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Alessandro Gialluisi,1 Federica Santonastaso,2 Marialaura Bonaccio,1 Francesca Bracone,1 Nitin Shivappa,3,4 James R Hebert,3,4 Chiara Cerletti,1 Maria Benedetta Donati,1 Giovanni de Gaetano,1 Licia Iacoviello1,2 On behalf of the Moli-sani Investigators1Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; 2Department of Medicine and Surgery, University of Insubria, Varese, Italy; 3Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; 4Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USACorrespondence: Alessandro GialluisiDepartment of Epidemiology and Prevention, IRCCS Neuromed, Via dell´Elettronica, 86077, Pozzilli, ItalyTel +390865915244Email alessandro.gialluisi@gmail.comBackground: Depression is a mood disorder characterized by a high rate of resistance to pharmacological treatments, which has often been linked to chronic inflammation. This can be influenced by different environmental factors, in particular pro-inflammatory diets. However, a mediating role of circulating inflammation has never been observed.Aim: To test the association between a dietary inflammatory index (DII®) and continuous depressive symptoms (adapted version of PHQ9) in an Italian population cohort (N=13,301), along with potential explanatory effect of a composite index (INFLA-score) based on four circulating inflammatory biomarkers: C-reactive protein, granulocyte-to-lymphocyte ratio, platelet and white blood cell counts.Results: Significant positive associations were observed between DII and total depressive symptoms (standardized β (SE) = 0.038 (0.005), p < 0.001), and with two factors tagging somatic (0.012 (0.003), p < 0.001) and cognitive symptoms (0.012 (0.003), p < 0.001), after adjustment for different potential confounders (socioeconomic status, chronic health conditions and lifestyles). These associations were about twice as strong in women than in men. INFLA-score explained a small but significant proportion of the association with total depressive symptoms (0.90– 2.30%, p < 0.05), which was mainly driven by granulocyte-to-lymphocyte ratio (1.18– 1.65%). This effect was even stronger for the somatic (2.66– 4.66%) but not for the cognitive factor (0%).Conclusion: These findings support a strong link between inflammatory diet and depression, especially with somatic symptoms and within women. Moreover, they provide novel evidence for a potential explanatory role of circulating inflammation in this association, suggesting new paths for prevention and treatment of major and atypical depression.Keywords: dietary inflammatory index, depressive symptoms, atypical depression, circulating inflammation, granulocyte-to-lymphocyte ratio, white blood cells

Wen Chen,1 Mo’ez Al-Islam E Faris,2 Nicola Luigi Bragazzi,3 Haifa MS AlGahtani,4,5 Zahra Saif,6 Ahmed Jahrami,7 Nitin Shivappa,8,9 James R Hebert,8,9 Haitham Jahrami4,6 1Department of Psychiatry, Xiamen Xianyue Hospital, Xiamen, 361000, People’s Republic of China; 2Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates; 3Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada; 4College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; 5Renewal and Reward Center, Dammam, Saudi Arabia; 6Ministry of Health, Manama, Bahrain; 7Bahraini Association for Intellectual Disabilities and Autism, Sanad, Bahrain; 8Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, 29208, USA; 9Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USACorrespondence: Haitham JahramiMinistry of Health, PO Box 12, Manama, BahrainTel +973 17286334Fax +973 17286335Email hjahrami@health.gov.bhPurpose: This case-control study aimed to examine the association between the inflammation potential of the diet and depression.Patients and Methods: Ninety-six patients with major depression disorder were matched with 96 age- and sex-matched healthy controls. Energy-adjusted DII (E-DIITM) scores were calculated based on the participants’ responses to a detailed nutritional assessment using a quantitative food frequency questionnaire. Descriptive results were reported. Logistic regression was used to estimate odds ratios and 95% confidence intervals associated with E-DII scores and depression adjusting for covariates including age, sex, body mass index, comorbidities, level of education, and employment.Results: The mean E-DII score of participants in the study was 1.32± 1.08, indicating a generally pro-inflammatory diet. Patients with depression had elevated E-DII scores compared to age- and sex-matched controls with E-DII scores of 1.72± 1.09 vs 0.90± 0.90, respectively (P=0.001). Results of logistic regression analysis revealed that patients with depression were nearly three times more likely to be in the extreme ends of pro-inflammatory diet (OR 2.75; 95% CI 1.82– 4.15).Conclusion: Adult Bahraini patients with depression have higher dietary inflammation potential compared to the general population controls. Further research is needed to confirm these results and provide effective interventions to reduce the burden of this dietary inflammation.Keywords: inflammation, depression, case-control study, mental health, Arabian population groups

Background & Aims: Childhood adiposity and inflammation impact long-term health. However, associations between dietary inflammation and childhood adiposity are unclear. We investigated if more pro-inflammatory diets are associated with greater adiposity in early-, mid-, and late-childhood., Methods: We pooled individual participant data (IPD) from 13,978 children in six European birth cohorts in the ALPHABET consortium: Lifeways Cross-Generation Cohort Study (Lifeways), the Randomised cOntrol trial of LOw glycaemic index diet during pregnancy study (ROLO), the Avon Longitudinal Study of Parents and Children (ALSPAC), the Southampton Women's Survey (SWS), the Polish Mother and Child Cohort (REPRO&#95;PL), and The Generation R Study (Generation R). Dietary inflammation was determined using the Children's Dietary Inflammatory Index (C-DII™). Adiposity-related outcomes included BMI z-score (primary outcome), abdominal circumference, skinfolds, fat-mass- and fat-free-mass-indices (secondary outcomes). Two-stage random effects IPD meta-analysis (IPD-MA), with adjusted linear and logistic regression models, was