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The association between dietary inflammation index and the risk of rheumatoid arthritis in Americans

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Abstract

Background

The correlation between dietary inflammation index (DII) and rheumatoid arthritis (RA) has been found, but the effect of confounding factors is not considered. This study aims to further explore the association between DII and RA risk by taking the Americans as the research object.

Methods

The data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES) database included 1819 self-reported RA individuals and 8602 non-RA individuals. The analytical methods include logistic regression, additive model, smooth curve fitting, and the recursive algorithm.

Results

There was a positive correlation between DII and RA in Americans (β = 1.068, 95% CI = 1.026 to 1.111, P = 0.001). This result was still presented in the subgroup analysis, including age less than 50 years, female, other Hispanics, BMI ≥ 25, and federal poverty rate > 185%, and it was more pronounced in smokers. The results show that the superposition of DII and other risk factors would increase the risk of RA (β > 1.068). In addition, individuals with RA are inadequate in intake of anti-inflammatory foods, in line with the Mediterranean diet.

Conclusions

The inflammatory potential of the diet is positively correlated with the risk of RA, and has a superimposed effect with other risk factors, increasing the probability of the risk of disease. These results emphasize that reducing the intake of pro-inflammatory foods may be an effective measure to prevent the onset of rheumatoid arthritis. However, eating anti-inflammatory foods exclusively is not the best option. Intaking some pro-inflammatory foods like protein, energy, and total saturated acids may be necessary to maintain the physiological function of the human body.

Key Points

• Dietary inflammation index (DII) is positively correlated with RA risk.

• When DII and other risk factors appear at the same time, the effects of the two will be superimposed on each other, increasing the risk of RA.

• When the DII is the same, Hispanic has a higher incidence of RA.

• Among the pro-inflammatory foods, the intake of protein, energy, and saturated fatty acids is still required by RA patients.

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References

  1. McInnes IB, Schett G (2011) The pathogenesis of rheumatoid arthritis. N Engl J Med 365:2205–2219. https://doi.org/10.1056/NEJMra1004965

    Article  CAS  PubMed  Google Scholar 

  2. Senftleber NK, Nielsen SM, Andersen JR et al (2017) Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. Nutrients 9:42. https://doi.org/10.3390/nu9010042

    Article  CAS  PubMed Central  Google Scholar 

  3. Tobón GJ, Youinou P, Saraux A (2010) The environment, geo-epidemiology, and autoimmune disease: rheumatoid arthritis. J Autoimmun 35:10–14. https://doi.org/10.1016/j.jaut.2009.12.009

    Article  PubMed  Google Scholar 

  4. Letarouilly JG, Flipo RM, Cortet B et al (2021) Body composition in patients with rheumatoid arthritis: a narrative literature review. Ther Adv Musculoskelet Dis 13:1759720x211015006. https://doi.org/10.1177/1759720X211015006

    Article  PubMed  PubMed Central  Google Scholar 

  5. Smolen JS, Aletaha D, McInnes IB (2016) Rheumatoid arthritis. Lancet 388:2023–2038. https://doi.org/10.1016/s0140-6736(16)30173-8

    Article  CAS  PubMed  Google Scholar 

  6. Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094–1108. https://doi.org/10.1016/s0140-6736(10)60826-4

    Article  PubMed  Google Scholar 

  7. Feng J, Chen Q, Yu F et al (2016) Body mass index and risk of rheumatoid arthritis: a meta-analysis of observational studies. Medicine (Baltimore) 95(8):e2859. https://doi.org/10.1097/md.0000000000002859

    Article  Google Scholar 

  8. Asoudeh F, Djafarian K, Akhalghi M et al (2022) The effect of probiotic cheese consumption on inflammatory and anti-inflammatory markers, disease severity, and symptoms in patients with rheumatoid arthritis: Study protocol for a randomized, double-blind, placebo-controlled trial. Trials 23:180. https://doi.org/10.1186/s13063-022-06113-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gioia C, Lucchino B, Tarsitano MG et al (2020) Dietary habits and nutrition in rheumatoid arthritis: can diet influence disease development and clinical manifestations? Nutrients 12:1456. https://doi.org/10.3390/nu12051456

