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Nutrition in acute and chronic diseases

Higher scores of dietary and lifestyle inflammatory indices are associated with increased risk of insulin-related disorders in Iranian adults

European Journal of Clinical Nutrition volume 76, pages 1566–1575 (2022)Cite this article

Subjects

Abstract

Background/Objectives

The roles of potential inflammation of diet and lifestyle in the risk of insulin-related disorders are unclear. In the current study, we aimed to assess the relationship between dietary inflammation scores (DIS), lifestyle inflammation scores (LIS), and dietary and lifestyle inflammation score (DLIS) and the risk of insulin resistance (IR) and hyperinsulinemia in Tehranian adults.

Subjects/Methods

A total of 1,244 participants, aged ≥20 years, who were free of insulin-related disorders at baseline (2006–08), were followed for 3.2 years (2009–11) to ascertain the incidence of hyperinsulinemia and IR. A food frequency questionnaire was used to determine the score of DIS, LIS, and DLIS at baseline. Logistic regression models were used to determine the odds ratio (ORs) of insulin-related disorders across tertiles of DIS, LIS, and DLIS.

Results

Mean ± SD age of participants (42.7% men) was 43.0 ± 13.0 years. During the 3.2 years follow-up, the incidence of IR and hyperinsulinemia was 30.0% and 20.0%, respectively. In the multivariable model, there was a direct association between the higher score of DLIS (OR = 2.10; 95% CI: 1.17–3.74) and DIS (OR = 1.84; 95% CI: 1.09–3.11) with the risk of IR incident (P for trend <0.05). Also, the higher score of LIS was related to increased risk of IR (OR = 2.28; 95% CI: 1.19–4.37) and hyperinsulinemia (OR = 1.69; 95% CI: 1.02–2.85) (P for trend <0.05). However, no significant association was observed between the higher score of DLIS and DIS with risk of hyperinsulinemia

Conclusion

The higher inflammatory potential of diet and lifestyle, determined by DLIS, DIS, and LIS scores, were associated with a higher risk of IR. Also, individuals with a higher score of LIS are more prone to hyperinsulinemia risk.

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Fig. 1: Flow chart of study population.
Fig. 2: The association of LIS, DLIS, and DIS with risk of insulin-related disorders.
Fig. 3: The association of LIS, DLIS, and DIS with risk of hyperinsulinemia and insulin resistance.

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Data availability

The datasets analyzed in the current study are available from the corresponding author on reasonable request.

References

  1. Utzschneider KM, Van de Lagemaat A, Faulenbach MV, Goedecke JH, Carr DB, Boyko EJ, et al. Insulin resistance is the best predictor of the metabolic syndrome in subjects with a first-degree relative with type 2 diabetes. Obes (Silver Spring) 2010;18:1781–7.

    Article  CAS  Google Scholar 

  2. Cerf ME. Beta cell dysfunction and insulin resistance. Front Endocrinol (Lausanne). 2013;4:37.

    Article  Google Scholar 

  3. Thomas DD, Corkey BE, Istfan NW, Apovian CM. Hyperinsulinemia: an early indicator of metabolic dysfunction. J Endocr Soc. 2019;3:1727–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Corkey BE. Banting lecture 2011: hyperinsulinemia: cause or consequence? Diabetes 2012;61:4–13.

    Article  CAS  PubMed  Google Scholar 

  5. Rehman K, Akash MSH. Mechanisms of inflammatory responses and development of insulin resistance: how are they interlinked? J Biomed Sci. 2016;23:87.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wang C, Guan Y, Yang J. Cytokines in the progression of pancreatic β-cell dysfunction. Int J Endocrinol. 2010;2010:515136.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Galland L. Diet and inflammation. Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral. Nutrition 2010;25:634–40.

    Google Scholar 

  8. Calder PC, Ahluwalia N, Brouns F, Buetler T, Clement K, Cunningham K, et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr. 2011;106:S5–78. Suppl 3

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Tabung FK, Smith-Warner SA, Chavarro JE, Wu K, Fuchs CS, Hu FB, et al. Development and validation of an empirical dietary inflammatory index. J Nutr. 2016;146:1560–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Shakeri Z, Mirmiran P, Khalili-Moghadam S, Hosseini-Esfahani F, Ataie-Jafari A, Azizi F. Empirical dietary inflammatory pattern and risk of metabolic syndrome and its components: Tehran Lipid and Glucose Study. Diabetol Metab Syndr. 2019;11:16.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Denova-Gutiérrez E, Muñoz-Aguirre P, Shivappa N, Hébert JR, Tolentino-Mayo L, Batis C, et al. Dietary Inflammatory Index and Type 2 Diabetes Mellitus in Adults: The Diabetes Mellitus Survey of Mexico City. Nutrients 2018;10:385.

