The Preoperative Dietary Inflammatory Index Predicts Changes in Cardiometabolic Risk Factors After 12 Months of Roux-en-Y Gastric Bypass



The objective of this study was to evaluate Dietary Inflammatory Index (DII®) in the preoperative period as well as 3 and 12 months post-surgery and its association with cardiometabolic risk factors after RYGB.

Materials and Methods

This is a prospective cohort study of 50 patients (both sexes) who underwent RYGB. All data were collected in 3 phases: before surgery, 3, and 12 months post-surgery. To calculate DII scores, we utilized mean nutrients from three 24-h recalls at each time point.


The patients had median age of 39.1 ± 7.9 years (70% women). Mean preoperative DII® score of 0.39 ± 1.49 was slightly pro-inflammatory. Mean DII score reduced to − 1.52 ± 1.27 after 3 months post-surgery and was classified anti-inflammatory. This value rebounded to − 0.88 ± 1.49 at 12 months but was still anti-inflammatory. From the adjusted linear regression analysis, we observed that preoperative DII score was statistically associated with variations in neck circumference (β = − 0.50; p = 0.03), waist-hip ratio (β = 0.01; p = 0.02), total cholesterol (β = 6.47; p = 0.002), and LDL cholesterol (β = 6.42; p = 0.001) after 12 months post-surgery. Changes in DII® at 3 and 12 months were not associated with changes in cardiometabolic risk factors.


We observe significant changes in the inflammation potential of diet after 3 and 12 months of RYGB. Patients with higher preoperative E-DII scores have a greater metabolic improvement after 12 months of surgery.

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  1. 1.

    Cox AR, Chernis N, Masschelin PM, et al. Immune cells gate white adipose tissue expansion. Endocrinology. 2019;160:1645–58.

    CAS  Article  Google Scholar 

  2. 2.

    Ouchi N, Parker JL, Lugus JJ, et al. Adipokines in inflammation and metabolic disease. Nat Rev Immunol Nature Publishing Group. 2011;11:85–97.

    CAS  Article  Google Scholar 

  3. 3.

    Mechanick JI, Kushner RF, Sugerman HJ, et al. Guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008;14:1–83.

    Article  Google Scholar 

  4. 4.

    Illán-Gómez F, Gonzálvez-Ortega M, Orea-Soler I, et al. Obesity and inflammation: change in adiponectin, C-reactive protein, tumour necrosis factor-alpha and interleukin-6 after bariatric surgery. Obes Surg. 2012;22:950–5.

    Article  Google Scholar 

  5. 5.

    Viana EC, Araujo-Dasilio KL, Miguel GPS, et al. Gastric bypass and sleeve gastrectomy: the same impact on IL-6 and TNF-α. prospective clinical trial. Obes Surg. 2013;23:1252–61.

    Article  Google Scholar 

  6. 6.

    Muller MK, Gero D, Reitnauer D, et al. Response to letter to the editor: the impact of Roux-en-Y gastric bypass on bone remodeling expressed by the P1NP/βCTX ratio: a single-center prospective cohort study. Obes Surg. 2019;29:3708–9.

    Article  Google Scholar 

  7. 7.

    Namazi N, Larijani B, Azadbakht L. Dietary inflammatory index and its association with the risk of cardiovascular diseases, metabolic syndrome, and mortality: a systematic review and meta-analysis. Horm Metab Res. 2018;50:345–58.

    CAS  Article  Google Scholar 

  8. 8.

    Shivappa N, Hebert JR, Marcos A, et al. Association between dietary inflammatory index and inflammatory markers in the HELENA study. Mol Nutr Food Res. 2017;61:1–23.

  9. 9.

    Shivappa N, Steck SE, Hurley TG, et al. Dietary inflammatory index. Public Health Nutr. 2014;17:1689–96.

    Article  Google Scholar 

  10. 10.

    Kim HS, Sohn C, Kwon M, et al. Positive association between dietary inflammatory index and the risk of osteoporosis: results from the KoGES_Health Examinee (HEXA) cohort study. Nutrients. 2018;10:1999.

    Article  Google Scholar 

  11. 11.