    Article  CAS  PubMed Central  Google Scholar 

  10. Ouchi N, Parker JL, Lugus JJ et al (2011) Adipokines in inflammation and metabolic disease. Nat Rev Immunol 11:85–97. https://doi.org/10.1038/nri2921

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Comee L, Taylor CA, Nahikian-Nelms M et al (2019) Dietary patterns and nutrient intake of individuals with rheumatoid arthritis and osteoarthritis in the united states. Nutrition 67–68:110533. https://doi.org/10.1016/j.nut.2019.06.014

    Article  CAS  PubMed  Google Scholar 

  12. Rosillo M, Alcaraz MJ, Sánchez-Hidalgo M et al (2014) Anti-inflammatory and joint protective effects of extra-virgin olive-oil polyphenol extract in experimental arthritis. J Nutr Biochem 25:1275–1281. https://doi.org/10.1016/j.jnutbio.2014.07.006

    Article  CAS  PubMed  Google Scholar 

  13. Wagenaar CA, van de Put M, Bisschops M et al (2021) The effect of dietary interventions on chronic inflammatory diseases in relation to the microbiome: a systematic review. Nutrients 13:3208. https://doi.org/10.3390/nu13093208

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Li M, Wang F (2021) Role of intestinal microbiota on gut homeostasis and rheumatoid arthritis. J Immunol Res 2021:8167283. https://doi.org/10.1155/2021/8167283

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sanchez P, Letarouilly JG, Nguyen Y et al (2022) Efficacy of probiotics in rheumatoid arthritis and spondyloarthritis: a systematic review and meta-analysis of randomized controlled trials. Nutrients 14:354. https://doi.org/10.3390/nu14020354

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ferro M, Charneca S, Dourado E et al (2021) Probiotic supplementation for rheumatoid arthritis: a promising adjuvant therapy in the gut microbiome era. Front Pharmacol 12:711788. https://doi.org/10.3389/fphar.2021.711788

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Turesson Wadell A, Bärebring L, Hulander E et al (2021) Effects on health-related quality of life in the randomized, controlled crossover trial adira (anti-inflammatory diet in rheumatoid arthritis). PLoS ONE 16:e0258716. https://doi.org/10.1371/journal.pone.0258716

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hulander E, Bärebring L, Turesson Wadell A et al (2021) Proposed anti-inflammatory diet reduces inflammation in compliant, weight-stable patients with rheumatoid arthritis in a randomized controlled crossover trial. J Nutr 151:3856–3864. https://doi.org/10.1093/jn/nxab313

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cavicchia PP, Steck SE, Hurley TG et al (2009) A new dietary inflammatory index predicts interval changes in serum high-sensitivity c-reactive protein. J Nutr 139:2365–2372. https://doi.org/10.3945/jn.109.114025

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Shivappa N, Steck SE, Hurley TG et al (2014) Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr 17:1689–1696. https://doi.org/10.1017/s1368980013002115

    Article  PubMed  Google Scholar 

  21. Geng J, Deng L, Qiu S et al (2020) Dietary inflammatory potential and risk of sarcopenia: data from national health and nutrition examination surveys. Aging 13:1913–1928. https://doi.org/10.18632/aging.202141

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shivappa N, Godos J, Hébert JR et al (2017) Dietary inflammatory index and colorectal cancer risk-a meta-analysis. Nutrients 9:1043. https://doi.org/10.3390/nu9091043

    Article  CAS  PubMed Central  Google Scholar 

  23. Shivappa N, Hébert JR, Zucchetto A et al (2016) Increased risk of nasopharyngeal carcinoma with increasing levels of diet-associated inflammation in an italian case-control study. Nutr Cancer 68:1123–1130. https://doi.org/10.1080/01635581.2016.1216137

