title: Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the PREDIMED Study.
abstract: Previous studies have reported an association between a more pro-inflammatory diet profile and various chronic metabolic diseases. The Dietary Inflammatory Index (DII) was used to assess the inflammatory potential of nutrients and foods in the context of a dietary pattern. We prospectively examined the association between the DII and the incidence of cardiovascular disease (CVD: myocardial infarction, stroke or cardiovascular death) in the PREDIMED (Prevención con Dieta Mediterránea) study including 7216 high-risk participants. The DII was computed based on a validated 137-item food frequency questionnaire. Multivariate-adjusted hazard ratios (HR) and 95% confidence intervals of CVD risk were computed across quartiles of the DII where the lowest (most anti-inflammatory) quartile is the referent. Risk increased across the quartiles (i.e., with increasing inflammatory potential): HR(quartile2) = 1.42 (95%CI = 0.97-2.09); HR(quartile3) = 1.85 (1.27-2.71); and HR(quartile4) = 1.73 (1.15-2.60). When fit as continuous the multiple-adjusted hazard ratio for each additional standard deviation of the DII was 1.22 (1.06-1.40). Our results provide direct prospective evidence that a pro-inflammatory diet is associated with a higher risk of cardiovascular clinical events.
authors.affiliation: Department of Emergency, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona 31008, Spain. raulramallal@hotmail.com.|The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. raulramallal@hotmail.com.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. raulramallal@hotmail.com.|Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona 31008, Spain. raulramallal@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia-Arellano
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona 31008, Spain. raulramallal@hotmail.com.|Department of Cardiology, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona 31008, Spain. raulramallal@hotmail.com.
authors.forename: Raul
authors.initials: R
authors.lastname: Ramallal
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. raulramallal@hotmail.com.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. raulramallal@hotmail.com.|Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona 31008, Spain. raulramallal@hotmail.com.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ruiz-Canela
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. jordi.salas@urv.cat.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. jordi.salas@urv.cat.|Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus 43201, Spain. jordi.salas@urv.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. dolores.corella@uv.es.|Department of Preventive Medicine, University of Valencia, Valencia 46071, Spain. dolores.corella@uv.es.
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.affiliation: South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208 USA. shivappa@email.sc.edu.
authors.forename: Nitin
authors.initials: N
authors.lastname: Shivappa
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. HSchoeder@imim.es.|Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona 08003, Spain. HSchoeder@imim.es.
authors.forename: Helmut
authors.initials: H
authors.lastname: Schröder
authors.affiliation: South Carolina Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208 USA. JHEBERT@mailbox.sc.edu.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. EROS@clinic.ub.es.|Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona 08036, Spain. EROS@clinic.ub.es.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. egomezgracia@uma.es.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. egomezgracia@uma.es.|Department of Preventive Medicine, University of Malaga, Malaga 29010, Spain. egomezgracia@uma.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Garcia
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. restruch@clinic.ub.es.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. restruch@clinic.ub.es.|Department of Internal Medicine Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona 08036, Spain. restruch@clinic.ub.es.
authors.forename: Ramon
authors.initials: R
authors.lastname: Estruch
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. jlapetra@ono.com.|Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville 41007, Spain. jlapetra@ono.com.
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. raulramallal@hotmail.com.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. raulramallal@hotmail.com.|Department of Cardiology, University Hospital of Alava, Vitoria 01009, Spain. raulramallal@hotmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. miquelfiol@yahoo.es.|Institute of Health Sciences (IUNICS), University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca 07120, Spain. miquelfiol@yahoo.es.
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. agarare@gmail.com.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. agarare@gmail.com.|Research Institut of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas 35001, Spain. agarare@gmail.com.
authors.forename: Lluis
authors.initials: L
authors.lastname: Serra-Majem
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. xpinto@bellvitgehospital.cat.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. xpinto@bellvitgehospital.cat.|Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona 08907, Spain. xpinto@bellvitgehospital.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. nancy.babio@urv.cat.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. nancy.babio@urv.cat.|Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus 43201, Spain. nancy.babio@urv.cat.
authors.forename: Nancy
authors.initials: N
authors.lastname: Babio
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. arraez@uv.es.|Department of Preventive Medicine, University of Valencia, Valencia 46071, Spain. arraez@uv.es.
authors.forename: José I
authors.initials: JI
authors.lastname: González
authors.affiliation: Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. miquelfiol@yahoo.es.|Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona 08003, Spain. miquelfiol@yahoo.es.
authors.forename: Montse
authors.initials: M
authors.lastname: Fitó
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. jalfmtz@unav.es.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. jalfmtz@unav.es.|Department of Physiology and Nutrition, University of Navarra, Pamplona 31008, Spain. jalfmtz@unav.es.
authors.forename: J Alfredo
authors.initials: JA
authors.lastname: Martínez
authors.affiliation: The PREDIMED (Prevención con Dieta Mediterránea) Research Network (RD 06/0045), Instituto de Salud Carlos III, Madrid 28029, Spain. raulramallal@hotmail.com.|Centro de Investigación Biomédica en Epidemiología y Salud Pública, Madrid 28029, Spain. raulramallal@hotmail.com.|Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona 31008, Spain. raulramallal@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
authors.affiliation: Department of Emergency, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona 31008, Spain. agarare@gmail.com.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D038441:Diet, Mediterranean; D023381:Endpoint Determination; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009754:Nuts; D000069463:Olive Oil; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000069463:Olive Oil
keywords: PREDIMED; cardiovascular disease; dietary inflammatory index; inflammation