Adiposity Mediates the Association between the Dietary Inflammatory Index and Markers of Type 2 Diabetes Risk in Middle-Aged Black South African Women.

Asanda Mtintsilana,Elin Chorell,Andre P Kengne,Lisa K Micklesfield,Julia H Goedecke,Tommy Olsson,James R Hebert,Nitin Shivappa

doi:10.3390/nu11061246

Abstract

The dietary inflammatory index (DII®), a validated tool used to measure the inflammatory potential of the diet, has been associated with metabolic disorders in various settings, but not in African populations. The aim of this study was to investigate whether the DII is associated with markers of type 2 diabetes (T2D) risk, and if this association is mediated by adiposity and/or low-grade inflammation, in black South Africa women. Energy-adjusted-DII (E-DII) scores were calculated in 190 women (median age, 53 years) from the Birth-to-Twenty plus cohort using a validated food frequency questionnaire. Fasting glucose, insulin, HbA1c, and inflammatory cytokines were measured, and an oral glucose tolerance test performed. Basic anthropometry and dual-energy x-ray absorptiometry-derived body fat, including estimate of visceral adipose tissue (VAT) area, were measured. E-DII scores were associated with all markers of T2D risk, namely, fasting glucose and insulin, HbA1c, HOMA2-IR, two-hour glucose and Matsuda index (all p < 0.05). After adjusting for age, measures of adiposity, but not inflammatory cytokines, mediated the association between E-DII and markers of T2D risk (p < 0.05). Measures of central obesity had proportionally higher (range: 23.5–100%) mediation effects than total obesity (range: 10–60%). The E-DII is associated with T2D risk through obesity, in particular central obesity, among black middle-aged South African women.

Highlights

The rapid increase in the prevalence of non-communicable diseases (NCDs), such as type 2 diabetes (T2D), has become a major health concern, in developing countries, such as SouthNutrients 2019, 11, 1246; doi:10.3390/nu11061246 www.mdpi.com/journal/nutrientsAfrica (SA) [1,2,3]
Of great concern is that urban black SA women are at even greater risk of NCDs compared to their rural counterparts [7,8]
The aim of this study was to determine whether dietary-induced inflammation, measured by the dietary inflammatory index (DII), is associated with markers of T2D risk, and if this association is mediated by adiposity and/or inflammatory markers, in middle-aged and older black SA women

Summary

Introduction

The rapid increase in the prevalence of non-communicable diseases (NCDs), such as type 2 diabetes (T2D), has become a major health concern, in developing countries, such as SouthNutrients 2019, 11, 1246; doi:10.3390/nu11061246 www.mdpi.com/journal/nutrientsAfrica (SA) [1,2,3]. The rapid increase in the prevalence of non-communicable diseases (NCDs), such as type 2 diabetes (T2D), has become a major health concern, in developing countries, such as South. South Africa had a diabetes prevalence of 5.5% in 2017 [3]. In 2016, diabetes was the second leading cause of mortality in SA after tuberculosis, accounting for 5.5% of all deaths in both males and females [2]. The prevalence of obesity and insulin resistance (IR), major risk factors for T2D, is higher in black SA women than in white SA women [4,5,6]. Of great concern is that urban black SA women are at even greater risk of NCDs compared to their rural counterparts [7,8].

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Conclusion