Higher Empirical Dietary Inflammatory Pattern Research Articles

Dietary inflammatory and insulinemic potential, risk of hepatocellular carcinoma, and chronic liver disease mortality.

Diet modulates inflammation and insulin response and may be an important modifiable factor in the primary prevention of hepatocellular carcinoma (HCC) and chronic liver disease (CLD). We developed the empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores to assess the inflammatory and insulinemic potentials of diet. We prospectively examined the associations of EDIP and EDIH at baseline with the following HCC risk and CLD mortality. We followed 485 931 individuals in the National Institutes of Health-American Association of Retired Persons Diet and Health Study since 1995. Cox proportional hazards regression was used to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs). We confirmed 635 incident HCC cases and 993 CLD deaths. Participants in the highest compared with those in the lowest EDIP quartile had a 1.35 times higher risk of developing HCC (95% CI = 1.08 to 1.70, Ptrend = .0005) and a 1.70 times higher CLD mortality (95% CI = 1.41 to 2.04, Ptrend < .0001). For the same comparison, participants with the highest EDIH were at increased risk of HCC (HR = 1.53, 95% CI = 1.20 to 1.95, Ptrend = .0004) and CLD mortality (HR = 1.72, 95% CI = 1.42 to 2.01, Ptrend < .0001). Similar positive associations of scores with HCC risk and CLD mortality were observed for both women and men. Moreover, individuals in both the highest EDIP and EDIH tertiles had a 92% increased HCC risk (95% CI = 1.43 to 2.58) and 98% increased CLD mortality (95% CI = 1.27 to 3.08) compared with those in both lowest tertiles. Our findings suggest that inflammation and hyperinsulinemia are potential mechanisms linking diet to HCC development and CLD mortality.

Abstract 16: Inflammatory and insulinemic dietary patterns and risk of endometrial cancer: Results from two prospective US cohort studies

Abstract Background: Whilst unopposed estrogen exposure is considered the major driver of endometrial carcinogenesis, inflammation and insulin resistance/hyperinsulinemia are major biological pathways that increase the risk of endometrial cancer. However, it is unclear whether diets with inflammatory or insulinemic potential are associated with risk of type 1 endometrial cancer. Methods: We prospectively followed 48,526 women from the Nurses’ Health Study (NHS, 1984-2016) and 87,323 women from the Nurses’ Health Study II (NHS II, 1989-2017). Using repeated measures of food frequency questionnaires, we calculated empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores which are food-based indices that characterize dietary inflammatory or insulinemic potential based on circulating biomarkers of inflammation or C-peptide, respectively. Cox regression was used to estimate Hazard Ratios (HRs) and 95% confidence intervals (CIs) for type 1 endometrial cancer risk. Results: We documented 1,468 type 1 endometrial cancer cases over 2,544,615 person-years of follow-up. Diets with higher inflammatory or insulinemic potential were associated with increased risk of type 1 endometrial cancer in the Nurses’ Health Studies. In the pooled multivariable-adjusted analyses, women in the highest EDIP or EDIH quintile had 1.66 times (HR, 1.66; 95% CI, 1.40-1.97) and 1.57 times (HR, 1.57; 95% CI, 1.33-1.86) higher risk of type 1 endometrial cancer, respectively, compared to women in the lowest quintile. However, additional adjustment for body mass index (BMI) attenuated the associations (HR, 1.15; 95% CI, 0.96-1.37 for EDIP; HR, 1.02; 95% CI, 0.85-1.21 for EDIH), suggesting adiposity may mediate the association of these dietary indices with type 1 endometrial cancer risk. In subgroup analyses, we observed a significant interaction by BMI (P-interaction&amp;lt;0.01), where a significant direct association with EDIP was evident in women with BMI between 27 and 30 (HRQ5vs.Q1 1.47; 95% CI 0.92, 2.35; p-trend=0.02), but not among normal weight or obese women. Further adjusting for continuous BMI did not change the scenario (HRQ5vs.Q11.44; 95% CI 0.90, 2.30). Conclusions: We found that higher dietary inflammatory or insulinemic potential was associated with increased type 1 endometrial cancer incidence, nonetheless this association was not independent of adiposity. Furthermore, among overweight women, greater EDIP was directly associated with risk, even after adjusting for BMI. Citation Format: Andrea Romanos-Nanclares, Fred K. Tabung, Jennifer Sinnott, Britton Trabert, Immaculata De Vivo, Mary C. Playdon, A. Heather Eliassen. Inflammatory and insulinemic dietary patterns and risk of endometrial cancer: Results from two prospective US cohort studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 16.