conducted. Quantile regression (QR) examined C-DII associations with BMI z-score percentiles., Results: Median, 25th and 75th percentile C-DII scores trended upwards from early 0.18 (-0.65, 1.03) to late-childhood 0.51 (-0.40, 1.49). Pooled QR revealed positive C-DII associations across BMI z-score percentiles, particularly in late-childhood unadjusted β (95 % CI) 75th (0.075 (0.046, 0.105), p < 0.001); 85th (0.077 (0.045, 0.108), p < 0.001); and 95th (0.051 (0.011, 0.091), p = 0.01). Adjusted cohort-specific QR identified contrasting associations at early-childhood (ALSPAC and SWS) and late-childhood (Generation R). Pooled adjusted IPD-MA showed C-DII associations with late-childhood obesity [OR (95 % CI) 0.89 (0.81, 0.97), p = 0.01]., Conclusions: C-DII associations across BMI z-score distribution varied by cohort, quantile, and time-point, with some potentially explained by adiposity rebound, reverse causation and questionnaire response biases, highlighting insights not evident with linear regression., Competing Interests: Conflict of interest KV, LWC, SC, LD, NCH, VWVJ, CK, FMM, KP, MS, JJ, MB, RS and CMP - no conflict of interest to declare. JH: Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina in order to develop computer and smart phone applications for patient counselling and dietary intervention in clinical settings. CHI owns exclusive right to the E-DII and C-DII. The subject matter of this paper has no direct bearing on that work, nor has any CHI-related activity exerted any influence on this project. This did not and will not alter our adherence to the journal policies on sharing data and materials, but note that we are unable to share the computational algorithm, which is protected by trademark and patent law., (Copyright © 2025 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background/objectives: Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality worldwide. Sleep duration, diet, and obesity have each been identified as modifiable risk factors linked to CRC. However, their joint effect on CRC incidence is underexplored. This study investigated the association between sleep duration and CRC incidence and explored the joint effects of sleep duration, a pro-inflammatory diet, and obesity on CRC incidence in the Multiethnic Cohort (MEC)., Methods: This prospective cohort study analyzed 193,027 participants from Hawaii and California enrolled in the MEC between 1993 and 1996. Sleep duration was self-reported and categorized as short (≤6 h), normal (7-8 h), or long (≥9 h). Diet was self-reported via FFQ and inflammatory potential was assessed using the energy-adjusted Dietary Inflammatory Index (E-DII). CRC cases were identified via cancer registries. Cox proportional hazards models estimated the hazard ratios (HRs) for CRC risk., Results: After 23.8 years of follow-up, 5825 CRC cases were identified. A pro-inflammatory diet combined with suboptimal sleep increased CRC risk by 12% (short sleep duration, aHR: 1.12; 95% CI: 1.02-1.24) and 22% (long sleep duration, aHR: 1.22, 95% CI: 1.05-1.43). Furthermore, long sleep duration was associated with a 10% increase in CRC risk (aHR: 1.10; 95% CI: 1.01-1.22) compared with normal sleep, while short sleep showed no significant association overall. Obese individuals with short or long sleep had significantly higher CRC risk (short sleep aHR: 1.35; 95% CI: 1.21-1.51; long sleep aHR: 1.36; 95% CI: 1.14-1.64) compared with non-obese individuals with corresponding sleep durations., Conclusions: Long sleep duration and a combination of suboptimal sleep duration and a pro-inflammatory dietary pattern or obesity amplifies the risk.

Nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant global public health dilemma with wide-ranging social and economic implications. Diet and lifestyle modifications remain essential components of NAFLD management. The current study investigated the association between diet-related inflammation and NAFLD among 3110 Iranian adults participating in the Amol Cohort Study (AmolCS), employing the Structural Equation Modeling (SEM) approach.The inflammatory potential of the diet was quantified using an energy-adjusted dietary index (E-DII) score. Findings showed that in the total sample and separately in males, the E-DII score had a significant effect on NAFLD, with mediation through hypertension (β standardized  = 0.16, and 0.13, p < 0.001, respectively) and c-reactive protein (CRP) (β standardized  = 0.07, and 0.07, p < 0.001, respectively). In the total sample and separately in females, the E-DII score significantly affected NAFLD, with mediation through diabetes (β standardized  = 0.06, p < 0.001, and 0.07, p = 0.006, respectively). In full and both gender-specific models, dyslipidemia was a risk factor for NAFLD and partially mediated the effect of hypertension on NAFLD.The current study concluded a mediated association between dietary inflammation and NAFLD through hypertension, CRP, diabetes, and dyslipidemia, suggesting further longitudinal studies, especially in high-risk populations. These findings underscore the complex interplay between diet, inflammation, and NAFLD in Iranian adults., Competing Interests: Declarations. Ethics approval and consent to participate: The investigation followed the guidelines specified in the Declaration of Helsinki and received approval from the ethical committee of the Iran University of Medical Sciences (IUMS) with the reference code IR.IUMS.REC.1401.950. Each individual involved in the study provided written consent after receiving comprehensive information regarding the study’s aims and procedures. Competing interests: The authors declare no competing interests. Consent for publication: Not applicable. Disclosure: Dr. James R. Hébert is the primary shareholder of Connecting Health Innovations LLC (CHI), which has secured authorization for his innovation, the dietary inflammatory index (DII®), from the University of South Carolina. CHI plans to use this invention to create computer and smartphone applications for patient counseling and dietary intervention in clinical settings. CHI also holds the exclusive rights to the E-DII™. The content of this paper is not related to CHI’s work, and CHI has not influenced this project in any way., (© 2024. The Author(s).)

