Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies

Ana Garcia-Arellano, Miguel A. Martínez-González, Raul Ramallal, Jordi Salas-Salvadó, James R. Hébert, Dolores Corella, Nitin Shivappa, Luis Forga, Helmut Schröder, Carlos Muñoz-Bravo, Ramón Estruch, Miquel Fiol, José Lapetra, Lluís Serra-Majem, Emilio Ros, Javier Rekondo, Estefanía Toledo, Cristina Razquin, Miguel Ruiz-Canela, A. AlonsoM. T. Barrio Lopez, F. J. Basterra-Gortari, S. Benito Corchon, M. Bes-Rastrollo, J. J. Beunza, S. Carlos, S. Cervantes, J. de Irala, P. A. de la Rosa, C. de la Fuente, C. L. Donat-Vargas, M. Donazar, A. Fernandez Montero, A. Gea, E. Goni-Ochandorena, F. Guillen-Grima, F. Lahortiga, J. Llorca, C. Lopez del Burgo, A. Mari-Sanchıs, A. Marti, R. Mendonça, J. M. Nuñez-Cordoba, A. M. Pimenta, A. Rico, A. Ruiz Zambrana, C. Sayon-Orea, J. Toledo-Atucha, Z. Vazquez Ruiz, I. Zazpe Garcıa, A. Sánchez- Tainta, P. Buil-Cosiales, J. Díez-Espino, B. Sanjulian, J. A. Martínez, M. Serrano-Martínez, J. V. Extremera-Urabayen, L. Garcia-Pérez, C. Arroyo-Azpa, A. F. Barcena, C. Oreja-Arrayago, M. J. Lasanta-Sáez, P. Cia-Lecumberri, T. Elcarte-Lopez, F. Artal-Moneva, J. M. Esparza-López, E. Figuerido-Garmendia, J. A. Tabar-Sarrias, L. Fernández- Urzainqui, M. J. Ariz-Arnedo, J. A. Cabeza-Beunza, P. Pascual-Pascual, M. D. Martínez-Mazo, E. Arina-Vergara, T. Macua-Martínez, P. Pascual Pascual, M. L. Garcés Ducar, R. Martí Massó, R. Villanueva Moreno, A. Parra-Osés, M. Serra-Mir, A. Pérez-Heras, C. Viñas, R. Casas, A. Medina-Remon, P. Villanueva, J. M. Baena, M. García, M. Oller, J. Amat, I. Duaso, Y. García, C. Iglesias, C. Simón, L. Quinzavos, L. Parra, M. Liroz, J. Benavent, J. Clos, I. Pla, M. Amorós, M. T. Bonet, M. T. Martín, M. S. Sánchez, J. Altirriba, E. Manzano, A. Altés, M. Cofán, C. Valls-Pedret, A. Sala-Vila, M. Doménech, M. Bulló, J. Basora-Gallisa, R. González, C. Molina, G. Mena, P. Martínez, N. Ibarrola, J. Sorlí, J. García Roselló, F. Martin, N. Tort, A. Isach, N. Babio, A. Salas-Huetos, N. Becerra-Tomás, N. Rosique- Esteban, P. Hernandez, S. Canudas, C. Papandreou, C. Ferreira, M. Cabre, G. Mestres, F. Paris, M. Llauradó, R. Pedret, J. Basells, J. Vizcaino, R. Segarra, S. Giardina, M. Guasch-Ferré, A. Díaz-López, J. Fernández-Ballart, R. Balanza, S. Tello, J. Vila, R. de la Torre, D. Muñoz-Aguayo, R. Elosua, J. Marrugat, N. Molina, E. Maestre, A. Rovira, O. Castañer, M. Farré, J. Sorli, P. Carrasco, C. Ortega-Azorín, E. M. Asensio, R. Osma, R. Barragán, F. Francés, M. Guillén, J. I. González, C. Sáiz, O. Portolés, F. J. Giménez, O. Coltell, R. Fernández-Carrión, P. Guillem-Sáiz, I. González-Monje, L. Quiles, V. Pascual, C. Riera, M. A. Pages, D. Godoy, A. Carratalá-Calvo, S. Sánchez-Navarro, C. Valero-Barceló, I. Salaverria, T. del Hierro, J. Algorta, S. Francisco, J. San Vicente, A. Casi, E. Sanz, I. Felipe, J. Rekondo, A. Loma-Osorio, J. Fernandez-Crehuet, A. Garcia-Rodriguez, J. Wärnberg, R. Benitez Pont, M. Bianchi Alba, R. Navajas, R. Gómez-Huelgas, J. Martínez-González, V. Velasco García, J. de Diego Salas, A. Baca Osorio, J. Gil Zarzosa, J. J. Sánchez Luque, E. Vargas López, D. Romaguera, M. García-Valdueza, A. Proenza, R. Prieto, G. Frontera, S. Munuera, M. Vivó, F. Bestard, J. A. Munar, L. Coll, F. Fiol, M. Ginard, A. Jover, J. García, J. M. Santos-Lozano, M. Ortega-Calvo, M. Leal, E. Martínez, L. Mellado, L. Miró-Moriano, C. Domínguez-Espinaco, S. Vaquero- Diaz, P. Iglesias, P. Román, Y. Corchado, J. M. Lozano-Rodríguez, R. Lamuela-Raventós, M. C. López- Sabater, A. I. Castellote-Bargalló, P. Quifer-Rada, A. Tresserra-Rimbau, J. Alvarez-Pérez, E. Díez Benítez, I. Bautista Castaño, I. Maldonado Díaz, A. Sanchez-Villegas, M. J. Férnandez- Rodríguez, F. Sarmiendo de la Fe, C. Simón García, I. Falcón Sanabria, B. Macías Gutiérrez, A. J. Santana Santana, E. de la Cruz, A. Galera, X. Pintó-Salas, F. Trias, I. Sarasa, M. A. Rodríguez, X. Corbella, E. Corbella, A. Goday, M. A. Muñoz, C. Cabezas, E. Vinyoles, M. A. Rovira, L. Garcia, P. Baby, A. Ramos, L. Mengual, P. Roura, M. C. Yuste, A. Guarner, M. I. Santamaria, M. Mata, C. de Juan, A. Brau, M. Fernandez, E. Gutierrez, C. Murillo, J. Garcia, M. Tafalla, I. Bobe, A. Díaz, M. Araque, E. Solis, T. Cervello, I. Montull, J. A. Tur, M. P. Portillo, G. Sáez

Research output: Contribution to journal › Article › peer-review

83 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1221-1231
Number of pages11
JournalClinical Nutrition
Volume38
Issue number3
DOIs
StatePublished - Jun 2019

Keywords

  • CRP
  • Cohort studies
  • Dietary inflammatory index
  • Inflammation
  • Mediterranean diet
  • Mortality

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

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