Higher empirical dietary inflammatory pattern scores are associated with worse cognitive performance in the Nurses’ Health Study

AbstractBackgroundWe evaluated whether higher cumulative Empirical Dietary Inflammatory Pattern (EDIP) scores were associated lower cognitive function, in the Nurses’ Health Study.Method16,058 post‐menopausal women (mean age 74 (Standard deviation, 2)) completed a validated 116‐item Food Frequency Questionnaire. The EDIP score, previously derived with the use of reduced rank regression to predict circulating inflammatory markers (i.e. C‐reactive protein, tumor necrosis factor α receptor 2 and interleukin‐6), consists of ten anti‐inflammatory and nine pro‐inflammatory components. A cumulative EDIP score was calculated by averaging across five exams (1984‐1998) taking the first exam (1984) or second exam (1986) as baseline exams. The EDIP score was categorized into five quintiles, taking the first (anti‐inflammatory) quintile as the reference category. Cognitive testing was performed through telephone interviews over four follow up exams (1995‐2008). A composite global cognition score, a composite verbal memory score and the Telephone Interview for Cognitive Status (TICS) were calculated and averaged across the four exams.ResultHigher cumulative EDIP scores (i.e. more pro‐inflammatory) were significantly associated with worse performance on global cognitive function (p for trend &lt;0.01) and TICS (p for trend &lt;0.001) after adjustment for age, education and body mass index, physical activity, energy intake, smoking, multivitamin use, depression. The relationship between higher cumulative EDIP scores and TICS remained (p for trend 0.04) following additional adjustments for hypertension, high cholesterol, myocardial infarction, diabetes, menopausal hormone use and nonsteroidal anti‐inflammatory drugs. But the association between the EDIP score and global cognitive function attenuated and became non‐significant. No association was observed between the EDIP score and verbal memory.ConclusionHigher cumulative EDIP scores strongly associated with worse performance on averaged TICS regardless of the model among older women. But the relationships between the EDIP score and global cognitive function and verbal memory were mainly explained by potential confounders and intermediates leaving findings attenuated and not significant. Our study shows that pro‐inflammatory diets not only are detrimental for risk factors of cognitive decline but also for cognitive function itself. Future studies are encouraged to investigate the relationships in men and over a long follow up period.

Dietary Inflammatory and Insulinemic Potential and Risk of Type 2 Diabetes: Results From Three Prospective U.S. Cohort Studies.

To examine whether proinflammatory and hyperinsulinemic diets are associated with increased risk of type 2 diabetes. We prospectively followed 74,767 women from the Nurses' Health Study (1984-2016), 90,786 women from the Nurses' Health Study II (1989-2017), and 39,442 men from the Health Professionals Follow-up Study (1986-2016). Using repeated measures of food-frequency questionnaires, we calculated empirical dietary inflammatory pattern (EDIP) and empirical dietary index for hyperinsulinemia (EDIH) scores, which are food-based indices that characterize dietary inflammatory or insulinemic potential based on circulating biomarkers of inflammation or C-peptide. Diagnoses of type 2 diabetes were confirmed by validated supplementary questionnaires. We documented 19,666 incident type 2 diabetes cases over 4.9 million person-years of follow-up. In the pooled multivariable-adjusted analyses, individuals in the highest EDIP or EDIH quintile had 3.11 times (95% CI 2.96-3.27) and 3.40 times (95% CI 3.23-3.58) higher type 2 diabetes risk, respectively, compared with those in the lowest quintile. Additional adjustment for BMI attenuated the associations (hazard ratio 1.95 [95% CI 1.85-2.05] for EDIP and hazard ratio 1.87 [95% CI 1.78-1.98] for EDIH), suggesting adiposity partly mediates the observed associations. Moreover, individuals in both highest EDIP and EDIH quintiles had 2.34 times higher type 2 diabetes risk (95% CI 2.17-2.52), compared with those in both lowest quintiles, after adjustment for BMI. Higher dietary inflammatory and insulinemic potential were associated with increased type 2 diabetes incidence. Findings suggest that inflammation and hyperinsulinemia are potential mechanisms linking dietary patterns and type 2 diabetes development.

