Age and sex adjusted baseline characteristics by quartiles of dietary inflammatory index score (DII) in the SUN study.

<p>SD: Standard Deviation; Q: Quartile; CHD: Coronary heart disease; METs: Metabolic equivalents.</p><p>*Adjusted by age and sex</p><p>Age and sex adjusted baseline characteristics by quartiles of dietary inflammatory index score (DII) in the SUN study.</p

Dietary Inflammatory Index and Incidence of Cardiovascular Disease in the SUN Cohort

<div><p>Background</p><p>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.</p><p>Objective</p><p>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.</p><p>Methods</p><p>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).</p><p>Results</p><p>The risk for cardiovascular events progressively increased with each increasing quartile of DII (p_trend = 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).</p><p>Conclusions</p><p>A pro-inflammatory diet was associated with a significantly higher risk for developing cardiovascular events.</p></div

Nelson-Aalen estimates of incidence of CVD across quartiles of the DII.

<p>Adjusted for sex, age, hypertension, dyslipidaemia, diabetes, smoking status (3 categories), familiar history of cardiovascular disease and total energy intake, using inverse probability weighting. The two intermediate quartiles were merged to build the “medium” category.</p

Sensitivity analysis Hazard ratios (95% CI) ^* for the risk of cardiovascular events between extreme quartiles of dietary inflammatory index score (the SUN).

<p>* Age as underlying time variable. Adjusted for sex, cardiovascular risk factors (hypertension, dyslipidaemia, diabetes, smoking status (3 categories), family history of cardiovascular disease), total energy intake (quartiles), physical activity (quartiles), body mass index (quartiles) educational level (4 categories), other cardiovascular diseases, special diet at baseline, snacking, average time sitting (quartiles), average time spent watching television (quartiles).</p><p>† For the 4 quartiles</p><p>Sensitivity analysis Hazard ratios (95% CI) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0135221#t003fn001" target="_blank">^*</a> for the risk of cardiovascular events between extreme quartiles of dietary inflammatory index score (the SUN).</p

Flow chart of participants.

<p><b>The SUN cohort.</b> * Cardiovascular disease: stroke, angina, myocardial infarction, and coronary artery revascularization.</p