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Phillips CM, Chen LW, Heude B et al (2019) Dietary inflammatory index and non-communicable disease risk: a narrative review. Nutrients 11:1873. https://doi.org/10.3390/nu11081873

    Article  CAS  PubMed Central  Google Scholar 

  25. Shivappa N, Godos J, Hébert JR et al (2018) Dietary inflammatory index and cardiovascular risk and mortality-a meta-analysis. Nutrients 10:200. https://doi.org/10.3390/nu10020200

    Article  CAS  PubMed Central  Google Scholar 

  26. Aslani Z, Qorbani M, Hébert JR et al (2019) Association of dietary inflammatory index with anthropometric indices in children and adolescents: The weight disorder survey of the childhood and adolescence surveillance and prevention of adult non-communicable disease (caspian)-iv study. Br J Nutr 121:340–350. https://doi.org/10.1017/s0007114518003240

    Article  CAS  PubMed  Google Scholar 

  27. Jandari S, Mosalmanzadeh N, Shadmand Foumani Moghadam MR et al (2021) Dietary inflammatory index and healthy eating index-2015 are associated with rheumatoid arthritis. Public Health Nutr 24:6007–6014. https://doi.org/10.1017/S1368980021001105

    Article  PubMed  Google Scholar 

  28. Matsumoto Y, Shivappa N, Sugioka Y et al (2021) Change in dietary inflammatory index score is associated with control of long-term rheumatoid arthritis disease activity in a japanese cohort: the tomorrow study. Arthritis Res Ther 23:105. https://doi.org/10.1186/s13075-021-02478-y

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tandorost A, Kheirouri S, Moludi J et al (2021) Association of dietary inflammatory index (dii) with disease activity and inflammatory cytokines in the patients with rheumatoid arthritis. Int J Clin Pract 75:e14792. https://doi.org/10.1111/ijcp.14792

    Article  CAS  PubMed  Google Scholar 

  30. Ain QU, Sarfraz M, Prasesti GK et al (2021) Confounders in identification and analysis of inflammatory biomarkers in cardiovascular diseases. Biomolecules 11:1464. https://doi.org/10.3390/biom11101464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kirkpatrick SI, Reedy J, Krebs-Smith SM et al (2018) Applications of the healthy eating index for surveillance, epidemiology, and intervention research: considerations and caveats. J Acad Nutr Diet 118:1603–1621. https://doi.org/10.1016/j.jand.2018.05.020

    Article  PubMed  PubMed Central  Google Scholar 

  32. Deng MG, Nie JQ, Li YY et al (2022) Higher hei-2015 scores are associated with lower risk of sleep disorder: results from a nationally representative survey of united states adults. Nutrients 14:873. https://doi.org/10.3390/nu14040873

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gay IC, Tran DT, Paquette DW (2018) Alcohol intake and periodontitis in adults aged ≥30 years: Nhanes 2009–2012. J Periodontol 89:625–634. https://doi.org/10.1002/jper.17-0276

    Article  CAS  PubMed  Google Scholar 

  34. Sparks JA (2019) Rheumatoid arthritis. Ann Intern Med 170:Itc1-itc16. https://doi.org/10.7326/aitc201901010

    Article  PubMed  Google Scholar 

  35. Zhou Y, Sun M (2018) A meta-analysis of the relationship between body mass index and risk of rheumatoid arthritis. Excli J 17:1079–1089. https://doi.org/10.17179/excli2018-1763

    Article  PubMed  PubMed Central  Google Scholar 

  36. Vessey MP, Villard-Mackintosh L, Yeates D (1987) Oral contraceptives, cigarette smoking and other factors in relation to arthritis. Contraception 35:457–464. https://doi.org/10.1016/0010-7824(87)90082-5

