Inflammatory potential of diet and all-cause, cardiovascular, and cancer mortality in National Health and Nutrition Examination Survey III Study
- 640 Downloads
Various dietary components have been studied in relation to overall mortality; however, little is known about the relationship between the inflammatory potential of overall diet and mortality.
Materials and methods
We examined the association between the dietary inflammatory index (DII) and mortality in the National Health and Nutrition Examination Survey III follow-up study. The DII was computed from baseline dietary intake assessed using 24-h dietary recalls (1988–1994). Mortality was determined from the National Death Index records through 2006. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence interval (95 % CI). During the follow-up, 2795 deaths were identified, including 1233 due to cardiovascular disease (CVD), and 615 due to cancer, 158 of which were due to digestive-tract cancers.
Multivariate Cox proportional hazards regression analyses, adjusting for age, race, diabetes status, hypertension, physical activity, body mass index, poverty index, and smoking, revealed positive associations between higher DII scores and mortality. Comparing subjects in DII tertile 3 versus tertile 1, significant associations were noted for all-cause mortality (HRTertile3vs1 1.34; 95 % CI 1.19–1.51, P trend < 0.0001), CVD mortality (HRTertile3vs1 1.46; 95 % CI 1.18–1.81, P trend = 0.0006), cancer mortality (HRTertile3vs1 1.46; 95 % CI 1.10–1.96, P trend = 0.01), and digestive-tract cancer mortality (HRTertile3vs1 2.10; 95 % CI 1.15–3.84, P trend = 0.03).
These results indicate that a pro-inflammatory diet, as indicated by higher DII scores, was associated with higher risk of all-cause, CVD, and cancer mortality.
KeywordsDietary inflammatory index Mortality NHANES III
Drs. Shivappa and Hébert were supported by Grant No. R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases.
Compliance with ethical standards
Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is a paid employee of CHI.
- 7.Toriola AT, Cheng TY, Neuhouser ML, Wener MH, Zheng Y, Brown E, Miller JW, Song X, Beresford SA, Gunter MJ, Caudill MA, Ulrich CM (2013) Biomarkers of inflammation are associated with colorectal cancer risk in women but are not suitable as early detection markers. Int J Cancer 132(11):2648–2658. doi: 10.1002/ijc.27942 CrossRefGoogle Scholar
- 8.World Health Organization (2008) The global burden of disease: 2004 update. WHO, GenevaGoogle Scholar
- 10.Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y (2009) Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):480–486CrossRefGoogle Scholar
- 11.de Mello VD, Schwab U, Kolehmainen M, Koenig W, Siloaho M, Poutanen K, Mykkanen H, Uusitupa M (2011) A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomised controlled trial: the Sysdimet study. Diabetologia 54(11):2755–2767CrossRefGoogle Scholar
- 12.Khoo J, Piantadosi C, Duncan R, Worthley SG, Jenkins A, Noakes M, Worthley MI, Lange K, Wittert GA (2011) Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men. J Sex Med 8(10):2868–2875CrossRefGoogle Scholar
- 17.Deng X, Song Y, Manson JE, Signorello LB, Zhang SM, Shrubsole MJ, Ness RM, Seidner DL, Dai Q (2013) Magnesium, vitamin D status and mortality: results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III. BMC Med 11:187. doi: 10.1186/1741-7015-11-187 CrossRefGoogle Scholar
- 19.Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Tabung F, Hebert JR (2014) A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr 17(8):1825–1833. doi: 10.1017/S1368980013002565 CrossRefGoogle Scholar
- 20.Wirth MD, Burch J, Shivappa N, Violanti JM, Burchfiel CM, Fekedulegn D, Andrew ME, Hartley TA, Miller DB, Mnatsakanova A, Charles LE, Steck SE, Hurley TG, Vena JE, Hebert JR (2014) Association of a dietary inflammatory index with inflammatory indices and metabolic syndrome among police officers. J Occup Environ Med 56(9):986–989CrossRefGoogle Scholar
