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Nutrition in acute and chronic diseases

Associations of empirical dietary inflammatory index with heart failure in adults from the United States



Recent evidence has shown associations between cardiovascular disease and a proinflammatory diet. We hypothesized that a proinflammatory diet, assessed using the Empirical Dietary Inflammatory Index (EDII), is associated with increased risk of prevalent heart failure (HF).


This analysis included 13,687 participants (44.8 ± 19.4 years; 45.7% male, 67.8% whites) from the Third National Health and Nutrition Examination Survey. EDII score was calculated from the Food Frequency Questionnaire. Prevalent HF was determined by physician-diagnosed self-report. Multivariable logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between EDII score and prevalent HF across tertiles (reference group first tertile) and per 1-unit standard deviation (1-SD) increase.


About 1.4% (n = 190) of the participants reported a history of HF. Each 1-SD increase in EDII score (0.276) conferred 25% increased odds of prevalent HF (OR (95% CI): 1.25 (1.07–1.46); p value = 0.006). Odds of HF increased as EDII tertile increased, indicating a dose–response relationship (OR (95% CI) for 2nd and 3rd tertiles compared to 1st tertile: 1.42 (0.99–2.04), 1.68 (1.15–2.46), respectively). These results were consistent in subgroups of the participants stratified by demographics and comorbidities.


Proinflammatory dietary patterns are associated with an increased risk of HF. The risk of HF could potentially be reduced by avoiding proinflammatory dietary patterns.

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Data availability

All data used in this study was obtained from NHANES-III. This data is fully anonymized and publicly available at


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There were no further contributions to this project beyond those of the listed authors.


Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001420 (EZS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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WP: Writing – original draft. RA: Writing – original draft. TS: Software, formal analysis, data curation, writing – original draft, visualization. ES: Conceptualization, methodology, writing – review and editing, supervision.

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Correspondence to Wesley R. Parker.

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Parker, W.R., Annabathula, R.V., Skipina, T.M. et al. Associations of empirical dietary inflammatory index with heart failure in adults from the United States. Eur J Clin Nutr (2022).

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