Abstract
Diet and chronic inflammation have been suggested to be risk factors in the development of cardiovascular disease (CVD) and related mortality. The possible link between the inflammatory potential of diet measured through the Dietary Inflammatory Index (DII®) and CVD has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from 14 studies were eligible, of which two were case-control, eleven were cohort, and one was cross-sectional. Results from the random-effects meta-analysis showed a positive association between increasing DII, indicating a pro-inflammatory diet, and CVD. Individuals in the highest versus the lowest (reference) DII category showed a 36% increased risk of CVD incidence and mortality, with moderate evidence of heterogeneity (relative risk (RR) = 1.36, 95% confidence interval (CI): 1.19, 1.57; heterogeneity index I2 = 69%, p < 0.001). When analyzed as a continuous variable, results showed an increased risk of CVD risk and mortality of 8% for each one-point increase in the DII score. Results remained unchanged when analyses were restricted to the prospective studies. Results of our meta-analysis support the importance of adopting a healthier anti-inflammatory diet for preventing CVD incidence and related mortality. In conclusion, a pro-inflammatory diet is associated with increased risk of CVD and CVD mortality. These results further substantiate the utility of DII as tool to characterize the inflammatory potential of diet and to predict CVD incidence and mortality.
Highlights
Chronic inflammation is characterized by the continuous presence of pro-inflammatory cytokines through increased blood flow during tissue injury, as a consequence of histamine released by damaged mast cells [1], and is known to play a major role in the development of cardiovascular diseases (CVD) and related mortality [2]
This meta-analysis, which used results from 14 studies that have examined the association between the DII and CVD, showed strong evidence of association between increasing inflammatory potential of diet and CVD risk and related mortality
Up until the development of the DII, all dietary indices fell into one of three categories: (1) those based on dietary recommendations such as the Healthy Eating Index-2010 (HEI-2010) [51], or the Alternative Healthy Eating Index (AHEI) [52], both based on the US Dietary Guidelines or the Dietary
Summary
Chronic inflammation is characterized by the continuous presence of pro-inflammatory cytokines through increased blood flow during tissue injury, as a consequence of histamine released by damaged mast cells [1], and is known to play a major role in the development of cardiovascular diseases (CVD) and related mortality [2]. Various dietary components have been implicated in playing a major role in the development of various CVDs [8,9,10]. In a recent meta-analysis, increased intake of processed meat has been shown to be associated with increased risk of CVD mortality [11]. Increased adherence to healthier dietary patterns characterized by increased intake of plant-based foods such as fruit and vegetables, nuts, and whole grains and adherence to a healthier dietary pattern has been shown to help prevent and to manage CVD [12,13,14]. An increased intake of polyphenols, anti-oxidants with ability to decreases oxidative stress and inflammation through scavenging free radicals [15], was shown to be associated with decreased risk of overall and CVD-related mortality [16]
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