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Epidemiology

Secular trends in Dietary Inflammatory Index among adults in the United States, 1999–2014

Abstract

Objective

The objective of this study was to evaluate secular trends in Dietary Inflammatory Index (DII) scores in the United States between 1999 and 2014.

Methods

Data from adults over 19 years from the 1999 to 2014 National Health and Nutrition Examination Survey (N = 39,191) were used. DII scores, at each 2-year cycle, were evaluated from a 24-h recall, including 26 food parameters for DII calculation. Analyses were conducted in 2018.

Results

For the entire sample, there was a quadratic trend (Ptrend < 0.001), with the DII scores peaking in 2003–2004, and then decreasing during the cycles from 2005 to 2014. Similar quadratic trends (Ptrend < 0.001) were observed by age, gender, race-ethnicity, and education.

Conclusion

Males, non-Hispanic Blacks, younger adults, and those with less education adults had the highest DII scores (i.e., indicating the greatest inflammatory potential). The overall DII scores of the US population showed a quadratic trend from 1999 to 2014. Continued monitoring of DII changes is needed to better understand changes in the inflammatory potential of diet of American adults, and how they relate to changes in the risk of chronic disease.

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References

  1. Wang DD, Leung CW, Li Y, Ding EL, Chiuve SE, Hu FB, et al. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med. 2014;174:1587–95.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO,III, Criqui M. et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499–511.

    Article  PubMed  Google Scholar 

  3. Keibel A, Singh V, Sharma MC. Inflammation, microenvironment, and the immune system in cancer progression. Curr Pharm Des. 2009;15:1949–55.

    Article  CAS  PubMed  Google Scholar 

  4. Pan MH, Lai CS, Dushenkov S, Ho CT. Modulation of inflammatory genes by natural dietary bioactive compounds. J Agric Food Chem. 2009;57:4467–77.

    Article  CAS  PubMed  Google Scholar 

  5. Thun MJ, Henley SJ, Gansler T. Inflammation and cancer: an epidemiological perspective. In: Cancer and inflammation: Novartis Foundation symposium. vol. 256. 2008. Wiley Online Library. https://www.ncbi.nlm.nih.gov/pubmed/15027481.

    Chapter  Google Scholar 

  6. Terzic J, Grivennikov S, Karin E, Karin M. Inflammation and colon cancer. Gastroenterology. 2010;138:2101–2114 e5.

    Article  CAS  PubMed  Google Scholar 

  7. Killeen K, Skora E. Pathophysiology, diagnosis, and clinical assessment of asthma in the adult. Nurs Clin North Am. 2013;48:11–23.

    Article  PubMed  Google Scholar 

  8. Wium-Andersen MK, Orsted DD, Nielsen SF, Nordestgaard BG. Elevated C-reactive protein levels, psychological distress, and depression in 73, 131 individuals. JAMA Psychiatry. 2013;70:176–84.

    Article  CAS  PubMed  Google Scholar 

  9. Galassetti P. Inflammation and oxidative stress in obesity, metabolic syndrome, and diabetes. Exp Diabetes Res. 2012;2012:943706.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A, et al. Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study. Diabetes. 2003;52:1799–805.

    Article  CAS  PubMed  Google Scholar 

  11. Shivappa N, Hébert JR, Rietzschel ER, De Buyzere ML, Langlois M, Debruyne E, et al. Associations between dietary inflammatory index and inflammatory markers in the Asklepios Study. Br J Nutr. 2015;113:665–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. De Mello V, Schwab U, Kolehmainen M, Koenig W, Siloaho M, Poutanen K, et al. 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. 2011;54:2755.

    Article  CAS  PubMed  Google Scholar 

  13. Nanri A, Moore MA, Kono S. Impact of C-reactive protein on disease risk and its relation to dietary factors: literature review. Asian Pac J Cancer Prev. 2007;8:167.

    PubMed  Google Scholar 

  14. Hlebowicz J, Persson M, Gullberg B, Sonestedt E, Wallström P, Drake I, et al. Food patterns, inflammation markers and incidence of cardiovascular disease: the Malmö Diet and Cancer study. J Intern Med Suppl. 2011;270:365–76.

    Article  CAS  Google Scholar 

  15. Galland L. Diet and inflammation. Nutr Clin Pract. 2010;25:634–40.

    Article  PubMed  Google Scholar 

  16. Liu S, Manson JE, Buring JE, Stampfer MJ, Willett WC, Ridker PM. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002;75:492–8.

