Abstract P215: Inflammatory and Insulinemic Dietary Patterns Are Associated With Modestly Increased Total and Cardiometabolic Mortality Among Low-Income Americans

Abstract

Introduction: Diet is a modifiable risk factor for cardiometabolic morbidity and mortality, potentially via increased inflammation. Two hypothesis-oriented dietary patterns, the empirical dietary inflammatory potential (EDIP) and empirical dietary index for hyperinsulinemia (EDIH), have been linked to increased risk of cardiometabolic diseases and overall mortality. However, their associations with total and cause-specific mortality in Black Americans and populations of low socioeconomic status (SES) have not been described. Hypothesis: We assessed the hypothesis that higher EDIP and EDIH scores are associated with increased total and cause-specific mortality in a low SES and predominately Black population. Methods: In the Southern Community Cohort Study, a prospective cohort of mostly low-income Black and White adults recruited from 12 Southeastern states in the US, we included 77,209 participants who completed a food frequency questionnaire (FFQ) at baseline (2002-2009) and had been followed-up for mortality outcomes through 2019. The EDIP and EDIH scores were estimated based on 18 components derived from the FFQ. Cox proportional hazard models were used to estimate hazard ratios (HRs) of total and cardiometabolic mortality for the highest vs. lowest quintiles (Q5 vs. Q1) of EDIP/EDIH, adjusting for sociodemographics, lifestyles, and history of major chronic diseases. In a subgroup of 5,162 participants with data on blood levels of high-sensitivity C-reactive protein (hs-CRP), we also evaluated the correlations of EDIP and EDIH with hs-CRP. Results: Of 77,209 participants, 46,233 (59.9%) were women, 49,925 were Black (64.7%), and mean age was 52.4 (SD: 8.8) years at baseline. During an average follow-up of 12.9 years, we documented 20,028 total deaths, including 6,296 from cardiovascular disease and 1,150 from diabetes. Higher EDIP and EDIH scores were both associated with increased total and cardiometabolic mortality. EDIP and EDIH Q5 vs. Q1 HRs were 1.10 and 1.11 for total mortality, respectively (95% CIs: 1.05-1.16 and 1.06-1.17), 1.20 and 1.15 for cardiovascular mortality, respectively (95% CIs: 1.11-1.31 and 1.06-1.25), and 1.38 and 1.34 for diabetes mortality, respectively (95% CIs: 1.13-1.67 and 1.10-1.63); all p-trend ≤0.001. EDIP and EDIH weakly correlated with hs-CRP, despite statistical significance (r=0.058 for EDIP and 0.081 for EDIH; both p<0.0001). Conclusions: In conclusion, empirical inflammatory and insulinemic dietary patterns are associated with modestly increased inflammation and total and cardiometabolic mortality among low-income Black and White Americans. Efforts to improve nutrition may improve overall cardiometabolic health and prognosis.