- 22.Shivappa N, Hebert JR, Rietzschel ER, De Buyzere ML, Langlois M, Debruyne E et al (2015) Associations between dietary inflammatory index and inflammatory markers in the Asklepios Study. Br J Nutr 113(4):665–671. PubMed PMID: 25639781. Pubmed Central PMCID: 4355619 Google Scholar
- 23.Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Agalliu I, Hingle M, Hou L, Hurley TG, Jiao L, Martin LW, Millen AE, Park HL, Rosal MC, Shikany JM, Shivappa N, Ockene JK, Hebert JR (2015) Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol 25(6):398–405. doi: 10.1016/j.annepidem.2015.03.009 CrossRefGoogle Scholar
- 27.Zamora-Ros R, Shivappa N, Steck SE, Canzian F, Landi S, Alonso MH, Hebert JR, Moreno V (2015) Dietary inflammatory index and inflammatory gene interactions in relation to colorectal cancer risk in the Bellvitge colorectal cancer case-control study. Genes Nutr 10(1):447. doi: 10.1007/s12263-014-0447-x CrossRefGoogle Scholar
- 29.Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Caan B, Hou L, Johnson KC, Mossavar-Rahmani Y, Shivappa N, Wactawski-Wende J, Ockene JK, Hebert JR (2015) The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women’s Health Initiative. Cancer Causes Control CCC 26(3):399–408. doi: 10.1007/s10552-014-0515-y CrossRefGoogle Scholar
- 38.Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–94. Series 1: programs and collection procedures (1994). Vital Health Stat 1(32):1–407Google Scholar
- 41.Otani T, Iwasaki M, Sasazuki S, Inoue M, Tsugane S, Japan Public Health Center-Based Prospective Study G (2006) Plasma C-reactive protein and risk of colorectal cancer in a nested case-control study: Japan Public Health Center-based prospective study. Cancer Epidemiol Biomarkers Prev 15(4):690–695CrossRefGoogle Scholar
- 46.Mitrou PN, Kipnis V, Thiebaut AC, Reedy J, Subar AF, Wirfalt E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A (2007) Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 167(22):2461–2468. doi: 10.1001/archinte.167.22.2461 CrossRefGoogle Scholar
- 48.Akbaraly TN, Ferrie JE, Berr C, Brunner EJ, Head J, Marmot MG, Singh-Manoux A, Ritchie K, Shipley MJ, Kivimaki M (2011) Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort. Am J Clin Nutr 94(1):247–253. doi: 10.3945/ajcn.111.013128 CrossRefGoogle Scholar
- 54.Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, Tabung F, Hebert JR (2013) A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr 10:1–9Google Scholar
- 55.Hebert JR (1985) Relationship of vegetarianism to child growth in South India. Am J Clin Nutr 42(6):1246–1254Google Scholar
- 56.Hebert JR (1985) Effects of water quality and water quantity on nutritional status: findings from a south Indian community. Bull World Health Organ 63(1):145–155Google Scholar
- 57.Hebert JR (1984) Water quality and water quantity and wasting in south India. Trop Geogr Med 36(4):375–381Google Scholar
- 59.Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC (2007) Dietary patterns and markers of systemic inflammation among Iranian women. J Nutr 137(4):992–998Google Scholar
- 62.Bruce WR, Giacca A, Medline A (2000) Possible mechanisms relating diet and risk of colon cancer. Cancer Epidemiol Biomarkers Prev 9(12):1271–1279Google Scholar
- 74.Sijtsma FP, Meyer KA, Steffen LM, Shikany JM, Van Horn L, Harnack L, Kromhout D, Jacobs DR Jr (2012) Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study. Am J Clin Nutr 95(3):580–586CrossRefGoogle Scholar
- 75.Thompson FE, Metzner HL, Lamphiear DE, Hawthorne VM (1990) Characteristics of individuals and long term reproducibility of dietary reports: the Tecumseh Diet Methodology Study. J Clin Epidemiol 43(11):1169–1178. http://www.ncbi.nlm.nih.gov/pubmed/2243254