Association of dietary inflammatory potential with cardiometabolic risk factors and diseases: a systematic review and dose-response meta-analysis of observational studies

Abstract

Context The association of dietary inflammatory index (DII (R)), as an index of inflammatory quality of diet, with cardiometabolic diseases (CMDs) and risk factors (CMRFs) has been inconsistent in previous studies. Objective The current systematic review and dose-response meta-analysis was performed to investigate the association of the DII score with CMDs and CMRFs. Data Sources All published observational studies (cohort, case-control and cross-sectional) using PubMed/Medline, Scopus, ISI Web of Science, and Google Scholar databases were retrieved from inception through November 2019. Data extraction Two reviewers independently extracted the data from included studies. Data analysis Pooled hazard ratio (HR) or odds ratio (OR) were calculated by using a random-effects model. Results Ten prospective cohort studies (total n = 291,968) with 31,069 CMDs-specific mortality, six prospective cohort studies (total n = 43,340) with 1311 CMDs-specific morbidity, two case-control studies with 2140 cases and 6246 controls and one cross-sectional study (total n = 15,613) with 1734 CMDs-specific morbidity were identified for CMDs. Meta-analyses of published observational studies demonstrated that the highest DII score category versus the lowest DII score category was associated with 29 increased risk of CMDs mortality (HR = 1.29; 95 confidence interval (CI) 1.18, 1.41). Moreover, there was a significant association between the DII score and risk of CMDs in cohort studies (HR = 1.35; 95 CI 1.13, 1.61) and non-cohort study (HR = 1.36; 95 CI 1.18, 1.57). We found a significant association between the DII score and metabolic syndrome (MetS) (OR: 1.13; 95 CI 1.03, 1.25), hyperglycemia and hypertension. None-linear dose response meta-analysis showed that there was a significant association between the DII score and risk of CMDs mortality (P-nonlinearity < 0.001). Moreover, evidence of none-linear association between the DII score and risk of CMDs was not observed (p-value = 0.1). Conclusions Adherence to pro-inflammatory diet was associated with increased risk of CMDs, mortality and MetS.