of interest. Wish to disclose that Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index™ (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project., (Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: A higher body mass index (BMI) is associated with shorter telomeres. The loss of muscle mass with aging is associated with adverse outcomes. The appendicular skeletal muscle index (ASMI) is currently used to quantify muscle mass., Objective: We investigated the association of the ASMI with leukocyte telomere length in adult Americans., Methods: This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) 1999-2002 dataset. Body composition was measured by dual-energy X-ray absorptiometry. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). The telomere-to-single-copy gene ratio (T/S ratio) was converted to base pairs. Generalized linear models were performed to evaluate the association of ASMI with telomere length., Results: In multivariable adjustment regression models, higher ASMI was associated with longer telomeres in US adults (β = 70.2, P < 0.001, P trend<0.001). In participants with preserved muscle mass, the ASMI was related to longer telomere length (β = 75.1, P < 0.001), but not significantly in low muscle mass participants (β = 68.7, P = 0.30). Further subgroup analysis by a combination of age groups and muscle mass status showed positive association with young-preserved muscle mass (β = 82.6, P < 0.001), old-preserved muscle mass (β = 44.4, P = 0.12), young-low muscle mass (β = 135.4, P = 0.20), and old-low muscle mass (β = 52.7, P = 0.55). Because each additional year of chronological age was associated with telomeres that were 15.3 base pairs shorter, on average, this would equate to 5.4 fewer years of biological aging (82.6 ÷ 15.3) in the young-preserved muscle mass participants., Conclusions: A higher ASMI is associated with longer telomeres. The prevention of skeletal muscle loss has the potential to delay telomere shortening and account for less biological aging., Competing Interests: Conflict of interest All authors declare no conflicts of interests., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background & Aims: For many decades diet, mainly its "pro-inflammatory" quality has been pondered as a possible risk factor for developing MS. However, the complexity of different dietary composition analysis provided controversial results. Recently a dietary inflammatory index (DII), a population-based score, was developed to objectify the inflammatory characteristics of a specific dietary intake., Methods: We investigated the potential association between DII (expressed as energy adjusted-DII (E-DII) and non-energy adjusted DII (DII)) assessed from a validated FFQ based on the participants' diet habits during adolescence and the risk for developing MS in a population-based incident case-control study. Multiple logistic regression was used to estimate the adjusted., Results: We recruited 547 incident MS cases and 1057 general population controls from Tehran, Iran (August 2013-February 2015). A statistically significant higher risk of MS was found in analyses using E-DII scores as a continuous variable with an adjusted odds ratio (AOR) of 1.53 (95% confidence interval (CI): 1.42-1.65, P = 0.001), and as a categorical variable (4th quartile OR 7.01, 95% CI: 4.87-10.1, vs the first quartile), test for trend; OR 1.86 (95% CI: 1.67-2.07), P for trend <0.001. A similar pattern was demonstrated for DII score and risk for MS., Conclusions: We identified a pro-inflammatory diet characterized by higher E-DII and DII scores during adolescence as a strong risk factor for MS onset. Given the worldwide role of diet in general population health, improving nutritional pattern through educational programs is likely to reduce MS risk., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

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., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Aging is characterized by progressive decline in physiologic reserves and functions as well as prolonged inflammation, increasing susceptibility to disease. Diet plays an important role in maintaining health, and reducing morbidity and mortality, especially in older populations. This study was designed to determine prospective associations between dietary inflammatory index (DII®) scores and bone health, sarcopenia-related outcomes, falls risk and incident fractures in community-dwelling Australian older adults., Methods: A total of 1098 [51% male; age (mean ± SD) 63.0 ± 7.5 years] non-institutionalized older adults who participated in the Tasmanian Older Adult Cohort Study (TASOAC) at baseline, 768 at 5 years, and 566 at 10 years follow-up were included in this analysis. Baseline energy-adjusted DII (E-DII) scores were calculated using a validated Food Frequency Questionnaire. Changes in bone mineral density (BMD) and appendicular lean mass (ALM) were measured over ten years using dual-energy x-ray absorptiometry. Ten-year changes in hand grip, knee extensor and whole lower-limb muscle strength and quality were assessed by dynamometers and change in falls risk score using the Physical Profile Assessment (PPA). Incident fractures at any site and non-vertebral fractures over 10 years were self-reported., Results: The E-DII range was -3.48 to +3.23 in men and -3.80 to +2.74 in women. Higher E-DII score (indicating a more pro-inflammatory diet) was associated with lower total hip (B: -0.009; 95% CI: -0.017, 0.000) and lumbar spine BMD (B: -0.013; 95% CI: -0.024, -0.002), and higher falls risk score (B: 0.040; 95% CI: 0.002, 0.078) over 10 years in men. Women with higher E-DII scores had higher whole lower-limb muscle quality over 10 years (B: 0.109; 95% CI: 0.002, 0.215). For every unit increase in E-DII score, incident fracture rates increased by 9.0% in men (IRR: 1.090; 95% CI: 1.011, 1.175) and decreased by 12.2% in women (IRR: 0.878; 95% CI: 0.800, 0.964) in a fully adjusted model., Conclusion: Higher E-DII scores were associated with lower bone density, higher falls risk, and increased incidence of fractures in community-dwelling older men, but decreased fracture incidence in women, over 10 years. This suggests pro-inflammatory diets may be more detrimental to musculoskeletal health in older men than in women. Additional studies are warranted to elucidate these sex differences., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Dietary inflammatory potential has been associated with several cancers. However, the relationship between the dietary inflammatory index (DII®) and glioma is not clear. The aim of this study was to examine DII in relation to glioma., Methods: In a hospital-based case-control study, we selected 128 newly-diagnosed cases of glioma and 256 controls. Cases were medically confirmed glioma patients, with no history of other cancers. A validated food frequency questionnaire was used to assess diet. DII scores were calculated based on the quantity of dietary components with inflammatory or anti-inflammatory potential. We used conditional logistic regression models to examine the association between the DII and glioma., Result: Study participants were on average 43 years old and predominantly male (58%). After controlling for age, sex and energy intake, individuals in the highest quartile of DII had 87% (95% CI: 1.00-3.47) increased risk of glioma compared to those in the lowest quartile. Additional adjustment for environmental confounders strengthened the relationship; participants with the greatest DII scores had approximately 2.1 times (95% CI: 1.06, 3.83) increased odds of glioma than those with the lowest intake scores. The association was not substantially altered by further adjustment for BMI (2.76; 1.15-6.60)., Conclusion: In conclusion, diets with high anti-inflammatory and low inflammatory nutrient contents are recommended to prevent glioma., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Breast cancer (BC) is the most commonly diagnosed cancer, and diet is suspected to play a role in its development. Dietary factors may mediate this process through modulation of inflammation, though findings from previous studies have not been consistent. We aimed to longitudinally assess the association between the dietary inflammatory index (DII ® ), a frequently used method to assess the inflammatory potential of the diet, and incident BC., Methods: We included 10,713 middle-aged, Spanish female university graduates from the SUN cohort. DII ® scores were derived from a validated 136-item food-frequency questionnaire, and it was based on scientific evidence on the relationship between diet and inflammatory biomarkers. Diagnosis of BC was reported by the participant or, if deceased, by the next of kin or identified from death certificates. Self-reports of BC were confirmed by revision of medical reports by an experienced oncologist. Cox proportional hazard models were used to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between quartiles of DII ® and incident BC., Results: After 10.3 years of median follow-up, we identified 100 confirmed and 168 probable incident BC cases. The multivariable-adjusted HR for participants in the 4th quartile to the 1st quartile was 1.44 (95% CI 0.76-2.72; p-trend: 0.339) when confirmed cases were analyzed, and 1.20 (95% CI 0.72-1.99; p-trend: 0.757) for the probable cases. We neither observed statistically significant differences in regard to menopausal status., Conclusions: The apparent increase in risk between DII ® scores and BC in our cohort was not statistically significant, which could be partly explained by the small number of observed cases., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII ® ) was developed to appraise the inflammatory potential of the diet., Objective: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts., Design: We assessed 18,566 participants in the "Seguimiento Universidad de Navarra" (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the "PREvencion con DIeta MEDiterránea" (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality., Results: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%-32%, for the highest vs lowest category of DII)., Conclusion: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: This study was designed to investigate the association between the dietary inflammatory index (DII ® ) scores, metabolic phenotypes, and risk of mortality risk in overweight/obese individuals from a representative sample of the U.S., Methods: Data from 3733 overweight/obese adults (BMI ≥ 25 kg/m 2 ) aged 20-90 years from the National Health and Nutrition Examination Survey III, 1988-1994 were analyzed; these participants were followed for mortality through December 31, 2011. DII scores were computed based on baseline dietary intake using 24-h dietary recalls. Metabolically unhealthy status was defined as having 2 or more of these metabolic abnormalities: high glucose, insulin resistance, elevated