    Cantero I, Abete I, Babio N, et al. Dietary inflammatory index and liver status in subjects with different adiposity levels within the PREDIMED trial. Clin Nutr. 2018;37:1736–43.

    Article  Google Scholar 

  12. 12.

    Ruiz-Canela M, Zazpe I, Shivappa N, et al. Dietary inflammatory index and anthropometric measures of obesity in a population sample at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) trial. Br J Nutr. 2015;113:984–95.

    CAS  Article  Google Scholar 

  13. 13.

    Garcia-Arellano A, Martínez-González MA, Ramallal R, et al. Dietary inflammatory index and all-cause mortality in large cohorts: the SUN and PREDIMED studies. Clin Nutr. 2018;38:1–11.

  14. 14.

    IBGE. Instituto Brasileiro de Geografia e Estatística - Pesquisa de Orçamentos Familiares: 2008–2009. Análise do Consumo Alimentar Pessoal no Brasil. Bibl. do Minist. do Planejamento, Orçamento e Gestão. 2011.

  15. 15.

    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

    CAS  Article  Google Scholar 

  16. 16.

    Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6:299–304.

    Article  Google Scholar 

  17. 17.

    Bedogni G, Bellentani S, Miglioli L, et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006;6:33.

    Article  Google Scholar 

  18. 18.

    Jellife D. Evoluación del estado nutricion dela comunidad. Ginebra: Organización Mundial de la Salud. Série Monogr. 1968;53.

  19. 19.

    Callaway CW. et al. Circumferences. Apud Lohman, TG; Roche, AF; Martorell, R Anthr Standarization Ref Manual Hum Kinet Books Illinois. 1988.

  20. 20.

    Ben-Noun L, Laor A. Relationship of neck circumference to cardiovascular risk factors. Obes Res. 2003;11:226–31.

    Article  Google Scholar 

  21. 21.

    Salud. OM de la. El estado físico: uso e interpretación de la antropometría: informe de un Comitê de Expertos de la OMS. Ginebra Oragización Mund la Salud. 1995.

  22. 22.

    Andrade PA, Hermsdorff HHM, Leite JIA, et al. Baseline pro-inflammatory diet is inversely associated with change in weight and body fat 6 months following-up to bariatric surgery. Obes Surg. 2019;29:457–63.

    Article  Google Scholar 

  23. 23.

    Pinto SL, da Silva DCG, Bressan J. Absolute and relative changes in ultra-processed food consumption and dietary antioxidants in severely obese adults 3 months after Roux-en-Y gastric bypass. Obes Surg. 2019;29:1810–5.

    Article  Google Scholar 

  24. 24.

    Phillips C, Shivappa N, Hébert J, et al. Dietary inflammatory index and biomarkers of lipoprotein metabolism, Inflammation and Glucose Homeostasis in Adults. Nutrients. 2018;10:1033.

    Article  Google Scholar 

  25. 25.

    Mazidi M, Shivappa N, Wirth MD, et al. Dietary inflammatory index and cardiometabolic risk in US adults. Atherosclerosis. 2018;276:23–7.

    CAS  Article  Google Scholar 

  26. 26.

    Kim H-Y, Lee J, Kim J. Association between dietary inflammatory index and metabolic syndrome in the general Korean population. Nutrients. 2018;10:648.

    Article  Google Scholar 

  27. 27.

    Shivappa N, Godos J, Hébert JR, Wirth MD, Piuri G, Speciani AF, et al. Dietary inflammatory index and colorectal cancer risk—a meta-analysis. Nutrients. 2017;9:1043.

  28. 28.

    Shivappa N, Hébert JR, Polesel J, et al. Inflammatory potential of diet and risk for hepatocellular cancer in a case-control study from Italy. Br J Nutr. 2016;115:324–31.

    CAS  Article  Google Scholar 

  29. 29.

    Vissers LET, Waller MA, van der Schouw YT, et al. The relationship between the dietary inflammatory index and risk of total cardiovascular disease, ischemic heart disease and cerebrovascular disease: findings from an Australian population-based prospective cohort study of women. Atherosclerosis Elsevier Ltd. 2016;253:164–70.

    CAS  Article  Google Scholar 

  30. 30.