    Article  CAS  PubMed  Google Scholar 

  17. Peairs AD, Rankin JW, Lee YW. Effects of acute ingestion of different fats on oxidative stress and inflammation in overweight and obese adults. Nutr J. 2011;10:122.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17:1689–96.

    Article  PubMed  Google Scholar 

  19. Shivappa N, Harris H, Wolk A, Hebert JR. Association between inflammatory potential of diet and mortality among women in the Swedish Mammography Cohort. Eur J Nutr. 2016;55:1891–1900.

    Article  PubMed  Google Scholar 

  20. Mellen PB, Gao SK, Vitolins MZ, Goff DC. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med. 2008;168:308–14.

    Article  PubMed  Google Scholar 

  21. Libby P. Inflammatory mechanisms: the molecular basis of inflammation and disease. Nutr Rev. 2007;65:S140–S146.

    Article  PubMed  Google Scholar 

  22. Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Caan B, et al. The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the Women’s Health Initiative. Cancer Causes Control. 2015;26:399–408.

    Article  PubMed  Google Scholar 

  23. Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, et al. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr. 2014;17:1825–33.

    Article  PubMed  Google Scholar 

  24. Shivappa N, Wirth MD, Hurley TG, Hébert JR. Association between the dietary inflammatory index (DII) and telomere length and C‐reactive protein from the National Health and Nutrition Examination Survey—1999–2002. Mol Nutr Food Res 2017;61.

    Article  Google Scholar 

  25. Wirth MD, Shivappa N, Davis L, Hurley TG, Ortaglia A, Drayton R, et al. Construct validation of the dietary inflammatory index among African Americans. J Nutr Health Aging. 2017;21:487–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shivappa N, Hébert JR, Karamati M, Shariati-Bafghi S-E, Rashidkhani B. Increased inflammatory potential of diet is associated with bone mineral density among postmenopausal women in Iran. Eur J Nutr. 2016;55:561–8.

    Article  CAS  PubMed  Google Scholar 

  27. Shivappa N, Hebert JR, Anderson LA, Shrubsole MJ, Murray LJ, Getty LB, et al. Dietary inflammatory index and risk of reflux oesophagitis, Barrett’s oesophagus and oesophageal adenocarcinoma: a population-based case-control study. Br J Nutr. 2017;117:1323–31.

    Article  CAS  PubMed  Google Scholar 

  28. Shivappa N, Hébert JR, Polesel J, Zucchetto A, Crispo A, Montella M, 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.

    Article  CAS  PubMed  Google Scholar 

  29. Shivappa N, Prizment AE, Blair CK, Jacobs DR, Steck SE, Hébert JR. Dietary inflammatory index and risk of colorectal cancer in the Iowa Women’s Health Study. Cancer Epidemiol Prevent Biomark. 2014;23:2383–92.

    Article  CAS  Google Scholar 

  30. Shivappa N, Bosetti C, Zucchetto A, Serraino D, La Vecchia C, Hébert JR. Dietary inflammatory index and risk of pancreatic cancer in an Italian case-control study. Br J Nutr. 2015;113:292–8.

    Article  CAS  PubMed  Google Scholar 

  31. Shivappa N, Bosetti C, Zucchetto A, Montella M, Serraino D, La Vecchia C, et al. Association between dietary inflammatory index and prostate cancer among Italian men. Br J Nutr. 2015;113:278–83.

    Article  CAS  PubMed  Google Scholar 

  32. Shivappa N, Sandin S, Löf M, Hébert JR, Adami H-O, Weiderpass E. Prospective study of dietary inflammatory index and risk of breast cancer in Swedish women. Br J Cancer. 2015;113:1099.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Shivappa N, Steck SE, Hussey JR, Ma Y, Hebert JR. Inflammatory potential of diet and all-cause, cardiovascular, and cancer mortality in National Health and Nutrition Examination Survey III Study. Eur J Nutr. 2017;56:683–92.