    Article  PubMed Central  Google Scholar 

  13. Lee DH, Li J, Li Y, Liu G, Wu K, Bhupathiraju S, et al. Dietary inflammatory and insulinemic potential and risk of type 2 diabetes: results from three prospective U.S. cohort studies. Diabetes Care. 2020;43:2675–2683.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Soltani S, Moslehi N, Hosseini-Esfahani F, Vafa M. The association between empirical dietary inflammatory pattern and metabolic phenotypes in overweight/obese adults. Int J Endocrinol Metab. 2018;16:e60048.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol (1985) 2005;98:1154–62.

    Article  CAS  Google Scholar 

  16. Wu H, Ballantyne CM. Metabolic inflammation and insulin resistance in. Obesity 2020;126:1549–64.

    CAS  Google Scholar 

  17. Attard R, Dingli P, Doggen CJ, Cassar K, Farrugia R, Wettinger SBJOH. The impact of passive and active smoking on inflammation, lipid profile and the risk of myocardial infarction. 2017;4:e000620.

  18. Byrd DA, Judd SE, Flanders WD, Hartman TJ, Fedirko V, Bostick RMJTJON. Development and validation of novel dietary and lifestyle inflammation scores. J Nutr. 2019;149:2206–18.

  19. Farhadnejad H, Parastouei K, Rostami H, Mirmiran P, Azizi FJD. Syndrome M Dietary and lifestyle inflammatory scores are associated with increased risk of metabolic syndrome in Iranian adults. 2021;13:1–10.

  20. Byrd DA, Judd SE, Flanders WD, Hartman TJ, Fedirko V, Agurs-Collins T, et al. Associations of Novel Dietary and Lifestyle Inflammation Scores With Incident Colorectal Cancer in the NIH-AARP Diet and Health Study. JNCI Cancer Spectrum. 2020;4:pkaa009.

  21. Li Z, Gao Y, Byrd DA, Gibbs DC, Prizment AE, Lazovich D, et al. Novel dietary and lifestyle inflammation scores directly associated with all-cause, all-cancer, and all-cardiovascular disease mortality risks among women. The J Nutr. 2021;151:930–9.

    Article  PubMed  Google Scholar 

  22. Byrd DA, Judd S, Flanders WD, Hartman TJ, Fedirko V, Bostick RMJCE, et al. Associations of novel dietary and lifestyle inflammation scores with incident, sporadic colorectal adenoma. Cancer Epidemiol Biomarkers Prev.2020;29:2300–8.

  23. Farazi M, Jayedi A, Noruzi Z, Janbozorgi N, Djafarian K, Shab-Bidar S. Association of dietary and lifestyle inflammation score with cardiorespiratory fitness. Frontiers in Nutrition. 2022;9:730841

  24. Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009;10:5.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Willett W. Implications of total energy intake for epidemiologic analyses. Nutritional epidemiology, 3rd ed. New York: Oxford University Press; 2013: 260–86.

  26. Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol. 2010;20:150–8.

    Article  PubMed  Google Scholar 

  27. Asghari G, Rezazadeh A, Hosseini-Esfahani F, Mehrabi Y, Mirmiran P, Azizi F. Reliability, comparative validity and stability of dietary patterns derived from an FFQ in the Tehran Lipid and Glucose Study. Br J Nutr. 2012;108:1109–17.

    Article  CAS  PubMed  Google Scholar 

  28. Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F. Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public health Nutr. 2010;13:654–62.

    Article  PubMed  Google Scholar 

  29. Byrd DA, Judd SE, Flanders WD, Hartman TJ, Fedirko V, Bostick RM. Development and validation of novel dietary and lifestyle inflammation scores. J Nutr. 2019;149: 2206–2218.

  30. Momenan AA, Delshad M, Sarbazi N, REZAEI GN, Ghanbarian A, AZIZI F. Reliability and validity of the Modifiable Activity Questionnaire (MAQ) in an Iranian urban adult population. Arch Iran Med. 2012;15:279-82.

  31. Ghasemi A, Tohidi M, Derakhshan A, Hasheminia M, Azizi F, Hadaegh F. Cut-off points of homeostasis model assessment of insulin resistance, beta-cell function, and fasting serum insulin to identify future type 2 diabetes: Tehran Lipid and Glucose Study. Acta diabetologica. 2015;52:905–15.

    Article  CAS  PubMed  Google Scholar 

  32. Mokhtari E, Teymoori F, Farhadnejad H, Mirmiran P, Azizi F. Development and validation of dietary and lifestyle insulinemic indices among Iranian adult population. Nutr Metab (Lond). 2022;19:5.

    Article  CAS  Google Scholar 

  33. Holt EM, Steffen LM, Moran A, Basu S, Steinberger J, Ross JA, et al. Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc. 2009;109:414–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Zhu F, Du B, Xu B. Anti-inflammatory effects of phytochemicals from fruits, vegetables, and food legumes: a review. Crit Rev food Sci Nutr. 2018;58:1260–70.

