Citation

Garcia-Arellano A, Martinez-Gonzalez MA, Ramallal R, Salas-Salvadó J, Hébert JR, Corella D, Shivappa N, Forga L, Schroder H, Muñoz-Bravo C, Estruch R, Fiol M, Lapetra J, Serra-Majem L, Ros E, Rekondo J, Toledo E, Razquin C, Ruiz-Canela M, SUN and PREDIMED Study Investigators. Clin. Nutr. 2019; 38(3): 1221-1231.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.clnu.2018.05.003

PMID

30651193

Abstract

BACKGROUND: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet.
OBJECTIVE: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts.
DESIGN: We assessed 18,566 participants in the "Seguimiento Universidad de Navarra" (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the "PREvencion con DIeta MEDiterránea" (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality.
RESULTS: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%-32%, for the highest vs lowest category of DII).
CONCLUSION: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively.

Language: en

Keywords

Humans; Risk Factors; Adult; Female; Male; Middle Aged; Mortality; Prospective Studies; Young Adult; Randomized Controlled Trials as Topic; Body Mass Index; Inflammation; Obesity; Cohort studies; Smoking; Diet; Patient Compliance; Diabetes Mellitus, Type 2; Mediterranean diet; CRP; Dietary inflammatory index; C-Reactive Protein; Diet, Mediterranean