Dietary Inflammatory Index in relation to Type 2 Diabetes: A Meta-Analysis

Impact of dietary inflammatory index on gestational diabetes mellitus in normal and overweight women: a systematic review and meta-analysis of observational studies

BACKGROUND AND OBJECTIVES

To systematically investigate the association between the dietary inflammatory index (DII) and gestational diabetes mellitus (GDM), with a focus on the role of BMI in this relationship.

METHODS AND STUDY DESIGN

A comprehensive search was conducted in PubMed, Embase, Web of Science, The Cochrane Library, Medline, CINAHL Complete, Chinese Periodical Full-text Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and China Wanfang Database for rele-vant observational studies published up to August 2023. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The pooled effect size was calculated using a random-effects model. Sub-group and meta-regression analyses were performed to explore potential sources of heterogeneity.

RESULTS

The study included 54,058 participants from 10 studies. Pregnant women with a higher DII, indicating a pro-inflammatory diet, had a significantly increased risk of GDM compared to those with a lower DII, indicating an anti-inflammatory diet (pooled OR: 1.17, 95% CI: 1.01-1.36; I²=70%, p <0.001). Subgroup analyses revealed a stronger association in normal weight stratification (OR: 1.25, 95%CI: 1.04-1.51), case-control studies (OR: 1.45, 95%CI: 1.03-2.05), Asia (OR: 1.26, 95%CI: 1.10-1.43), Europe (OR: 1.27, 95%CI: 1.09-1.48), 3-day dietary record as a dietary assessment tool (OR: 1.30, 95%CI: 1.16-1.46), physical activity adjustment (OR: 1.28, 95%CI: 1.13-1.46), and energy intake adjustment (OR: 1.33, 95%CI: 1.19-1.48). Meta-regression analysis confirmed that geographical region significantly influenced heterogeneity between studies (p <0.05).

CONCLUSIONS

An elevated DII is independently linked to a higher risk of GDM, especially in women of normal weight.

Dietary inflammatory index and lower glomerular filtration rate in Mexican adults

We hypothesized that higher scores on the dietary inflammatory index (DII) would be associated with a lower glomerular filtration rate (GFR). This cross-sectional study included 2098 participants from Mexican Teachers Cohort Study, the Health Workers Cohort Study, and the Comitán Study belonging to the RenMex consortium. Energy-adjusted DII scores were estimated using a semi-quantitative food frequency questionnaire (FFQ). eGFR was estimated by the CKD Epidemiology Collaboration equation. Quantile regression models and ordered regression models were estimated to assess the associations of interest. Median age of study participants was 47 years, median eGFR was 102.9 mL/min/1.73m2, and the median energy-adjusted DII was 0.89 (range, -2.25, +4.86). The median eGFR was lower in participants in the highest percentile of DII compared to those in the lowest percentile (103.8 vs 101.4). We found that continuous and categorical energy-adjusted DII scores were associated with lower eGFR, especially at the lower percentiles. In adjusted ordered logistic regression, we found that the highest DII category was associated with 1.80 times the odds of belonging to the mildly decreased eGFR category or moderately decreased eGFR category compared lowest DII category (OR: 1.80, 95%CI 1.35, 2.40). A high DII score was associated with a lower eGFR among the Mexican population. Additional studies are crucial to validate these findings and explore potential strategies to reduce the consumption of pro-inflammatory foods as a preventive approach for chronic kidney disease (CKD).

Dietary inflammatory index after liver transplantation: Associated effects and long-term outcomes

BACKGROUND & AIMS

We examined the dietary inflammatory potential in patients who underwent liver transplantation (LTx), associated factors and its relationship with clinical outcomes ten years after the initial evaluation.

METHODS

Dietary Inflammatory Index (DII®) scores were generated from data derived from the 24-h recall in 108 patients.

RESULTS

Patients with higher DII scores (highest tertile), indicating a pro-inflammatory diet, had significantly higher serum LDL cholesterol (108.0 vs 78.2 mg/dL, p = <0.01) at the initial evaluation. However, DII scores did not significantly predict the occurrence of clinical outcomes after ten years of follow-up. Patient age was predictive of neoplasia (OR:1.05 95% CI:1.00-1.11; p = 0.03). Higher BMI at the initial evaluation was associated with steatosis (OR:1.51; 95% CI:1.29-1.77; p < 0.01), and smoking history was associated with the occurrence of cardiovascular events (OR:7.71; 95% CI:1.53-38.79; p = 0.01).

CONCLUSIONS

A pro-inflammatory diet was associated with higher serum LDL cholesterol in the initial evaluation but may not be strongly related to clinical outcomes during long-term follow-up.