Importance: It remains unclear whether diet may influence the risk of prostate cancer grade reclassification in men undergoing active surveillance., Objective: To assess the association of diet quality and dietary inflammatory potential with prostate cancer grade reclassification during active surveillance., Design, Setting, and Participants: This prospective cohort study included men diagnosed with grade group (GG) 1 prostate cancer from January 2005 to February 2017 who were undergoing active surveillance and at active surveillance enrollment prospectively completed a validated food frequency questionnaire regarding their usual dietary patterns. Data were analyzed from October 29, 2023, to June 17, 2024., Exposures: The Healthy Eating Index 1999-2000 (HEI) and energy-adjusted HEI (E-HEI) scores as a measure of adherence to the Dietary Guidelines for Americans and the Dietary Inflammatory Index (DII) and energy-adjusted DII (E-DII) scores as metrics of dietary inflammatory potential were calculated using self-reported diet data., Main Outcomes and Measures: A competing risk regression was performed to test the baseline HEI, E-HEI, DII, and E-DII scores for an association with grade reclassification to GG2 or greater or GG3 or greater (ie, extreme grade reclassification) during active surveillance, adjusting for established active surveillance prognostic factors and smoking history at baseline., Results: The study included 886 men (median age at diagnosis, 66 years [IQR, 61-69 years]). After median follow-up of 6.5 years (IQR, 4.0-9.1 years), 187 (21%) had grade reclassification to GG2 or greater, including 55 (6%) with extreme grade reclassification. The cumulative incidence of grade reclassification was 7% (95% CI, 5%-9%) at 3 years, 15% (95% CI, 12%-17%) at 5 years, and 33% (95% CI, 29%-37%) at 10 years; that of extreme grade reclassification was 2% (95% CI, 1%-4%) at 3 years, 4% (95% CI, 3%-5%) at 5 years, and 10% (95% CI, 7%-13%) at 10 years. Higher baseline HEI (subdistribution hazard ratio [SHR], 0.85; 95% CI, 0.73-0.98; P = .03) and E-HEI (SHR, 0.86; 95% CI, 0.74-1.00; P = .047) per 1-SD increase in score were associated with a significantly lower risk of grade reclassification. Higher baseline HEI (SHR, 0.72; 95% CI, 0.57-0.93; P = .01) and E-HEI (SHR, 0.73; 95% CI, 0.57-0.94; P = .01) per 1-SD increase in score were associated with a significantly lower risk of extreme grade reclassification. Neither the baseline DII nor E-DII was associated with either grade reclassification outcome (eg, for grade reclassification to ≥GG2, the SHR was 1.08 [95% CI, 0.93-1.26] per 1-SD increase in DII score and 1.02 [95% CI, 0.86-1.21] per 1-SD increase in E-DII score)., Conclusions and Relevance: The findings suggest that in men diagnosed with GG1 prostate cancer undergoing active surveillance, higher adherence to American dietary guideline recommendations may be associated with a lower risk of grade reclassification, particularly to GG3 or greater disease, which mandates curative treatment.