blood pressure, triglycerides, C-reactive protein levels, or low high-density lipoprotein-cholesterol values., Results: In metabolically unhealthy overweight/obese (MUO) individuals, DII score was associated with increased risk of all-cause mortality (HR Tertile 3 vs Tertile 1 1.44; 95% CI 1.11-1.86 P trend  = 0.008; HR 1SD increase 1.08; 95% CI 0.99-1.18). Additionally, a stronger association with cardiovascular mortality was observed (HR T3 vs T1 3.29; 95% CI 2.01-5.37 P trend  < 0.001; HR 1SD increase 1.40; 95% CI 1.18-1.66), after adjusting for potential confounders. Furthermore, when analyses were restricted to obese individuals (BMI ≥ 30 kg/m 2 ), the association was more pronounced, especially for cardiovascular mortality (HR T3 vs T1 5.55; 95% CI 2.11-14.57 P trend  = 0.006; HR 1SD increase 1.74; 95% CI 1.21-2.50). No association was observed between DII score and risk of mortality in individuals with metabolically healthy overweight/obese (MHO) phenotype, or for cancer mortality in either MHO or MUO phenotype., Conclusions: A pro-inflammatory diet appears to increase risk of all-cause and cardiovascular mortality in the MUO phenotype, but not among the MHO phenotype., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: The relationship between diet, inflammation and mental health is of increasing interest. However, limited data regarding the role of dietary inflammatory potential in this context exist. Therefore the aim of this work was to examine associations between the inflammatory potential of habitual diet and mental health outcomes in a cross-sectional sample of 2047 adults (50.8% female)., Methods: Diet was assessed using a self-completed food frequency questionnaire from which dietary inflammatory index (DII ® ) scores were determined. Depressive symptoms, anxiety and well-being were assessed using the CES-D, HADS-A and WHO-5 screening tools., Results: Logistic regression analyses revealed that higher energy-adjusted DII (E-DII ® ) scores, reflecting a more pro-inflammatory diet, were associated with increased risk of depressive symptoms (odds ratios (OR) 1.70, 95% confidence intervals (CI) 1.23-2.35, p = 0.001) and anxiety (OR 1.60, 95% CI 1.15-2.24, p = 0.006) and lower likelihood of well-being (OR 0.62, 95% CI 0.46-0.83, p = 0.001), comparing highest to lowest tertile of E-DII. In gender-stratified analyses associations were noted in women only. Women with the highest E-DII scores were at elevated risk of depressive symptoms (OR 2.29, 95% CI 1.49-3.51, p < 0.001) and anxiety (OR 2.00, 95% CI 1.30-3.06, p = 0.002), while likelihood of reporting good well-being was lower (OR 0.55, 95% CI 0.36-0.79, p = 0.002), relative to those with the lowest E-DII scores., Conclusions: These findings, which suggest that a pro-inflammatory diet is associated with adverse mental health, may be of clinical and public health significance regarding the development of novel nutritional psychiatry approaches to promote good mental health., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: To assess the possible association between a validated Dietary Inflammatory Index (DII) and specific dietary components with suitable non-invasive markers of liver status in overweight and obese subjects within the PREDIMED study., Methods: A cross-sectional study encompassing 794 randomized overweight and obese participants (mean ± SD age: 67.0 ± 5.0 y, 55% females) from the PREDIMED (PREvención con DIeta MEDiterránea) trial was conducted. DII is a validated tool evaluating the effect of diet on six inflammatory biomarkers (IL-1b, IL-4, IL-6, IL-10, TNF-α and C-reactive protein). Furthermore, a validated 137-item food-frequency-questionnaire was used to obtain the information about the food intake. In addition, anthropometric measurements and several non-invasive markers of liver status were assessed and the Fatty Liver Index (FLI) score was calculated., Results: A higher DII and lower adherence to Mediterranean diet (MeDiet) were associated with a higher degree of liver damage (FLI > 60) in obese as compared to overweight participants. Furthermore, the DII score was positively associated with relevant non-invasive liver markers (ALT, AST, GGT and FLI) and directly affected FLI values. Interestingly, a positive correlation was observed between liver damage (>50th percentile FLI) and nutrients and foods linked to a pro-inflammatory dietary pattern., Conclusions: This study reinforced the concept that obesity is associated with liver damage and revealed that the consumption of a pro-inflammatory dietary pattern might contribute to obesity and fatty liver disease features. These data suggest that a well-designed precision diet including putative anti-inflammatory components could specifically prevent and ameliorate non-alcoholic fatty liver manifestations in addition to obesity., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: The deleterious effect of cariogenic dietary patterns on tooth loss is well characterized, but the contribution of diet-borne systemic inflammation to loss of teeth remains uncharted. Recent efforts have unveiled a protective role of single nutrients to periodontal health. However, the assessment of overall diet as a modifiable risk factor for oral health remains elusive. Thus, the aim of this study was to assess the association between diet-borne systemic inflammation and tooth loss in a representative sample of the US adult non-institutionalized population., Methods: A cross-sectional