Genetic predisposition, lifestyle inflammation score, food-based dietary inflammatory index, and the risk for incident diabetes: Findings from the KoGES data

BACKGROUND AND AIMS

We investigated whether genetic predisposition, the Lifestyle Inflammation Score (LIS), or the Food-based Dietary Inflammatory Index (FDII) were associated with diabetes incidence and whether these factors interact.

METHODS AND RESULTS

The study was conducted using population-based cohort data derived from the Korean Genome and Epidemiology Study, which included 6568 people aged 40-69 years. Based on 25 genetic variants related to diabetes, genetic risk scores (GRSs) were determined and LISs and FDIIs were calculated and stratified into quartiles. We investigated the effects of gene-lifestyle interactions on the incident diabetes. The multivariate Cox proportional hazard model was used to generate hazard ratios with 95 % CIs. During the 16-year follow-up period, diabetes incidence was 13.6 per 1000 person-years. A dose-response association with diabetes was observed for both GRS and LIS quartiles but not for FDII quartiles. The GRS and LIS were also independently associated with diabetes incidence in a multivariate model. Compared to the bottom quartile, the top LIS quartile and the top GRS quartile had a 2.4-fold (95 % CI, 2.0-2.8) and a 1.4-fold (95 % CI, 1.2-1.7) higher diabetes risk, respectively. However, the FDII exhibited null association. When each genetic variant was evaluated, the top versus bottom LIS quartiles exhibited heterogeneous diabetes risks for rs560887 within G6PC2, rs7072268 within HK1, and rs837763 within CDT1; however, these differences were not statistically significant in multiple comparison.

CONCLUSION

Both GRS and LIS factors independently affect the incident diabetes, but their interaction effect showed insignificant association. Therefore, regardless of genetic susceptibility, more effort is needed to lower the risk for diabetes by improving lifestyle behaviors.

Precision Nutrition Unveiled: Gene-Nutrient Interactions, Microbiota Dynamics, and Lifestyle Factors in Obesity Management

BACKGROUND

Obesity is a complex metabolic disorder that is associated with several diseases. Recently, precision nutrition (PN) has emerged as a tailored approach to provide individualised dietary recommendations.

AIM

This review discusses the major intrinsic and extrinsic components considered when applying PN during the management of obesity and common associated chronic conditions.

RESULTS

The review identified three main PN components: gene-nutrient interactions, intestinal microbiota, and lifestyle factors. Genetic makeup significantly contributes to inter-individual variations in dietary behaviours, with advanced genome sequencing and population genetics aiding in detecting gene variants associated with obesity. Additionally, PN-based host-microbiota evaluation emerges as an advanced therapeutic tool, impacting disease control and prevention. The gut microbiome's composition regulates diverse responses to nutritional recommendations. Several studies highlight PN's effectiveness in improving diet quality and enhancing adherence to physical activity among obese patients. PN is a key strategy for addressing obesity-related risk factors, encompassing dietary patterns, body weight, fat, blood lipids, glucose levels, and insulin resistance.

CONCLUSION

PN stands out as a feasible tool for effectively managing obesity, considering its ability to integrate genetic and lifestyle factors. The application of PN-based approaches not only improves current obesity conditions but also holds promise for preventing obesity and its associated complications in the long term.

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.

Associations between the New DNA-Methylation-Based Telomere Length Estimator, the Mediterranean Diet and Genetics in a Spanish Population at High Cardiovascular Risk

Biological aging is a relevant risk factor for chronic diseases, and several indicators for measuring this factor have been proposed, with telomere length (TL) among the most studied. Oxidative stress may regulate telomere shortening, which is implicated in the increased risk. Using a novel estimator for TL, we examined whether adherence to the Mediterranean diet (MedDiet), a highly antioxidant-rich dietary pattern, is associated with longer TL. We determined TL using DNA methylation algorithms (DNAmTL) in 414 subjects at high cardiovascular risk from Spain. Adherence to the MedDiet was assessed by a validated score, and genetic variants in candidate genes and at the genome-wide level were analyzed. We observed several significant associations (p < 0.05) between DNAmTL and candidate genes (TERT, TERF2, RTEL1, and DCAF4), contributing to the validity of DNAmTL as a biomarker in this population. Higher adherence to the MedDiet was associated with lower odds of having a shorter TL in the whole sample (OR = 0.93; 95% CI: 0.85-0.99; p = 0.049 after fully multivariate adjustment). Nevertheless, this association was stronger in women than in men. Likewise, in women, we observed a direct association between adherence to the MedDiet score and DNAmTL as a continuous variable (beta = 0.015; SE: 0.005; p = 0.003), indicating that a one-point increase in adherence was related to an average increase of 0.015 ± 0.005 kb in TL. Upon examination of specific dietary items within the global score, we found that fruits, fish, "sofrito", and whole grains exhibited the strongest associations in women. The novel score combining these items was significantly associated in the whole population. In the genome-wide association study (GWAS), we identified ten polymorphisms at the suggestive level of significance (p < 1 × 10-5) for DNAmTL (intergenics, in the IQSEC1, NCAPG2, and ABI3BP genes) and detected some gene-MedDiet modulations on DNAmTL. As this is the first study analyzing the DNAmTL estimator, genetics, and modulation by the MedDiet, more studies are needed to confirm these findings.

