Association of Chronic Kidney Disease With Dietary Inflammatory Index in Adults Aged 50 Years and Older: Dose-Response Analysis of a Nationally Representative Population-Based Study

Association between dietary inflammatory index score and cardiovascular-kidney-metabolic syndrome: a cross-sectional study based on NHANES

Background

Cardiovascular-kidney-metabolic (CKM) syndrome affects 25% of US adults, with chronic inflammation as a key pathophysiological mechanism. While the inflammatory basis of CKM syndrome is established, associations of the energy-adjusted dietary inflammatory index (E-DII) with CKM syndrome remain unexplored in the general population.

Methods

Using data from 7,110 participants in the National Health and Nutrition Examination Survey (2007-2018), we examined the association between E-DII (calculated from dietary recall data) and CKM syndrome (defined as co-occurrence of cardiometabolic syndrome and chronic kidney disease). Multiple logistic regression, restricted cubic spline analyses, weighted quantile sum regression, and quantile g-computation were performed to assess associations and dietary component contributions.

Results

Higher E-DII scores correlated with increased CKM syndrome prevalence (OR: 1.22, 95% CI: 1.09-1.37). The relationship exhibited linearity (p for nonlinearity = 0.464). Stratified analyses across demographic and socioeconomic subgroups revealed consistent associations. Component analyses identified alcohol as the dietary factor with the strongest association with CKM syndrome.

Conclusion

The findings demonstrate a significant association between dietary inflammatory potential and CKM syndrome, with alcohol consumption emerging as a key modifiable factor. These results provide evidence-based insights for developing targeted dietary interventions in CKM syndrome prevention.

Association between dietary inflammatory index and risk of chronic kidney disease and low glomerular filtration rate; a systematic review and meta-analysis of observational studies

OBJECTIVE

Earlier studies on the association between the dietary inflammatory index (DII) and the risk of chronic kidney disease (CKD) and low estimated glomerular filtration rate (low-eGFR) have provided uncertain findings. Therefore, this study aimed to summarize the existing literature on the association between DII and CKD and low-eGFR.

METHODS

In April 2024, PubMed, Scopus, and Web of Science were searched for observational studies, along with manual inclusion of Google Scholar and Embase. The review was submitted to PROSPERO (CRD42024536756) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Studies which reported risk for CKD or low-eGFR were included.

RESULTS

The random-effects model was used for statistical analysis and pooled effect sizes were reported as odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). A total of 13 studies, all with a cross-sectional design, were identified eligible for inclusion in the meta-analysis. The results revealed that higher DII scores were associated with significantly higher odds of CKD (OR: 1.36, 95% CI: 1.20-1.56, p < 0.001) and low-eGFR (OR: 1.58, 95% CI: 1.26-2.00, p = 0.001).

CONCLUSION

This study found a significant positive association between the DII and the odds of CKD and low-eGFR, suggesting a higher likelihood of CKD in individuals who adhere to a pro-inflammatory diet. Large-scale prospective cohort studies are required to confirm these findings, particularly by assessing different indicators of kidney function.

Novel Dietary Inflammatory Score and Risk of Incident CKD

Key Points

Inflammation is relevant for CKD. Dietary intake influences inflammation. In 9814 individuals, our study found that concordance to a proinflammatory diet was associated with greater risk of CKD. Our results suggest that clinicians should consider recommending reducing dietary patterns high in inflammatory potential.

Background

Inflammation contributes to the onset of CKD. Diet is a modifiable risk factor for CKD; however, it remains unknown if the inflammatory potential of the diet is prospectively associated with CKD risk in healthy individuals.

Methods

In 9814 participants (mean age: 60 years) free of CKD in the Atherosclerosis Risk in Communities Study at visit 3 (1993–1995), we developed a novel empirically derived, food-based, dietary inflammatory score (Comprehensive Dietary Inflammation Index [CDII]) from a random two-thirds sample (N =6,542, discovery) and validated in the remaining one-third sample (N =3,272, validation). Reduced rank regression with 13 inflammatory biomarkers as the response variables and 31 food groups as the independent variables was used to develop the CDII. Cox proportional hazards models were used to calculate hazard ratios and 95% confidence intervals and test the association between the CDII and incident CKD, adjusting for important confounders.

Results

The CDII included eight food groups (four proinflammatory and four anti-inflammatory), with a higher score representing a more proinflammatory diet. In the validation sample, the CDII was positively correlated with most proinflammatory proteins (C-reactive protein, interferon-γ , IL-8, IL-6, and monocyte chemoattractant protein-1) and negatively correlated with adiponectin. However, the CDII was positively associated with one anti-inflammatory protein (transforming growth factor-β ). Over a median follow-up of 19 years (mean follow-up of 18 years), 3293 participants developed CKD. A diet that was the most versus least concordant with the CDII (quartile 4 versus quartile 1) had 28% greater risk of incident CKD (hazard ratio, 1.28; 95% confidence interval, 1.15 to 1.43; P trend < 0.001).

Conclusions

A novel diet score, representing its inflammatory potential, was associated with a higher risk of developing CKD. Reducing consumption of proinflammatory diet may be a strategy to prevent CKD.

Higher Dietary Inflammatory Index and Systemic Immune-Inflammation Index Score are Associated With Higher Risk of Chronic Kidney Disease: Analysis of the National Health and Nutrition Examination Survey From 1999 to 2018

OBJECTIVE

Chronic kidney disease (CKD) is characterized by a gradual decline in kidney function over time. The role of dietary inflammatory index (DII) and systemic immune-inflammation index (SII) in individuals with CKD remains uncertain. We aimed to explore the potential correlation between DII and SII with the prevalence of CKD in adult Americans.