Abstract 26: Polygenic Risk Score for Obesity Modifies Associations of Proinflammatory Diets With Obesity, Long-term Weight Gain, and Cardiovascular Disease Risk: The Utilization of Polygenic Prediction in 3 US Prospective Cohorts

Background: Individuals predisposed to higher genetic risk of obesity may need early dietary interventions to prevent obesity and its comorbidities. Hypothesis: Proinflammatory diets may interact with genetic background to modify risks of obesity, long-term weight gain, and cardiovascular disease (CVD). Methods: We prospectively followed 16 281 and 11 832 women in the Nurses’ Health Study I and II, and 10 172 men in Health Professionals Follow-up Study, with available genetic data, for up to 28 years. Diet and weight were assessed every 4 years. Dietary inflammatory potential was assessed by an empirical dietary inflammatory pattern (EDIP) score pre-defined based on associations of foods with inflammatory markers. Polygenic risk scores (PRS) of body mass index (BMI), waist-hip ratio, and body fat mass, developed based on genome-wide association data of 9 million variants in 389 972 UK Biobank participants using LDpred, were applied to characterize genetic predispositions to obesity, central obesity, and adiposity. Results: All 3 PRS were highly predictive for BMI ( Fig. A ). In pooled multivariable analyses, higher EDIP scores were associated with a higher BMI, with the association 2-3 folds stronger comparing participants in the highest 10% to the lowest 10% of genetic risk of obesity/adiposity ( P interaction ≤0.001; Fig. B ). The positive association between EDIP and CVD incidence was 1.6-fold stronger in participants at a higher genetic risk of central obesity ( P interaction =0.04; Fig. C ). In addition, an increase in EDIP scores was associated with a greater long-term weight gain, while a reduction in EDIP was associated with a greater weight loss, comparing participants in the highest 10% of genetic risk to those at lower risks, among participants aged &lt;65 years but not above ( P interaction &lt;0.005; Fig. D ). Conclusions: Polygenic background modifies associations of proinflammatory diets with obesity, long-term weight change, and CVD risk. PRS may be useful tools to identify individuals in need for early dietary interventions.

Abstract 030: Dietary Inflammatory Potential is Associated with Cardiovascular Disease Risk in Two Large Prospective Cohort Studies of US Men and Women

Introduction: Chronic inflammation plays a pathogenic role in cardiovascular disease (CVD) development. Dietary factors have been implicated in CVD etiology and may have an impact on chronic inflammation. Hypothesis: Proinflammatory diets are associated with higher CVD risk. Methods: We include74,544 women in the Nurses’ Health Study (from 1984 through 2012) and 43,904 men in the Health Professionals Follow-up Study (from 1986 through 2012), who were free of heart disease, stroke, and cancer at baseline. Dietary inflammatory potentials were assessed using an empirical dietary inflammatory pattern (EDIP) score that has been pre-defined by 18 food components based on their associations with circulating levels of systemic inflammation markers C-reactive protein, interleukin-6, and tumor necrosis factor-α receptor 2. Adjusted hazard ratios (HRs) and 95% confidence internals (CIs) for CVD were calculated using Cox regressions. Results: During 2,831,128 person-years of follow-up, we documented 13,249 incident CVD cases, including 8,178 coronary heart disease cases and 5,182 stroke cases. After adjusting for established risk factors and potential confounders including body-mass index and aspirin or other nonsteroidal anti-inflammatory medication use, a higher EDIP score was associated with an increased risk of CVD (in pooled analyses, HR [95% CI] comparing the highest to the lowest quintiles were 1.29 [1.22 to 1.37]; P trend &lt;0.001), CHD (HR = 1.32[1.23 to 1.42]; P trend &lt;0.001), and stroke (HR = 1.25 [1.14 to 1.37]; P trend &lt;0.001). Associations were similar among subgroups of participants, including by age, sex, family history, BMI, physical activity, and alcohol intake; but were stronger among non/past-smoking than current smoking women ( P interaction &lt;0.002). Conclusions: Findings from two large US prospective cohort studies suggest that inflammation may be a potential mechanism linking dietary patterns to CVD progression. Reducing the proinflammatory potentials of the diet may assist CVD prevention.

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