Diet represents an important set of potential risk factors for rheumatoid arthritis (RA), a known inflammatory condition. This case-control study examined the association between the inflammatory potential of diet, as determined by the dietary inflammatory index (DII®), and RA risk in an Iranian population. The present Case-control study was conducted on 100 RA patients and 200 age- and sex-matched controls in Isfahan, Iran. The presence of RA was determined by expert Rheumatologist assessment based on the American College of Rheumatology definitions. A 168-item food frequency questionnaire was used to collect dietary intake from which DII scores were computed. Odds ratios (OR) and 95 % confidence intervals (CI) for the association between the DII, expressed in tertiles, and RA risk were estimated by two multivariable logistic regression models, one crude model and one in which we controlled for important potential confounders. In the crude model, individuals in the top DII tertile (most pro-inflammatory diet) had more than triple the risk of RA compared to those in the lowest tertile (OR tertile3vs1 = 3.57; 95 % CI, 1.95-6.53; p< 0.001). The association was essentially unchanged after controlling for potential confounders (OR tertile3vs1 = 3.83; 95 % CI, 1.66-8.81; p<0.001). We found that a pro-inflammatory diet is associated with increased risk of RA. Higher volume studies are needed to confirm the results., Competing Interests: Declaration of Competing Interest Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Pancreatic cancer (PC), a highly malignant cancer with a poor diagnosis, may be influenced by diet-related inflammation. This study examined the association between dietary inflammatory index (DII) scores and the incidence and prognosis of PC in Korea., Methods: A total of 55 patients with PC were matched with 280 healthy controls (HCs) by age and sex. We also analyzed the combined effects of DII scores and fasting blood glucose (FBG) levels or smoking status on the risk of PC and performed a survival analysis using the Cox proportional hazards method., Results: The DII scores were higher in the patients with PC than those in HCs (odds ratio [OR] = 3.36, confidence interval [CI] = 1.16-9.73, p = 0.03), and the effect was larger in women (OR = 6.13, CI = 1.11-33.82, p = 0.04). A high DII score was jointly associated with FBG ≥ 126 mg/dL in raising PC risk [OR = 32.5, relative excess risk due to interaction/synergy (RERI/S) index = 24.2/4.34, p -interaction = 0.04], indicating a multiplicative interaction. A high DII score combined with ex/current smoker status increased PC risk through an additive interaction (RERI/S = 1.01/1.54, p -interaction = 0.76). However, DII scores did not influence disease-free survival., Conclusions: The consumption of an anti-inflammatory diet, coupled with maintaining normal FBG levels and abstaining from smoking, may help reduce the risk of PC by mitigating pancreatic inflammation.

Background: Type 2 diabetes is a major public health concern in the United States and worldwide. The dietary inflammatory index (DII) and the energy-adjusted DII (E-DII) are tools that assess dietary inflammation. Previous evidence suggests that obesity can modify the association between inflammation and disease., Objective: The aim of this study was to evaluate the association between the DII/E-DII and incident diabetes in self-identified Hispanic women from the Women's Health Initiative (WHI). The secondary aim was to evaluate whether obesity modifies the association between the DII/E-DII scores and incident diabetes., Design: Participants were from the WHI Observational Study and the Clinical Trial Components (except women from the treatment arm in the Dietary Modification Trial) conducted among postmenopausal women in the United States. DII/E-DII scores were calculated from a self-administered food frequency questionnaire at baseline that included 122 food items, of which 12 are representative of Hispanic eating patterns., Participants/settings: Participants included 3,849 postmenopausal women who self-identified as Hispanic that were recruited for the WHI from 1993 to 1998 at 40 US clinical centers., Main Outcome Measures: The outcome was incident diabetes., Statistical Analysis Performed: Cox regression models were used to assess the association between DII/E-DII and incident diabetes. Models were adjusted for age at baseline, lifestyle-related risk factors, known type 2 diabetes mellitus (T2DM) risk factors, and neighborhood socioeconomic status. Interaction was tested between the DII/E-DII scores and obesity., Results: The incidence of diabetes was 13.1% after a median follow-up of 13 years. Higher E-DII scores were associated with a higher risk of incident diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.04-1.14). There was no interaction between E-DII scores and obesity (P = 0.73)., Conclusions: Pro-inflammatory diets, as measured by higher E-DII scores, were associated with a higher risk of incident diabetes. Future research is needed for understanding how the inflammatory potential of diets can be decreased., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Introduction: Disadvantaged populations have higher rates of chronic disease, including heart disease, cancer, and diabetes. Race, ethnicity, lower socioeconomic status, and poverty all contribute to these disproportionate rates. Other factors, including systemic racism, climate change, poor diet, lack of food access, and epigenetic influences, that are distributed and experienced differently across vulnerable populations also play a significant role in the development of chronic diseases. This comprehensive review of contributors to chronic diseases emphasizes a unique focus on these identified emerging factors., Methods: An ad hoc literature review using OVID Medline and Web of Science was conducted., Results: Findings from prior studies indicate that multiple stressors, both in isolation and in combination, and their negative impacts on both physical and mental health of minorities are exacerbated by climate change., Discussion: Various stressors dramatically increase chronic disease risk in minority groups. Recommendations for future research to elucidate the impacts of climatic, racial, and dietary adversity with minority populations are presented. Further study in this area is critical for achieving the UN Sustainable Development Goals and improving public health outcomes., (© 2024. The Author(s).)

