Abstract
BackgroundChronic, low-grade inflammation is an established risk factor for cardiovascular disease. The inflammatory impact of diet can be reflected by concentrations of inflammatory markers in the bloodstream and the inflammatory potential of diet can be estimated by the dietary inflammatory index (DIITM), which has been associated with cardiovascular disease risk in some previous studies. We aimed to examine the association between the DII and the risk of first myocardial infarction (MI) in a population-based study with long follow-up.MethodWe conducted a prospective case–control study of 1389 verified cases of first MI and 5555 matched controls nested within the population-based cohorts of the Northern Sweden Health and Disease Study (NSHDS), of which the largest is the ongoing Västerbotten Intervention Programme (VIP) with nearly 100 000 participants during the study period. Median follow-up from recruitment to MI diagnosis was 6.4 years (6.2 for men and 7.2 for women). DII scores were derived from a validated food frequency questionnaire (FFQ) administered in 1986–2006. Multivariable conditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using quartile 1 (most anti-inflammatory diet) as the reference category. For validation, general linear models were used to estimate the association between the DII scores and two inflammatory markers, high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) in a subset (n = 605) of the study population.ResultsMale participants with the most pro-inflammatory DII scores had an increased risk of MI [ORQ4vsQ1 = 1.57 (95% CI 1.21–2.02) Ptrend = 0.02], which was essentially unchanged after adjustment for potential confounders, including cardiovascular risk factors [ORQ4vsQ1 = 1.50 (95% CI 1.14–1.99), Ptrend = 0.10]. No association was found between DII and MI in women. An increase of one DII score unit was associated with 9% higher hsCRP (95% CI 0.03–0.14) and 6% higher IL-6 (95% CI 0.02–0.11) in 605 controls with biomarker data available.ConclusionA pro-inflammatory diet was associated with an elevated risk of first myocardial infarction in men; whereas for women the relationship was null. Consideration of the inflammatory impact of diet could improve prevention of cardiovascular disease.
Highlights
Chronic, low-grade inflammation is an established risk factor for cardiovascular disease
Male participants with the most pro-inflammatory dietary inflammatory index (DII) scores had an increased risk of myocardial infarction (MI) [ORQ4vsQ1 = 1.57 Ptrend = 0.02], which was essentially unchanged after adjustment for potential confounders, including cardiovascular risk factors [ORQ4vsQ1 = 1.50, Ptrend = 0.10]
An increase of one DII score unit was associated with 9% higher high-sensitivity C-reactive protein (hsCRP) and 6% higher IL-6 in 605 controls with biomarker data available
Summary
Low-grade inflammation is an established risk factor for cardiovascular disease. The inflammatory impact of diet can be reflected by concentrations of inflammatory markers in the bloodstream and the inflammatory potential of diet can be estimated by the dietary inflammatory index (DIITM), which has been associated with cardiovascular disease risk in some previous studies. Low-grade, systemic inflammation in the human body is associated with several chronic diseases and there is evidence that diet might affect the incidence of cardiovascular disease (CVD) through inflammatory mechanisms [1,2,3,4,5]. The impact of diet on chronic low-grade inflammation can be reflected by concentrations of inflammatory markers in the bloodstream, including cytokines, acute-phase proteins, soluble adhesion molecules and cytokine receptors [6]. Because questions about recreational physical activity varied in the two cohorts, three different variables concerning physical activity were harmonized on a three-level scale (low, medium, high) [31]
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