    Ramallal R, Toledo E, Martínez-González MA, et al. Dietary inflammatory index and incidence of cardiovascular disease in the SUN cohort. Eckel J, editor. PLoS One. 2015;10:e0135221.

    Article  Google Scholar 

  31. 31.

    Garcia-Arellano A, Ramallal R, Ruiz-Canela M, et al. Dietary inflammatory index and incidence of cardiovascular disease in the PREDIMED study. Nutrients. 2015;7:4124–38.

    Article  Google Scholar 

  32. 32.

    Shivappa N, Godos J, Hébert JR, et al. Dietary inflammatory index and cardiovascular risk and mortality—a meta-analysis. Nutrients. 2018;10:1–15.

    Article  Google Scholar 

  33. 33.

    Phillips CM, Shivappa N, Hébert JR, et al. Dietary inflammatory index and mental health: a cross-sectional analysis of the relationship with depressive symptoms, anxiety and well-being in adults. Clin Nutr. 2018;37:1485–91.

    Article  Google Scholar 

  34. 34.

    Wirth MD, Shivappa N, Burch JB, et al. The dietary inflammatory index, shift work, and depression: results from NHANES. Health Psychol. 2017;36:760–9.

    Article  Google Scholar 

  35. 35.

    Ren Z, Zhao A, Wang Y, et al. Association between dietary inflammatory index, C-Reactive Protein and Metabolic Syndrome: A Cross-Sectional Study. Nutrients. 2018;10:831.

    Article  Google Scholar 

  36. 36.

    Sokol A, Wirth MD, Manczuk M, et al. Association between the dietary inflammatory index, waist-to-hip ratio and metabolic syndrome. Nutr Res. 2016;36:1298–303.

    CAS  Article  Google Scholar 

  37. 37.

    Neufcourt L, Assmann KE, Fezeu LK, et al. Prospective association between the dietary inflammatory index and cardiovascular diseases in the SUpplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) cohort. J Am Heart Assoc. 2016;5:e002735.

  38. 38.

    Shook RP, Hand GA, O’Connor DP, et al. Energy intake derived from an energy balance equation, validated activity monitors, and dual x-ray absorptiometry can provide acceptable caloric intake data among young adults. J Nutr. 2018;148:490–6.

    Article  Google Scholar 

  39. 39.

    Hebert JR, Ebbeling CB, Matthews CE, et al. Systematic errors in middle-aged women’s estimates of energy intake: comparing three self-report measures to total energy expenditure from doubly labeled water. Ann Epidemiol. 2002;12:577–86.

    Article  Google Scholar 

  40. 40.

    O’Loughlin G, Cullen SJ, McGoldrick A, et al. Using a wearable camera to increase the accuracy of dietary analysis. Am J Prev Med. Elsevier Inc. 2013;44:297–301.

    Article  Google Scholar 

  41. 41.

    Nielsen MS, Christensen BJ, Ritz C, et al. Roux-en-Y gastric bypass and sleeve gastrectomy does not affect food preferences when assessed by an ad libitum buffet meal. Obes Surg. 2017;27:2599–605.

    Article  Google Scholar 

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To the Coordination for the Improvement of Personnel at the - CAPES for the financing of the project

Author information




Sônia L Pinto contributed in the design of the study, data collection, analysis and interpretation, manuscript writing, and final version approval. Sônia L Pinto, Leidjaira L Juvanhol, Alessandra da Silva, and Josefina Bressan contributed in the design of the study, analysis and interpretation of the data, critical revision of the manuscript, and approval of the final version. Nitin Shivappa and James R Hébert contributed in analysis and interpretation of the data, critical revision of the manuscript, and approval of the final version.

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Correspondence to Sônia L Pinto.

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Pinto, S.L., Juvanhol, L.L., da Silva, A. et al. The Preoperative Dietary Inflammatory Index Predicts Changes in Cardiometabolic Risk Factors After 12 Months of Roux-en-Y Gastric Bypass. OBES SURG 30, 3932–3939 (2020).

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  • Gastric bypass
  • Inflammation
  • Dietary inflammatory index
  • Cardiometabolic risk factors