Adherence to diet with higher dietary diabetes risk reduction score is associated with reduced risk of type 2 diabetes incident in Iranian adults

BACKGROUND

The Dietary diabetes risk reduction score (DDRRS) has recently been considered by researchers as a diet quality index to predict the risk of chronic diseases, such as type 2 diabetes (T2D). In this study, we aimed to assess the association of DDRRS with T2D risk in Iranian adults.

METHODS

Subjects aged ≥ 40 years without T2D (n = 2081) were selected for the current study from participants of the Tehran Lipid and Glucose Study (2009-2011) and followed for a mean of 6.01 years. We used the food frequency questionnaire to determine the DDRRS that is characterized by eight components, including higher consumption of nuts, cereal fiber, coffee, and polyunsaturated to saturated fat ratio and lower consumption of red or processed meats, trans fats, sugar-sweetened beverages, and high glycemic index foods. The multivariable logistic regression analysis was used to determine the odds ratio (ORs) and 95% confidence interval (CI) of T2D across the DDRRS tertiles.

RESULTS

The mean ± SD age of individuals was 50.4 ± 8.2 years at baseline. The Median (25-75 interquartile range) DDRRS of the study population was 24(22-27). During the study follow-up, 233(11.2%) new cases of T2D were ascertained. In the age and sex-adjusted model, the odds of T2D were decreased across tertiles of DDRRS (OR = 0.68; 95%CI: 0.48-0.97, P for trend = 0.037). Based on the multivariable-adjusted model, after controlling all potential confounders, the risk of T2D is reduced across tertiles of DDRRS (OR = 0.66; 95%CI: 0.44-0.98, P for trend = 0.047). Also, higher scores (lower consumption) of red and processed meat (OR = 0.59; 95%CI: 0.39-0.88, P = 0.012) and sugar-sweetened beverages (OR = 0.49; 95%CI: 0.32-0.76, P = 0.002) as DDRRS components were associated with decreased T2D incident.

CONCLUSIONS

Our findings suggested that a diet with a higher score of DDRRS may be related to reducing the risk of T2D in Iranian adults.

Omics biomarkers and an approach for their practical implementation to delineate health status for personalized nutrition strategies

Personalized nutrition (PN) has gained much attention as a tool for empowerment of consumers to promote changes in dietary behavior, optimizing health status and preventing diet related diseases. Generalized implementation of PN faces different obstacles, one of the most relevant being metabolic characterization of the individual. Although omics technologies allow for assessment the dynamics of metabolism with unprecedented detail, its translatability as affordable and simple PN protocols is still difficult due to the complexity of metabolic regulation and to different technical and economical constrains. In this work, we propose a conceptual framework that considers the dysregulation of a few overarching processes, namely Carbohydrate metabolism, lipid metabolism, inflammation, oxidative stress and microbiota-derived metabolites, as the basis of the onset of several non-communicable diseases. These processes can be assessed and characterized by specific sets of proteomic, metabolomic and genetic markers that minimize operational constrains and maximize the information obtained at the individual level. Current machine learning and data analysis methodologies allow the development of algorithms to integrate omics and genetic markers. Reduction of dimensionality of variables facilitates the implementation of omics and genetic information in digital tools. This framework is exemplified by presenting the EU-Funded project PREVENTOMICS as a use case.

A Proinflammatory Diet Is Associated with Higher Risk of Peripheral Artery Disease

Peripheral arterial disease (PAD) has a strong relationship with inflammation. However, it is unclear whether the dietary inflammatory potential is associated with PAD. We aimed to address this knowledge gap. The dietary inflammatory index (DII) was obtained using a 24-h dietary recall interview for each individual. Logistic regression models and restricted cubic spline were performed to assess the relationship of DII with the prevalence of PAD. In addition, Spearman correlation analysis and subgroup analysis were also undertaken. In total, 5840 individuals from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) were enrolled in our study. Participants in higher DII quartile tended to have higher rates of PAD. The increase in DII scores showed a positive association with PAD after fully multivariate adjustment (OR (odds ratios) = 1.094, 95% confidence interval (CI): 1.022–1.171). The multivariable-adjusted OR and 95% CI of the highest DII index quartile compared with the lowest quartile was 1.543 (95% CI: 1.116–2.133). Subgroup analysis demonstrated that the positive association between DII and PAD was persistent across population subgroups. In conclusion, we report that a proinflammatory dietary pattern is related to a higher risk of developing PAD among US adults.