Sleep has strong inflammatory underpinnings and diet is one of the primary determinants of systemic inflammation. A systematic literature review was conducted to synthesize current research associating dietary inflammatory potential, as measured by the dietary inflammatory index (DII®) or the energy-adjusted DII (E-DII™) and sleep quality and duration. The National Library of Medicine (Medline), Web of Science, and PsycInfo databases were searched through March 2023. Studies must have used the DII/E-DII as the independent variable and sleep outcomes as dependent variables. Study characteristics, based on STROBE guidelines, were scored based on the presence of the recommendation. Out of the initial 14 studies identified, a total of 12 studies were included for data synthesis. In all 12 studies, more anti-inflammatory diets (i.e., low DII/E-DII scores) were associated with better sleep in at least one sleep domain (most often sleep efficiency and wake-after-sleep-onset). Among those studies with more rigorous diet and sleep measurements, such as dietary recalls and actigraphy, associations between DII/E-DII and sleep outcomes were stronger and more consistent compared to studies using primarily subjective assessments. More rigorous measurement of diet and sleep, especially those relating to sleep stage structure, should be considered in future studies with prospective designs., Competing Interests: Declaration of competing interest Dr. James Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company licensing the right to his invention of the Dietary Inflammatory Index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Androgenic alopecia (AGA), the most prevalent hair loss type, causes major psychological distress and reduced quality of life. A definite and safe cure/prevention for this condition is still lacking. The role of oxidative stress and inflammation in AGA pathogenesis prompted us to investigate the association between dietary antioxidant index (DAI) and energy-adjusted dietary inflammatory index (E-DII) with AGA., Methods: The investigation was designed based on data from 10,138 participants from the Fasa Adult Cohort Study (FACS). DAI and energy-adjusted DII (E-DII) were calculated utilizing a validated 125-item food frequency questionnaire (FFQ). A physician diagnosed AGA. Logistic regression models were utilized to evaluate the association of DAI and E-DII with AGA., Results: After exclusion, 9,647 participants (44.0% men, mean age: 48.6 ± 9.5 years) consisting of 7,348 participants with AGA entered the analyses. Higher DAI was associated with 10% lower AGA odds, while higher E-DII showed 4% higher AGA odds after adjusting for various confounding variables. However, significant associations were found only among women, and adjusting for metabolic syndrome (MetS) made the E-DII-AGA association insignificant., Conclusion: Antioxidant-rich diets protect against AGA, while pro-inflammatory diets increase the risk, likely through developing MetS. Patient nutrition is frequently overlooked in clinical practice, yet it plays a crucial role, especially for women genetically predisposed to androgenetic alopecia. Dietary changes, such as reducing pro-inflammatory foods (like trans and saturated fats) and increasing anti-inflammatory options (fruits and vegetables), can help prevent hair loss and mitigate its psychological impacts, ultimately lowering future treatment costs., Competing Interests: JH owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. CHI owns exclusive rights to the energy-adjusted DII (E-DIITM). The subject matter of this paper has no direct bearing on that work, nor has any CHI-related activity exerted any influence on this project. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bazmi, Sepehrinia, Pourmontaseri, Bazyar, Vahid, Farjam, Dehghan, Hébert, Homayounfar and Shakouri.)

Background and Aims: Research into the relationship between an Energy-adjusted Diet-Inflammatory Index (E-DII) and a wider health-related biomarkers profile is limited. Much of the existing evidence centers on traditional metabolic biomarkers in populations with chronic diseases, with scarce data on healthy individuals. Thus, this study aims to investigate the association between an E-DII score and 30 biomarkers spanning metabolic health, endocrine, bone health, liver function, cardiovascular, and renal functions, in healthy individuals., Methods and Results: 66,978 healthy UK Biobank participants, the overall mean age was 55.3 (7.9) years were included in this cross-sectional study. E-DII scores, based on 18 food parameters, were categorised as anti-inflammatory (E-DII < -1), neutral (-1 to 1), and pro-inflammatory (>1). Regression analyses, adjusted for confounding factors, were conducted to investigate the association of 30 biomarkers with E-DII. Compared to those with an anti-inflammatory diet, individuals with a pro-inflammatory diet had increased levels of 16 biomarkers, including six cardiometabolic, five liver, and four renal markers. The concentration difference ranged from 0.27 SD for creatinine to 0.03 SD for total cholesterol. Conversely, those on a pro-inflammatory diet had decreased concentrations in six biomarkers, including two for endocrine and cardiometabolic. The association range varied from -0.04 for IGF-1 to -0.23 for SHBG., Conclusion: This study highlighted that a pro-inflammatory diet was associated with an adverse profile of biomarkers linked to cardiometabolic health, endocrine, liver function, and renal health., Competing Interests: Conflict of interest The authors have no conflict of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

This study analyzed the overall quality of the diet using predefined indices, including the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII ® ), to explore their association with the risk of bladder cancer in the Multiethnic Cohort Study. Data were taken from 186,979 African American, Japanese American, Latino, Native Hawaiian, and non-Hispanic White participants aged 45-75 years, with 1152 incident cases of invasive bladder cancer during a mean follow-up period of 19.2 ± 6.6 years. Cox models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) with comprehensive adjustment for smoking. Comparing the highest vs. lowest diet quality score quintile, HRs (95% CIs) in men was 1.08 (0.86-1.36) for HEI-2015, 1.05 (0.84-1.30) for AHEI-2010, 1.01 (0.80-1.27) for aMED, 1.13 (0.90-1.41) for DASH, and 0.96 (0.76-1.21) for DII ® , whereas the corresponding HRs for women were 0.75 (0.53-1.07), 0.64 (0.45-0.92), 0.60 (0.40-0.88), 0.66 (0.46-0.95), and 0.63 (0.43-0.90) with all p values for trend <0.05. The inverse association found in women did not vary by smoking status or race and ethnicity. Our findings suggest that adopting high-quality diets may reduce the risk of invasive bladder cancer among women in a multiethnic population.

