Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the SUN Cohort.
BACKGROUND
Diet is known to play a key role in atherogenesis and in the development of cardiovascular events. Dietary factors may mediate these processes acting as potential modulators of inflammation. Potential Links between inflammatory properties of diet and the occurrence of cardiovascular events have not been tested previously.


OBJECTIVE
We aimed to assess the association between the dietary inflammatory index (DII), a method to assess the inflammatory potential of the diet, and incident cardiovascular disease.


METHODS
In the prospective, dynamic SUN cohort, 18,794 middle-aged, Spanish university graduates were followed up for 8.9 years (median). A validated 136-item food-frequency questionnaire was used to calculate the DII. The DII is based on scientific evidence about the relationship between diet and inflammatory biomarkers (C-reactive protein, IL-1β, IL-4, IL-6, IL-10 and TNF-α). Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between the DII and incident cardiovascular disease (myocardial infarction, stroke or cardiovascular death).


RESULTS
The risk for cardiovascular events progressively increased with each increasing quartile of DII (ptrend = 0.017). The multivariable-adjusted HR for participants in the highest (most pro-inflammatory) vs. the lowest quartile of the DII was 2.03 (95% CI 1.06-3.88).


CONCLUSIONS
A pro-inflammatory diet was associated with a significantly higher risk for developing cardiovascular events.
Department of Cardiology, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
Raúl
R
Ramallal
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Ciber de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
Estefanía
E
Toledo
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Ciber de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
Miguel A
MA
Martínez-González
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
Aitor
A
Hernández-Hernández
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Ciber de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
Ana
A
García-Arellano
Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
Nitin
N
Shivappa
Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
James R
JR
Hébert
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Ciber de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
Miguel
M
Ruiz-Canela
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis / Q000276:immunology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000276:immunology; D004032:Diet / Q000009:adverse effects*; D038441:Diet, Mediterranean / Q000009:adverse effects; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology / Q000276:immunology; D006973:Hypertension / Q000209:etiology / Q000276:immunology; D015994:Incidence; D007249:Inflammation / Q000150:complications* / Q000209:etiology* / Q000276:immunology; D016753:Interleukin-10 / Q000032:analysis / Q000276:immunology; D053583:Interleukin-1beta / Q000032:analysis / Q000276:immunology; D015847:Interleukin-4 / Q000032:analysis / Q000276:immunology; D015850:Interleukin-6 / Q000032:analysis / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000276:immunology
D015415:Biomarkers; C508609:IL10 protein, human; D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4; D002097:C-Reactive Protein