Adapted dietary inflammatory index and its association with a summary score for low-grade inflammation and markers of glucose metabolism: the Cohort study on Diabetes and Atherosclerosis Maastricht (CODAM) and the Hoorn study

doi:10.3945/ajcn.112.056333

The American Journal of Clinical Nutrition

Volume 98, Issue 6, December 2013, Pages 1533-1542

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ABSTRACT

Background:

Diet may be associated with the development of type 2 diabetes through its effects on low-grade inflammation.

Objectives:

We investigated whether an adapted dietary inflammatory index (ADII) is associated with a summary score for low-grade inflammation and markers of glucose metabolism. In addition, we investigated the mediating role of inflammation in the association between ADII and markers of glucose metabolism.

Design:

We performed cross-sectional analyses of 2 Dutch cohort studies (n= 1024). An ADII was obtained by multiplying standardized energy-adjusted intakes of dietary components by literature-based dietary inflammatory weights that reflected the inflammatory potential of components. Subsequently, these multiplications were summed. Six biomarkers of inflammation were compiled in a summary score. Associations of the ADII (expressed per SD) with the summary score for inflammation and markers of glucose metabolism were investigated by using multiple linear regression models. Inflammation was considered a potential mediator in the analysis with markers of glucose metabolism.

Results:

A higher ADII was associated with a higher summary score for inflammation [β-adjusted = 0.04 per SD (95% CI: 0.01, 0.07 per SD)]. The ADII was also adversely associated with insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR): β-adjusted = 3.5% per SD (95% CI: 0.6%, 6.3% per SD)]. This association was attenuated after the inclusion of the summary score for inflammation [β-adjusted+inflammation = 2.2% (95% CI: −0.6%, 5.0%)]. The ADII was also adversely associated with fasting glucose and postload glucose but not with glycated hemoglobin.

Conclusion:

The significant mediating role of low-grade inflammation in the association between the ADII and HOMA-IR suggests that inflammation might be one of the pathways through which diet affects insulin resistance.

Cited by (0)

^¹: From the Division of Human Nutrition, Wageningen University, Wageningen, Netherlands (GJvW, DT, AK, and EJMF); the CARIM School for Cardiovascular Diseases (IF, MMvG, CJvdK, CGS, and CDAS), the Department of Human Biology (EEB) and the NUTRIM School for Toxicology, Metabolism, and Nutrition (EEB), Maastricht University, Maastricht Netherlands; the Departments of Internal Medicine (IF, MMvG, CJvdK, CGS, and CDAS) and Clinical Epidemiology and Medical Technology Assessment (IF), Maastricht University Medical Center, Maastricht, Netherlands; the National Institute for Public Health and the Environment, Bilthoven, Netherlands (MCO); and the Departments of General Practice (GN) and Epidemiology and Biostatistics (JMD), EMGO Institute for Health and Care Research, Vrije Universiteit University Medical Center, Amsterdam, Netherlands.

^²: Funding sources were not involved in the conduct of this study or writing of the manuscript.

^³: The Hoorn study was supported by grants from the Dutch Diabetes Research Foundation, the Dutch Organization for Scientific Research, the Netherlands Heart Foundation, and the Health Research and Development Council of the Netherlands. The Cohort study on Diabetes and Atherosclerosis Maastricht was supported by grants from the Netherlands Organization for Scientific Research (940-35-034) and the Dutch Diabetes Foundation (98.901). IF is supported by the Dutch Heart Foundation (senior postdoc research grant 2006T06).

^⁴: Address reprint requests and correspondence to GJ van Woudenbergh, Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV Wageningen, Netherlands. E-mail: [email protected].

^⁵: Abbreviations used: ADII, adapted dietary inflammatory index; AHEI, alternative healthy eating index; CODAM, Cohort study on Diabetes and Atherosclerosis Maastricht; CRP, C-reactive protein; DII, dietary inflammatory index; FFQ, food-frequency questionnaire; Hb A_1c, glycated hemoglobin; MDS, multiarray detection system; MEDI, alternate Mediterranean diet index; SAA, serum amyloid A; sICAM, soluble intercellular adhesion molecule-1.