Introduction: Dietary choices play a crucial role in influencing systemic inflammation and the eventual development of cardiovascular diseases (CVD). The Dietary Inflammatory Index (DII®) is a novel tool designed to assess the inflammatory potential of one's diet. Firefighting, which is characterized by high-stress environments and elevated CVD risk, represents an interesting context for exploring the dietary inflammatory-CVD connection., Aim: This study aims to investigate the associations between Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and cardiometabolic risk parameters among US firefighters., Methods: The study analyzed 413 participants from the Indianapolis Fire Department who took part in a Federal Emergency Management Agency (FEMA)-sponsored Mediterranean diet intervention trial. Thorough medical evaluations, encompassing physical examinations, standard laboratory tests, resting electrocardiograms, and submaximal treadmill exercise testing, were carried out. Participants also completed a detailed food frequency questionnaire to evaluate dietary patterns, and E-DII scores were subsequently computed based on the gathered information., Results: Participants had a mean body mass index (BMI) of 30.0 ± 4.5 kg/m 2 and an average body fat percentage of 28.1 ± 6.6%. Regression analyses, adjusted for sex, BMI, maximal oxygen consumption (VO 2 max), max metabolic equivalents (METS), age, and body fat percentage, revealed significant associations between high vs. low E-DII scores and total cholesterol ( β = 10.37, p = 0.04). When comparing low Vs median E-DII scores there is an increase in glucose ( β = 0.91, p = 0.72) and total cholesterol ( β = 5.51, p = 0.26)., Conclusion: Our findings support an association between higher E-DII scores and increasing adiposity, as well as worse lipid profiles., Competing Interests: LZ and JH were employed by Connecting Health Innovations LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Christodoulou, Christophi, Sotos-Prieto, Moffatt, Zhao, Kales and Hébert.)

Objective: To deepen the understanding of the influence of diet on weight gain and metabolic disturbances, we examined associations between diet-related inflammation and body composition and fecal bacteria abundances in participants of the Nutritionists' Health Study., Methods: Early-life, dietary and clinical data were obtained from 114 women aged ≤45 years. A validated food frequency questionnaire was used to calculate the energy-adjusted dietary inflammatory index (E-DII). Participants' data were compared by E-DII quartiles using ANOVA or Kruskal-Wallis. Associations of DXA-determined body composition with the E-DII were tested by multiple linear regression using DAG-oriented adjustments. Fecal microbiota was analyzed targeting the V4 region of the 16S rRNA gene. Spearman correlation coefficients were used to test linear associations; differential abundance of genera across the E-DII quartiles was assessed by pair-wise comparisons., Results: E-DII score was associated with total fat (b=1.80, p<0.001), FMI (b=0.08, p<0.001) and visceral fat (b=1.19, p=0.02), independently of maternal BMI, birth type and breastfeeding. E-DII score was directly correlated to HOMA-IR (r=0.30; p=0.004), C-reactive protein (r=0.29; p=0.003) and to the abundance of Actinomyces, and inversely correlated to the abundance of Eubacterium.xylanophilum.group. Actinomyces were significantly more abundant in the highest (most proinflammatory) E-DII quartile., Conclusions: Association of E-DII with markers of insulin resistance, inflammation, body adiposity and certain gut bacteria are consistent with beneficial effects of anti-inflammatory diet on body composition and metabolic profile. Bacterial markers, such as Actinomyces, could be involved in the association between the dietary inflammation with visceral adiposity. Studies designed to explore how a pro-inflammatory diet affects both central fat deposition and gut microbiota are needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years ( n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DII TM ) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up ( n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.

Patients with Ulcerative Colitis (UC) seek a variety of methods to manage the physical and psychosocial burdens of illness on daily life. This study examines how individuals with UC: (1) utilize treatment and self-management methods and (2) make decisions regarding their use of these methods throughout the disease course. Adults living with UC ≥5 years and experienced ≥1 disease flare, participated in individual, semi-structured qualitative interviews. Transcripts were thematically analyzed using a constant comparative approach in NVivo12 ® . Participants (N = 21) described their decisions to utilize medical, lifestyle, and complementary methods, which were shaped by sources of information, attitudes toward self-management, and personal motivations. The poor quality of life associated with the daily burden of living with UC emerged as a primary motive for exploration and utilization of treatment and management methods. Participants reported primarily utilizing treatment and management methods as reactive responses to flares instead of preventive measures. Results provide insight into patient decision-making and may inform individualized patient care, improve patient-provider communication, and guide interdisciplinary efforts to support self-management among patients with UC. Findings highlight a need for greater focus on promoting preventive self-management lifestyle behaviors to protect against disease activity and progressive impairment., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Background and Aims: Although there is extensive literature showing the ability of the dietary inflammation index (DII®) to predict concentrations of plasma inflammatory markers, few studies are testing the association between DII scores and nonalcoholic fatty liver disease (NAFLD). Considering the high prevalence of NAFLD and its complications, we conducted a validation study of DII scores and examined its association with NAFLD in the general adult population of Iran., Methods: This cross-sectional study was conducted on 3110 adult participants in the Amol Cohort Study (AmolCS) who underwent abdominal ultrasonography to diagnose NAFLD. DII and energy-adjusted DII (E-DII™) scores were computed using data from a valid semi-quantitative 168-item food frequency questionnaire (FFQ). Multivariable logistic regression adjusting for socio-demographic, lifestyle, and health-related factors was used to assess association., Results: The EDII was associated with CRP inflammatory biomarker. Participants in the