analysis of a sample of participants of the 2009-2010 and 2011-2012 continuous NHANES receiving an oral exam and providing dietary recall data was performed. Dietary inflammatory potential was assessed by the Dietary Inflammatory Index (DII), a composite measure computed based on the association between nutrients and systemic pro-inflammatory cytokine levels. The outcome measure was prevalent tooth loss. Numbers of missing teeth were regressed across quartiles of the DII using multivariable linear regression models., Results: 6887 eligible NHANES participants were included in the analysis; participants in the highest quartile of the DII index (pro-inflammatory diet) had an average [95% CI] of 0.84 [0.24, 1.45] additional more teeth lost as compared to those in the lowest quartile of DII (anti-inflammatory diet) (p = 0.015), after adjusting for known confounders. This significant association remained in subgroup analyses, including the lowest tertiles of energy-adjusted carbohydrate intake, and in persons aged ≥50 years., Conclusions: Adherence to an anti-inflammatory diet is associated with fewer missing teeth. These results suggest protective dietary patterns as a modifiable protective factor for tooth loss in the US adult population and support the incorporation of tooth loss prevention in the agenda of dietary public health interventions to prevent chronic inflammatory diseases., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Relationships between food consumption/nutrient intake and tobacco smoking have been described in the literature. However, little is known about the association between smoking and overall diet quality. This study examined the associations between eight diet quality indices, namely, the Diet Quality Index-International (DQI-I), Recommendation Compliance Index (RCI), Dietary Approach to Stop Hypertension (DASH) score, Energy Density Score (EDS), Dietary Diversity Score (DDS), Recommended Food Score (RFS), non-Recommended Food Score (non-RFS), and Dietary Inflammatory Index (DII), and smoking status with a focus on smoking intensity., Methods: Analyses were based on a sample of 1352 participants in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) survey, a nationwide population-based cross-sectional study of adults aged 18-69 years. Nutritional data from food frequency questionnaire (FFQ) were used to compute selected diet quality indices. Participants were classified as never smoker, former smoker (≥12 months cessation period), occasional or light smokers (≤1 cig/d), moderate smokers (≤20 cig/d) and heavy smokers (>20 cig/d). Descriptive and linear regression analyses were performed, after adjustment for several potential covariates., Results: Compared to the other groups, heavy smokers had significantly higher prevalence of dyslipidemia (83%), obesity (34%), and elevated glycemic biomarkers. About 50% of former smokers had hypertension. Diet quality of heavy smokers was significantly poorer than those who never smoked independent of several socioeconomic, lifestyle, and biologic confounding factors (all p < 0.001). Heavy smokers were less compliant with national or international dietary recommendations, expressed by RCI, DQI-I, and RFS. In addition, they consumed a more pro-inflammatory diet, as expressed by higher DII scores (P < 0.001) and self-reported less dietary diversity in their food choices, as expressed by DDS., Conclusion: This study provides new evidence concerning an inverse relationship between the intensity of tobacco consumption and overall diet quality. The implication is that efforts aimed at tobacco control should target heavy smokers and intervention on smoking cessation should take into account diet quality of smokers and their nutritional habits, to increase effectiveness and relevance of public health messages., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: We prospectively assessed the association between adherence to several a priori defined healthy food patterns and risk of metabolic syndrome (MetS)., Methods: We assessed 6851 participants of a Spanish dynamic prospective cohort of university graduates, initially free of any MetS-specific definition criteria, and followed-up for a median of 8.3 years. We calculated the adherence to thirteen different a priori defined food patterns or dietary indexes. MetS was classified according to the updated harmonizing criteria. We estimated multivariable-adjusted Incidence Rate Ratios (IRR) of metabolic syndrome and their 95% Confidence Intervals (95% CI), using Poisson regression models., Results: The cumulative incidence of MetS was 5.0%. Moderate adherence to the Pro-Vegetarian Diet (PVEG) was significantly associated with a lower risk for developing MetS (IRR = 0.75, 95% CI = 0.59-0.97). Among women, an inverse association with the PVEG was significant not only for a moderate adherence (IRR = 0.54, 95% CI = 0.36-0.82), but also for higher adherence (IRR = 0.63, 95% CI = 0.43-0.93). A higher adherence to the Dietary Approaches to Stop Hypertension (DASH) diet showed an inverse association with the MetS among participants, but only if they had low alcohol intake (RR = 0.41, 95% CI = 0.20-0.85)., Conclusions: Our findings support the adoption of a PVEG dietary pattern for the reduction of MetS risk. The same statement can be applied in relation to the DASH diet, insofar a limited consumption of alcoholic beverages is also maintained., (Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)