title: Prospective association between the Dietary Inflammatory Index and mortality: modulation by antioxidant supplementation in the SU.VI.MAX randomized controlled trial.
abstract: BACKGROUND
  Chronic inflammation is a central mechanism involved in cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, 4 leading causes of mortality. Diet is a major source of pro- and anti-inflammatory bioactive compounds. The Dietary Inflammatory Index (DII) was designed to estimate the overall inflammatory potential of the diet.
  
  
  OBJECTIVE
  Our aim was to study the prospective association between the DII and mortality, as well as assess whether antioxidant supplementation could modulate this association.
  
  
  METHODS
  The Supplémentation en Vitamines et Minéraux Antioxydants study was a randomized, double-blind, placebo-controlled trial in which participants received low-dose antioxidants or a placebo from 1994 to 2002. In this observational prospective analysis, 8089 participants (mean ± SD age at baseline: 49.0 ± 6.3 y) were followed between 1994 and 2007 (median: 12.4 y). The DII was calculated from repeated 24-h dietary records; higher scores correspond to more proinflammatory diets. A total of 207 deaths occurred during follow-up, including 123 due to cancer and 41 due to cardiovascular events. Multivariate Cox proportional hazards models were computed.
  
  
  RESULTS
  Sex-specific tertiles of the DII were positively associated with cardiovascular + cancer mortality (HR for tertile 3 compared with tertile 1 = 1.53; 95% CI: 1.01, 2.32; P-trend = 0.05) and specific cancer mortality (HR for tertile 3 compared with tertile 1 = 1.83; 95% CI: 1.12, 2.99; P-trend = 0.02). The corresponding P value was 0.07 for all-cause mortality. The DII was statistically significantly associated with increased all-cause mortality in the placebo group (HR for tertile 3 compared with tertile 1 = 2.10; 95% CI: 1.15, 3.84; P-trend = 0.02) but not in the antioxidant-supplemented group (P-trend = 0.8; P-interaction = 0.098).
  
  
  CONCLUSIONS
  These results suggest that a proinflammatory diet is associated with increased all-cause and cancer mortality and antioxidants may counteract some of the proinflammatory effects of the diet. This trial was registered at clinicaltrials.gov as NCT00272428.
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
authors: Laurie
authors: L
authors: Graffouillère
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
authors: Mélanie
authors: M
authors: Deschasaux
authors: AgroParisTech and INRA, Research Center in Human Nutrition from the Ile-de-France region, Mixt Research Unit 914 Nutrition Physiology and Ingestive Behavior, Paris, France;
authors: François
authors: F
authors: Mariotti
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
authors: Lola
authors: L
authors: Neufcourt
authors: Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; and Connecting Health Innovations LLC, Columbia, SC; and.
authors: Nitin
authors: N
authors: Shivappa
authors: Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; and Connecting Health Innovations LLC, Columbia, SC; and.
authors: James R
authors: JR
authors: Hébert
authors: Cancer Prevention and Control Program, and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; and Connecting Health Innovations LLC, Columbia, SC; and.
authors: Michael D
authors: MD
authors: Wirth
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
authors: Paule
authors: P
authors: Latino-Martel
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; Public Health Department, Avicenne Hospital, Bobigny, France.
authors: Serge
authors: S
authors: Hercberg
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
authors: Pilar
authors: P
authors: Galan
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; Public Health Department, Avicenne Hospital, Bobigny, France.
authors: Chantal
authors: C
authors: Julia
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;
authors: Emmanuelle
authors: E
authors: Kesse-Guyot
authors: Sorbonne Paris Cité Epidemiology and Statistics Research Center, French National Institutes of Health and Medical Research (Inserm) U1153, French National Institute for Agricultural Research (INRA) U1125, French National Conservatory of Arts and Crafts (Cnam), Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; m.touvier@eren.smbh.univ-paris13.fr.
authors: Mathilde
authors: M
authors: Touvier
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality*; D004032:Diet / Q000009:adverse effects*; D015930:Diet Records; D019587:Dietary Supplements; D004311:Double-Blind Method; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D000975:Antioxidants
keywords: Dietary Inflammatory Index; antioxidants; inflammation; mortality; prospective study