highest, i.e., most pro-inflammatory tertile had the highest odds of NAFLD by ultrasound in all models [fully adjusted model: OR (95 % CI) tertile3vs.1 :1.54 (1.05-2.05); P trend  = 0.04, and 1.63 (1.19-2.21); P trend  = 0.03 in women and men, respectively]. The highest tertile had the highest OR for NAFLD by fatty liver index (FLI) only in men [fully adjusted model OR (95 % CI) tertile3vs.1 : 1.77 (1.15-2.71); P trend  = 0.01]. Similar results were also obtained for NAFLD by hepatic steatosis index (HSI) in women [fully adjusted model: OR (95 % CI) tertile3vs.1 : 1.70 (1.12-2.58); P trend  = 0.03]. The results of the fully adjusted multivariable model of liver markers and NAFLD status, stratified by gender and abdominal obesity, revealed that the highest tertiles had the highest OR for NAFLD by ultrasound and NAFLD by FLI only in men without abdominal obesity [fully adjusted model: OR (95 % CI) tertile3vs.1 : 1.83 (1.17-2.84); P trend  = 0.03, and, respectively]. NAFLD by FLI tended to increase strongly with tertile E-DII scores in men without abdominal obesity in crude and three adjusted models [full-adjusted model: OR (95 % CI) tertile3vs.1 : 3.64 (1.56-8.46); P trend  = 0.005]. By contrast, women with abdominal obesity in the highest tertile had the highest OR for NAFLD by ultrasound in all models [full-adjusted model: OR (95 % CI) tertile3vs.1 : 1.67 (1.07-2.62); P trend  = 0.02]., Conclusions: Our results suggest that diet plays a role in regulating inflammation. Additionally, we observed an inflammatory diet predicts the risk of NAFLD in Iranian adults. However, longitudinal studies are required in order to further substantiate the utility of the DII in the development of more effective dietary interventions among populations at risk of chronic disease., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background and Aims: Previous studies have demonstrated associations between the Dietary Inflammatory Index (DII®), an analytical tool which evaluates the inflammatory potential of the diet according to the pro- and anti-inflammatory properties of its components, and renal stone formation. However, these have not comprehensively addressed important parameters such as stone type, gender, DII scores in stone formers (SFs) and healthy controls (Cs) and associations of DII with urine and blood chemistries. These were adopted as the survey parameters for the present study, the purpose of which was to test whether the contributory role of an inflammatory diet on stone formation could be further confirmed., Methods: 97 calcium oxalate (CaOx) SFs and 63 Cs, matched for age and gender each completed a semi-quantitative food frequency questionnaire from which nutrient composition was computed. These data were used to calculate the DII® score. To control the effect of energy intake, energy-adjusted DII scores were calculated per 1000 kcal consumed (E-DII™). A single blood sample and two consecutive overnight (8h) urine samples were collected from a subset (n = 59 SFs and n = 54 Cs) of the overall number of particpants (n = 160). These were analysed for renal stone risk factors. Data were analysed using regression models fit in R software., Results: E-DII scores were found to fit the data better than DII, so they were used throughout. E-DII scores were significantly more positive (more pro-inflammatory) in SFs than in controls in the combined gender group (-0.34 vs. -1.73, p < 0.0001) and separately in males (-0.43 vs. -1.78, p = 0.01) and females (-0.26 vs. - 1.61, p = 0.05). In blood, a significant negative correlation was seen between E-DII and HDL cholesterol. In urine significant positive correlations were seen between E-DII and each of calcium (ρ = 0.25, p = 0.02), phosphate (ρ = 0.48, p < 0.001), magnesium (ρ = 0.33, p < 0.0001) and uric acid (ρ = 0.27, p = 0.004) concentrations. A significant negative correlation was seen between E-DII and urinary volume ρ = -0.27, p = 0.003). There was no correlation between E-DII scores and the relative supersaturations of urinary CaOx, calcium phosphate (brushite) and uric acid., Conclusions: Our findings provide hitherto unreported quantitative evidence in support of the notion that the diet of calcium oxalate renal stone patients is significantly more pro-inflammatory than that of healthy controls., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Introduction: Sleep disruption affects biological processes that facilitate carcinogenesis. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record system to test the hypothesis that patients with diagnosed sleep disorders had an increased risk of prostate, breast, colorectal, or other cancers (1999-2010, N=663,869). This study builds upon existing evidence by examining whether patients with more severe or longer-duration diagnoses were at a greater risk of these cancers relative to those with a less severe or shorter duration sleep disorder., Methods: Incident cancer cases were identified in the VA Tumor Registry and sleep disorders were defined by International Classification of Sleep Disorder codes. Analyses were performed using extended Cox regression with sleep disorder diagnosis as a time-varying covariate., Results: Sleep disorders were present among 56,055 eligible patients (8% of the study population); sleep apnea (46%) and insomnia (40%) were the most common diagnoses. There were 18,181 cancer diagnoses (41% prostate, 12% colorectal, 1% female breast, 46% other). The hazard ratio (HR) for a cancer diagnosis was 1.45 (95% confidence interval [CI]: 1.37, 1.54) among those with any sleep disorder, after adjustment for age, sex, state of residence, and marital status. Risks increased with increasing sleep disorder duration (short [<1-2 years] HR: 1.04 [CI: 1.03-1.06], medium [>2-5 years] 1.23 [1.16-1.32]; long [>5-12 years] 1.52 [1.34-1.73]). Risks also increased with increasing sleep disorder severity using cumulative sleep disorder treatments as a surrogate exposure; African Americans with more severe disorders had greater risks relative to those with fewer treatments and other race groups. Results among patients with only sleep apnea, insomnia, or another sleep disorder were similar to those for all sleep disorders combined., Discussion: The findings are consistent with other studies indicating that sleep disruption is a cancer risk factor. Optimal sleep and appropriate sleep disorder management are modifiable risk factors that may facilitate cancer prevention., Competing Interests: Author AD is currently employed by Palmetto GBA, LLC. When the study was conducted, she was employed by the University of South Carolina. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Burch, Delage, Zhang, McLain, Ray, Miller, Adams and Hébert.)