    Article  CAS  PubMed  Google Scholar 

  35. Bonaccio M, Pounis G, Cerletti C, Donati MB, Iacoviello L, de Gaetano G, et al. Mediterranean diet, dietary polyphenols and low grade inflammation: results from the MOLI-SANI study. Br J Clin Pharm. 2017;83:107–13.

    Article  CAS  Google Scholar 

  36. Farhadnejad H, Emamat H, Teymoori F, Tangestani H, Hekmatdoost A, Mirmiran P. Role of dietary approaches to stop hypertension diet in risk of metabolic syndrome: Evidence from observational and interventional studies. Int J Preventive Med. 2021;12:24.

    Article  Google Scholar 

  37. Esfandiari S, Bahadoran Z, Mirmiran P, Tohidi M, Azizi F. Adherence to the dietary approaches to stop hypertension trial (DASH) diet is inversely associated with incidence of insulin resistance in adults: the Tehran lipid and glucose study. J Clin Biochem Nutr. 2017;61:123–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns and markers of systemic inflammation among Iranian Women. J Nutr. 2007;137:992–8.

    Article  CAS  PubMed  Google Scholar 

  39. Bawaked RA, Schröder H, Ribas-Barba L, Izquierdo-Pulido M, Pérez-Rodrigo C, Fíto M, et al. Association of diet quality with dietary inflammatory potential in youth. Food Nutr Res. 2017;61:1328961.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology 2003;144:2195–200.

    Article  CAS  PubMed  Google Scholar 

  41. Elks CM, Francis J. Central adiposity, systemic inflammation, and the metabolic syndrome. Curr Hypertension Rep. 2010;12:99–104.

    Article  CAS  Google Scholar 

  42. Okura T, Nakamura R, Fujioka Y, Kawamoto-Kitao S, Ito Y, Matsumoto K, et al. Body mass index ≥23 is a risk factor for insulin resistance and diabetes in Japanese people: a brief report. Plos one. 2018;13:e0201052.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, et al. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Investig. 2017;114:1752–61.

    Article  Google Scholar 

  44. Stadler M, Tomann L, Storka A, Wolzt M, Peric S, Bieglmayer C, et al. Effects of smoking cessation on β-cell function, insulin sensitivity, body weight, and appetite. Eur J Endocrinol. 2014;170:219–7.

    Article  CAS  PubMed  Google Scholar 

  45. Anan F, Takahashi N, Shinohara T, Nakagawa M, Masaki T, Katsuragi I, et al. Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur J Clin Investig. 2006;36:459–65.

    Article  CAS  Google Scholar 

  46. Gomez-Cabrera M-C, Domenech E, Viña J. Moderate exercise is an antioxidant: upregulation of antioxidant genes by training. Free Radic Biol Med. 2008;44:126–31.

    Article  CAS  PubMed  Google Scholar 

  47. Jiménez-Pavón D, Ruiz JR, Ortega FB, Martínez-Gómez D, Moreno S, Urzanqui A, et al. Physical activity and markers of insulin resistance in adolescents: role of cardiorespiratory fitness levels—the HELENA study. Pediatr Diabetes. 2013;14:249–58.

    Article  PubMed  Google Scholar 

  48. Fischer C, Berntsen A, Perstrup L, Eskildsen P, Pedersen B. Plasma levels of interleukin‐6 and C‐reactive protein are associated with physical inactivity independent of obesity. Scand J Med Sci Sports. 2007;17:580–7.

    CAS  PubMed  Google Scholar 

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Acknowledgements

Research reported in this publication was supported by Elite Researcher Grant Committee under award number [No.996622] from the National Institutes for Medical Research Development (NIMAD), Tehran, Iran. We express appreciation to the participants in the Tehran Lipid and Glucose Study for their enthusiastic support and to the staff of the Research Institute for Endocrine Sciences, Tehran Lipid and Glucose Study Unit, for their valuable help.

Funding

Research reported in this publication was supported by Elite Researcher Grant Committee under award number [No.996622] from the National Institute for Medical Research Development (NIMAD), Tehran, Iran.

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Authors and Affiliations

  1. Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Hossein Farhadnejad, Farshad Teymoori, Ebrahim Mokhtari & Parvin Mirmiran

  2. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Parvin Mirmiran

  3. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

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Contributions

HF and FT conceptualized and designed the study. FT, EM, and HF drafted the initial manuscript; FT and EM analyzed and interpreted the data; PM and FA supervised the project; all authors have read and approved the final version of the manuscript.

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Correspondence to Farshad Teymoori or Parvin Mirmiran.

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The authors declare no competing interests.

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Written informed consent was obtained from all participants. The study protocol was approved by the ethics research committee of the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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Farhadnejad, H., Teymoori, F., Mokhtari, E. et al. Higher scores of dietary and lifestyle inflammatory indices are associated with increased risk of insulin-related disorders in Iranian adults. Eur J Clin Nutr 76, 1566–1575 (2022). https://doi.org/10.1038/s41430-022-01143-0

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