    Article  CAS  PubMed  Google Scholar 

  37. Ryan AS, Craig LD, Finn SC (1992) Nutrient intakes and dietary patterns of older americans: a national study. J Gerontol 47:M145-150. https://doi.org/10.1093/geronj/47.5.m145

    Article  CAS  PubMed  Google Scholar 

  38. Hiza HA, Casavale KO, Guenther PM et al (2013) Diet quality of americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet 113:297–306. https://doi.org/10.1016/j.jand.2012.08.011

    Article  PubMed  Google Scholar 

  39. Chen Q, Li H, Liu Y et al (2022) Epigenetic regulation of immune and inflammatory responses in rheumatoid arthritis. Front Immunol 13:881191. https://doi.org/10.3389/fimmu.2022.881191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Frisell T, Saevarsdottir S, Askling J (2016) Family history of rheumatoid arthritis: an old concept with new developments. Nat Rev Rheumatol 12:335–343. https://doi.org/10.1038/nrrheum.2016.52

    Article  CAS  PubMed  Google Scholar 

  41. Del Rincón I, Battafarano DF, Arroyo RA et al (2003) Ethnic variation in the clinical manifestations of rheumatoid arthritis: role of hla-drb1 alleles. Arthritis Rheum 49:200–208. https://doi.org/10.1002/art.11000

    Article  PubMed  Google Scholar 

  42. del Rincón I, Escalante A (1999) Hla-drb1 alleles associated with susceptibility or resistance to rheumatoid arthritis, articular deformities, and disability in mexican americans. Arthritis Rheum 42:1329–1338. https://doi.org/10.1002/1529-0131(199907)42:7%3c1329::aid-anr5%3e3.0.co;2-1

    Article  PubMed  Google Scholar 

  43. Pardo MR, Garicano Vilar E, San Mauro Martín I et al (2021) Bioavailability of magnesium food supplements: a systematic review. Nutrition 89:111294. https://doi.org/10.1016/j.nut.2021.111294

    Article  CAS  PubMed  Google Scholar 

  44. Mehdi Y, Hornick JL, Istasse L et al (2013) Selenium in the environment, metabolism and involvement in body functions. Molecules 18:3292–3311. https://doi.org/10.3390/molecules18033292

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Meyer-Ficca M, Kirkland JB (2016) Niacin. Adv Nutr 7:556–558. https://doi.org/10.3945/an.115.011239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Petersson S, Philippou E, Rodomar C et al (2018) The mediterranean diet, fish oil supplements and rheumatoid arthritis outcomes: evidence from clinical trials. Autoimmun Rev 17(11):1105–1114. https://doi.org/10.1016/j.autrev.2018.06.007

    Article  CAS  PubMed  Google Scholar 

  47. Philippou E, Petersson SD, Rodomar C et al (2021) Rheumatoid arthritis and dietary interventions: Systematic review of clinical trials. Nutr Rev 79:410–428. https://doi.org/10.1093/nutrit/nuaa033

    Article  PubMed  Google Scholar 

  48. Smedslund G, Byfuglien MG, Olsen SU et al (2010) Effectiveness and safety of dietary interventions for rheumatoid arthritis: a systematic review of randomized controlled trials. J Am Diet Assoc 110:727–735. https://doi.org/10.1016/j.jada.2010.02.010

    Article  PubMed  Google Scholar 

  49. Lanchais K, Capel F, Tournadre A (2020) Could omega 3 fatty acids preserve muscle health in rheumatoid arthritis? Nutrients 12:223. https://doi.org/10.3390/nu12010223

    Article  CAS  PubMed Central  Google Scholar 

  50. Harcombe Z (2019) Us dietary guidelines: is saturated fat a nutrient of concern? Br J Sports Med 53:1393–1396. https://doi.org/10.1136/bjsports-2018-099420

