title: Dietary inflammatory index and risk of first myocardial infarction; a prospective population-based study.
abstract: Chronic, low-grade inflammation is an established risk factor for cardiovascular disease. The inflammatory impact of diet can be reflected by concentrations of inflammatory markers in the bloodstream and the inflammatory potential of diet can be estimated by the dietary inflammatory index (DIITM), which has been associated with cardiovascular disease risk in some previous studies. We aimed to examine the association between the DII and the risk of first myocardial infarction (MI) in a population-based study with long follow-up.
  
  
  
  We conducted a prospective case-control study of 1389 verified cases of first MI and 5555 matched controls nested within the population-based cohorts of the Northern Sweden Health and Disease Study (NSHDS), of which the largest is the ongoing Västerbotten Intervention Programme (VIP) with nearly 100 000 participants during the study period. Median follow-up from recruitment to MI diagnosis was 6.4 years (6.2 for men and 7.2 for women). DII scores were derived from a validated food frequency questionnaire (FFQ) administered in 1986-2006. Multivariable conditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using quartile 1 (most anti-inflammatory diet) as the reference category. For validation, general linear models were used to estimate the association between the DII scores and two inflammatory markers, high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) in a subset (n = 605) of the study population.
  
  
  
  Male participants with the most pro-inflammatory DII scores had an increased risk of MI [ORQ4vsQ1= 1.57 (95% CI 1.21-2.02) Ptrend= 0.02], which was essentially unchanged after adjustment for potential confounders, including cardiovascular risk factors [ORQ4vsQ1= 1.50 (95% CI 1.14-1.99), Ptrend= 0.10]. No association was found between DII and MI in women. An increase of one DII score unit was associated with 9% higher hsCRP (95% CI 0.03-0.14) and 6% higher IL-6 (95% CI 0.02-0.11) in 605 controls with biomarker data available.
  
  
  
  A pro-inflammatory diet was associated with an elevated risk of first myocardial infarction in men; whereas for women the relationship was null. Consideration of the inflammatory impact of diet could improve prevention of cardiovascular disease.
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, SE-901 87, Sweden. stina.boden@umu.se.
authors.forename: Stina
authors.identifier: 0000-0002-8958-975X
authors.initials: S
authors.lastname: Bodén
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, SE-901 87, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Wennberg
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, SE-901 87, Sweden.
authors.forename: Bethany
authors.initials: B
authors.lastname: Van Guelpen
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, SE-901 87, Sweden.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.affiliation: Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, SE-901 87, Sweden.
authors.forename: Bernt
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, SE-901 87, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Andersson
authors.affiliation: Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 241, Columbia, SC, 29208, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.|Connecting Health Innovations LLC, 1417 Gregg St., Columbia, SC, 29201, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Shivappa
authors.affiliation: Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Suite 241, Columbia, SC, 29208, USA.|Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.|Connecting Health Innovations LLC, 1417 Gregg St., Columbia, SC, 29201, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hebert
authors.affiliation: Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, SE-901 87, Sweden.|Arctic Research Centre (Arcum), Umeå University, Umeå, SE-901 87, Sweden.
authors.forename: Lena Maria
authors.initials: LM
authors.lastname: Nilsson
mesh_terms: D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D004032:Diet; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000453:epidemiology*; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology*; D015596:Nutrition Assessment; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein
keywords: CVD cardiovascular disease; DII Dietary inflammatory index; IL-6 interleukin 6; MI Myocardial infarction; MONICA Monitoring of trends and determinants in cardiovascular disease; NSHDS Northern Sweden health and disease study; VIP Västerbotten intervention programme; hsCRP high-sensitivity C-reactive protein