    Article  CAS  PubMed  Google Scholar 

  34. Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Tylavsky FA, et al. Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in postmenopausal women. Eur J Clin Nutr. 2016;70:1374–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Lane DS, et al. Changes in the inflammatory potential of diet over time and risk of colorectal cancer in postmenopausal women. Am J Epidemiol. 2017;186:514–23.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Tabung FK, Steck SE, Liese AD, Zhang J, Ma Y, Johnson KC, et al. Patterns of change over time and history of the inflammatory potential of diet and risk of breast cancer among postmenopausal women. Breast Cancer Res Treat. 2016;159:139–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Shivappa N, Hébert JR, Ferraroni M, La Vecchia C, Rossi M. Association between dietary inflammatory index and gastric cancer risk in an Italian case-control study. Nutr Cancer. 2016;68:1262–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Shivappa N, Jackson MD, Bennett F, Hébert JR. Increased Dietary Inflammatory Index (DII) is associated with increased risk of prostate cancer in Jamaican men. Nutr Cancer. 2015;67:941–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Statistics NCfH. Plan and operation of the third National Health and Nutrition Examination Survey, 1988–94. Vital Health Stat. 1994;32:1–407.

    Google Scholar 

  40. Shivappa N, Steck SE, Hurley TG, Hussey JR, Ma Y, Ockene IS, et al. A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS). Public Health Nutr. 2014;17:1825–33.

    Article  PubMed  Google Scholar 

  41. Tabung FK, Steck SE, Zhang J, Ma Y, Liese AD, Agalliu I, et al. Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol. 2015;25:398–405.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wirth MD, Shivappa N, Davis L. et al. Construct validation of the Dietary Inflammatory Index among African Americans. J Nutr Health Aging. 2016;21:1–5.

    Google Scholar 

  43. Wirth MD, Burch J, Shivappa N, Violanti JM, Burchfiel CM, Fekedulegn D, et al. Association of a dietary inflammatory index with inflammatory indices and metabolic syndrome among police officers. J Occup Environ Med. 2014;56:986–9.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ramallal R, Toledo E, Martinez-Gonzalez MA, Hernandez-Hernandez A, Garcia-Arellano A, Shivappa N, et al. Dietary inflammatory index and incidence of cardiovascular disease in the SUN Cohort. PLoS One 2015;10.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wirth MD, Shivappa N, Hurley TG, Hébert JR. Association between previously diagnosed circulatory conditions and a dietary inflammatory index. Nutr Res. 2016;36:227–33.

    Article  CAS  PubMed  Google Scholar 

  46. Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi AM, Knuppel S, Iqbal K, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2017;105:1462–73.

    CAS  PubMed  Google Scholar 

  47. Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004;24:401–31.

    Article  CAS  PubMed  Google Scholar 

  48. T Kennedy E, Ohls J, Carlson S, Fleming K. The healthy eating index: design and applications. J Acad Nutr Diet. 1995;95:1103–8.

    Google Scholar 

  49. Steck S, Shivappa N, Tabung F, Harmon B, Wirth M, Hurley T, et al. The dietary inflammatory index: a new tool for assessing diet quality based on inflammatory potential. Digest. 2014;49:1–9.

    Google Scholar 

  50. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–7.

    Article  PubMed  Google Scholar 

  51. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291:2847–50.

    Article  CAS  PubMed  Google Scholar 

  52. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.

    Article  CAS  PubMed  Google Scholar 

  53. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–41.

    Article  CAS  PubMed  Google Scholar 

  54. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7.

    Article  PubMed  Google Scholar 

  55. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315:2284–91.

    Article  CAS  PubMed  Google Scholar 

  57. Sturm R, An R. Obesity and economic environments. CA Cancer J Clin. 2014;64:337–50.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Group N. NPD’s new dieting monitor tracks America’s dieting habits. 2004.

  59. Rehm CD, Monsivais P, Drewnowski A. Relation between diet cost and Healthy Eating Index 2010 scores among adults in the United States 2007–2010. Prev Med. 2015;73:70–75.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Basiotis PP, Carlson A, Gerrior SA, Juan W, Lino M. The healthy eating index, 1999-2000: charting dietary patterns of Americans. Fam Econ Nutr Rev. 2004;16:39.

    Google Scholar 

  61. Bowman S, Lino M, Gerrior S, Basiotis P. The healthy eating index: 1994–1996. Washington, DC: US Department of Agriculture, Center for Nutrition Policy and Promotion; 1998.

  62. Wang Y, Chen X. How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition-and health-related psychosocial factors and socioeconomic status among US adults? J Am Diet Assoc. 2011;111:1904–11.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Wardle J, Parmenter K, Waller J. Nutrition knowledge and food intake. Appetite. 2000;34:269–75.