    Article  PubMed  Google Scholar 

  51. Lopez S, Bermudez B, Ortega A et al (2011) Effects of meals rich in either monounsaturated or saturated fat on lipid concentrations and on insulin secretion and action in subjects with high fasting triglyceride concentrations. Am J Clin Nutr 93:494–499. https://doi.org/10.3945/ajcn.110.003251

    Article  CAS  PubMed  Google Scholar 

  52. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF et al (1991) Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 338:899–902. https://doi.org/10.1016/0140-6736(91)91770-u

    Article  CAS  PubMed  Google Scholar 

  53. Guagnano MT, D’Angelo C, Caniglia D et al (2021) Improvement of inflammation and pain after three months’ exclusion diet in rheumatoid arthritis patients. Nutrients 13:3535. https://doi.org/10.3390/nu13103535

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Vadell AKE, Bärebring L, Hulander E et al (2020) Anti-inflammatory diet in rheumatoid arthritis (adira)-a randomized, controlled crossover trial indicating effects on disease activity. Am J Clin Nutr 111:1203–1213. https://doi.org/10.1093/ajcn/nqaa019

    Article  PubMed  PubMed Central  Google Scholar 

  55. Taylor PC, Moore A, Vasilescu R et al (2016) A structured literature review of the burden of illness and unmet needs in patients with rheumatoid arthritis: a current perspective. Rheumatol Int 36:685–695. https://doi.org/10.1007/s00296-015-3415-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Bungau SG, Behl T, Singh A et al (2021) Targeting probiotics in rheumatoid arthritis. Nutrients 13:3376. https://doi.org/10.3390/nu13103376

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Le Roy CI, Kurilshikov A, Leeming ER et al (2022) Yoghurt consumption is associated with changes in the composition of the human gut microbiome and metabolome. BMC Microbiol 22:39. https://doi.org/10.1186/s12866-021-02364-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Alkushi AG, Abdelfattah-Hassan A, Eldoumani H et al (2022) Probiotics-loaded nanoparticles attenuated colon inflammation, oxidative stress, and apoptosis in colitis. Sci Rep 12:5116. https://doi.org/10.1038/s41598-022-08915-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This research was funded by the National Natural Science Foundation of China (Nos. 81904223, 81774179, 81973778); Medical Health Science and Technology Program of Zhejiang Province (No. 2020KY659); Youth Research and Innovation Fund of Zhejiang Chinese Medical University (No. KC201933); Bethune Charitable Foundation (No. G-X-2020–1107-17); Talent Cultivation Project of Zhejiang Association for Science and Technology (No. CTZB-2020080127); and Zhejiang University Student Science and Technology Innovation Activity Plan and New Seed Talent Plan (No. 2021R410056).

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Author notes

  1. Shate Xiang, Yao Wang and Suhai Qian contributed equally to this work.

Authors and Affiliations

  1. School of Basic Medical Sciences, Zhejiang Chinese Medical University, NO. 548 Binwen Road, Binjiang District, Hangzhou City, Zhejiang Province, China

    Shate Xiang, Yao Wang, Suhai Qian, Jie Li, Yibo Jin & Xinghong Ding

  2. The First Affiliated Hospital of Zhejiang Chinese Medical University, You Dian Road NO. 54, Hangzhou City, 310006, Zhejiang Province, China

    Taotao Xu

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  1. Shate Xiang
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Contributions

Conceptualization, SX and YW; methodology, TX; software, SX; validation, YW and SQ; formal analysis, SQ; investigation, JL; resources, YJ; data curation, JL; writing—original draft preparation, SX; writing—review and editing, YW.; visualization, SQ; super-vision, XD; project administration, XD and TX; funding acquisition, XD and TX. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Xinghong Ding or Taotao Xu.

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Xiang, S., Wang, Y., Qian, S. et al. The association between dietary inflammation index and the risk of rheumatoid arthritis in Americans. Clin Rheumatol 41, 2647–2658 (2022). https://doi.org/10.1007/s10067-022-06217-9

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