METHODS

This cross-sectional study used data from the National Health and Nutrition Examination Study between 1999 and 2018. The DII was calculated based on the 24-hour dietary history interview, while the SII was calculated as the product of platelet count multiplied by neutrophil count and divided by lymphocyte count. CKD was diagnosed based on impaired glomerular filtration rate (<60 mL/min per 1.73 m2) or urinary albumin-creatinine ratio ≥30 mg/g. Multivariable logistic regression analyses and subgroup analyses were performed to examine the association between DII/SII and CKD.

RESULTS

In total, this study included 40,388 participants, of whom 7443 (18.4%) had CKD. The prevalence of CKD changed from 14.84% (95% confidence interval (CI): 13.20-16.48%) in 1999-2000 to 12.76% (95% CI: 11.10-14.43%) in 2017-2018. According to adjusted multivariate logistic regression models, individuals with higher DII scores had a higher likelihood of having CKD (odds ratio = 1.24; 95% CI: 1.12-1.37). Similarly, higher SII scores were associated with a higher risk of CKD (odds ratio = 1.37; 95% CI: 1.25-1.50). Subgroup analyses further demonstrated relatively stronger associations between DII/SII and CKD among individuals with other factors such as sex, age, body mass index, smoking status, drinking status, hypertension, and diabetes.

CONCLUSIONS

The DII and SII scores were significantly positively associated with higher risks of CKD. Anti-inflammatory diet might have the potential to prevent CKD. The SII may serve as a cost-effective and straightforward approach for detecting CKD. Further prospective longitudinal studies are needed to verify the causality.

The relationship between dietary inflammatory index (DII) and early renal injury in population with/without hypertension: analysis of the National health and nutrition examination survey 2001-2002

BACKGROUND

Inflammation plays a crucial role in occurrence of kidney injury, and specific dietary patterns can influence systemic inflammation levels. However, the relationship between dietary inflammatory potential and early-stage kidney damage remains unclear.

METHOD

2,108 participants was recruited from 2001-2002 National Health and Nutrition Examination Survey (NHANES). Dietary Inflammatory Index (DII) is utilized to assess dietary inflammatory potential, calculated through a 24-h dietary recall questionnaire. Early renal injury was evaluated using urinary albumin to creatinine (UACR), cystatin C (CysC), β-2 microglobulin (β2M), and estimated glomerular filtration rate (eGFR) based on serum creatinine (eGFRs), cystatin C (eGFRc), and both Scr and CysC (eGFRs&c). Participant characteristics were analyzed, and association between DII, hypertension, and early renal injury markers was explored using multiple linear and logistic regression models.

RESULTS

The average age of participants was 53.9 years. DII exhibited a positive correlation with UACR (β = -0.048[0.017,0.078]), β2M (β = 0.019[0.010,0.027]), CysC (β = 0.012 [0.004,0.021]). Conversely, a negative correlation was observed between DII and eGFRc (β = -1.126[-1.554, -0.699]), eGFRs&c (β=-1.101[-1.653, -0.549]). A significant association was observed between hypertension and abnormality of early kidney damage markers. Subgroup analysis reveals that the positive correlation between DII and the occurrence of abnormal markers of early kidney damage is only observed in individuals with hypertension. Furthermore, an interaction between DII and hypertension was detected in eGFRs&c (OR:1.250[1.042, 1.499], p for interaction = 0.03).

CONCLUSION

Higher levels of DII may be associated with occurrence of early kidney damage. For individuals with hypertension, avoiding excessive consumption of pro-inflammatory foods may reduce the risk of renal injury.

Association between dietary inflammatory index and chronic kidney disease in middle-aged and elderly populations

Background

A link between food-induced inflammation and common chronic diseases has been identified in studies. However, there was uncertainty about the influence of dietary inflammatory potential on the risk of chronic kidney disease (CKD) among middle-aged and older groups. Our research aimed to examine the connection between dietary inflammatory index (DII) to CKD in people aged 40 years and older.

Methods

This study comprised ten cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Linear associations of DII with CKD, low-eGFR, and albuminuria were examined using multiple logistic regression, whereas non-linear associations were assessed by smoothed curve fitting. Besides, we conducted subgroup analyses and interaction tests.

Results

Of the 23,175 middle-aged and older individuals, a total of 5,847 suffered from CKD, making up 25.23% of all participants. After adjustment for all covariates, we found that increased DII scores were positive with an increased hazard of CKD (OR = 1.08, 95% CI: 1.05, 1.10, p < 0.0001), and the same was shown between DII and low-eGFR (OR = 1.16, 95% CI: 1.13, 1.19, p < 0.0001). After further converting DII into categorical variables, the above relationship still existed. These relations were consistent in different ages, genders, BMI, whether smoking, whether suffering from hypertension, and whether suffering from diabetes, with no significant stratification differences (all P for interaction >0.05). Surprisingly, we did not find a statistically significant correlation of DII to albuminuria after complete adjustment for covariates (OR = 1.02, 95% CI: 1.00, 1.05, p = 0.0742). Even when DII was considered as a categorical variable, this relation was still not statistically significant. Furthermore, we found an association in the shape of a U between DII and low-eGFR in the fully adjusted model, with a turning point at a DII of 1.6.

Conclusion

Our findings indicated that middle-aged and older persons with greater levels of DII had a significantly higher risk of CKD.