    Article  CAS  PubMed  Google Scholar 

  64. Hebert JR, Clemow L, Pbert L, Ockene IS, Ockene JK. Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. Int J Epidemiol. 1995;24:389–98.

    Article  CAS  PubMed  Google Scholar 

  65. Hebert JR, Ma Y, Clemow L, Ockene IS, Saperia G, Stanek EJ, et al. Gender differences in social desirability and social approval bias in dietary self report. Am J Epidemiol. 1997;146:1046–55.

    Article  CAS  PubMed  Google Scholar 

  66. Hebert JR, Peterson KE, Hurley TG, Stoddard AM, Cohen N, Field AE, et al. The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees. Ann Epidemiol. 2001;11:417–27.

    Article  CAS  PubMed  Google Scholar 

  67. Hebert JR, Ebbeling CB, Matthews CE, Ma Y, Clemow L, Hurley TG, 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  PubMed  Google Scholar 

  68. Fan Y, Jin X, Man C, Gao Z, Wang X. Meta-analysis of the association between the inflammatory potential of diet and colorectal cancer risk. Oncotarget. 2017;8:59592–59600.

    PubMed  PubMed Central  Google Scholar 

  69. Fowler ME, Akinyemiju TF. Meta-analysis of the association between dietary inflammatory index (DII) and cancer outcomes. Int J Cancer. 2017;141:2215–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Shivappa N, Godos J, Hebert JR, Wirth MD, Piuri G, Speciani AF, et al. Dietary inflammatory index and colorectal cancer risk-a meta-analysis. Nutrients. 2017;9:E1043.

    Article  PubMed  Google Scholar 

  71. Shivappa N, Hebert JR, Kivimaki M, Akbaraly T. Alternative Healthy Eating Index 2010, Dietary Inflammatory Index and risk of mortality: results from the Whitehall II cohort study and meta-analysis of previous Dietary Inflammatory Index and mortality studies. Br J Nutr. 2017;118:210–21.

    Article  CAS  PubMed  Google Scholar 

  72. Zhong X, Guo L, Zhang L, Li Y, He R, Cheng G. Inflammatory potential of diet and risk of cardiovascular disease or mortality: a meta-analysis. Sci Rep. 2017;7:6367.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Jayedi A, Emadi A, Shab-Bidar S. Dietary Inflammatory Index and site-specific cancer risk: a systematic review and dose-response meta-analysis. Adv Nutr. 2018;9:388–403.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Li D, Hao X, Li J, Wu Z, Chen S, Lin J, et al. Dose-response relation between dietary inflammatory index and human cancer risk: evidence from 44 epidemiologic studies involving 1,082,092 participants. Am J Clin Nutr. 2018;107:371–88.

    Article  PubMed  Google Scholar 

  75. Shivappa N, Godos J, Hebert JR, Wirth MD, Piuri G, Speciani AF, et al. Dietary Inflammatory Index and cardiovascular risk and mortality—a meta-analysis. Nutrients. 2018;10:E200.

    Article  PubMed  Google Scholar 

  76. Zahedi H, Djalalinia S, Sadeghi O, Asayesh H, Noorozi M, Gorabi AM, et al. Dietary Inflammatory Potential Score and risk of breast cancer: a systematic review and meta-analysis. Clin Breast Cancer. 2018;18:e561–e570.

    Article  PubMed  Google Scholar 

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Author contributions

Author SR prepared part of the initial draft of the manuscript. Author NS assisted in the calculation of the DII. Author PDL computed the analyses. Authors SR, MK, NS, NV, JRM, JRH, MDW, and PDL helped conceptualize the study and provided feedback on various drafts of the manuscript.

Funding

MDW, NS, and JRH were supported by grant number R44DK103377 from NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. NIH had no role in the design, analysis or writing of this article.

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Correspondence to James R. Hébert.

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Conflict of interest

JRH 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. MDW and NS are employees of CHI. The remaining authors declare that they have no conflict of interest.

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Ryu, S., Shivappa, N., Veronese, N. et al. Secular trends in Dietary Inflammatory Index among adults in the United States, 1999–2014. Eur J Clin Nutr 73, 1343–1351 (2019). https://doi.org/10.1038/s41430-018-0378-5

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