Background: Individuals with ulcerative colitis (UC) seek complementary treatment methods, including diet and physical activity, to manage the burden of living with UC. This study examined associations between diet-associated inflammation, physical activity (PA), and UC-related health outcomes., Methods: Data were obtained from 2052 IBD Partners e-cohort participants with UC. To quantify the inflammatory potential of food intake, dietary data were converted into Dietary Inflammatory Index (DII) and energy adjusted (E-DII) scores. Physical activity data were collected using the Godin-Shephard Leisure Time Activity Index. Outcome variables included the Simple Clinical Colitis Activity Index, Short Inflammatory Bowel Disease Questionnaire, and psychosocial PROMIS domains., Results: Higher E-DII scores, as indicator of increased dietary inflammatory potential, were associated with increased disease activity (β = 0.166; P < .001), anxiety (β = 0.342; P = .006), depression (β = 0.408; P = .004), fatigue (β = 0.386; P = .005), sleep disturbance (β = 0.339; P = .003), and decreased social satisfaction (β = -0.370; P = .004) and quality of life (β = -0.056; P < .001). Physical activity was inversely associated with disease activity (β = -0.108; P < .001), anxiety (β = -0.025; P = .001), depression (β = -0.025; P = .001), fatigue (β = -0.058; P < .001), and sleep disturbance (β = -0.019; P = .008), while positively associated with social satisfaction (β = 0.063; P < .001) and quality of life (β = 0.005; P < .001). Beneficial effects were generally greater for strenuous PA intensity., Conclusions: An anti-inflammatory diet and increased PA are associated with decreased disease activity, anxiety symptoms, depression symptoms, and fatigue, and associated with improved quality of life, sleep, and social satisfaction for patients with UC. Such modalities may reduce the daily burden of illness and aid in managing systemic and localized inflammation associated with UC., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Cognitive impairment is amongst the most substantial mental health problems in elderly people, and inflammation is an underlying mechanism for cognitive impairment. The dietary inflammatory index (DII®) reflects the overall inflammatory potential of individuals' diets. The current study aimed to assess the relationship between the DII and cognitive function among the Iranian old population., Methods: This cross-sectional study was conducted on 221 subjects≥65 years old in healthcare centers in five socioeconomically distinct districts of Tehran, Iran. Dietary intake data were obtained using a validated food frequency questionnaire (FFQ). Energy-adjusted-DII (E-DIITM) scores were calculated for each participant according to a total of 35 food parameters, which were available from the FFQ. Mini mental state examination (MMSE), a brief screening questionnaire was used to assess cognitive function., Results: E-DII scores were not significantly associated with cognitive function, both in the crude model (β=-0.04, p-value=0.82) and after adjusting for potential confounders (β=0.22, pvalue= 0.14). Additionally, in the unadjusted model, individuals in the highest tertile of E-DII score had increased odds of mild cognitive impairment (OR=1.13, p-trend=0.01) compared to those older adults in the lowest tertile of E-DII score. However, after controlling for potential confounders, these relationships faded (AOR=1.46, p-trend=0.12)., Conclusion: The findings of the present study showed no significant relationship between E- DII and cognitive function among the Iranian elderly. Future prospective studies should be undertaken to explore the association between diet-associated inflammation and cognitive decline in the elderly., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

It is unclear whether diet-associated inflammation is related to the development of anxiety disorders. We aimed to investigate the association between energy-adjusted dietary inflammatory index (E-DII) scores and the incidence of anxiety disorders, and explore the joint effects of E-DII scores with other inflammatory lifestyles in enhancing anxiety risk. In the UK Biobank Study of 96,679 participants, baseline E-DII scores were calculated from the average intake of at least two 24 h dietary recalls. Multivariable-adjusted Cox models were used to evaluate the associations between E-DII scores and the incidence of total anxiety disorders, and primary types and subtypes; additive and multiplicative interactions of a pro-inflammatory diet and seven inflammatory lifestyles were examined. After a median follow-up of 9.4 years, 2785 incident cases of anxiety disorders occurred. Consuming a pro-inflammatory diet was significantly associated with a higher risk of total anxiety disorders (HR Q4vsQ1 = 1.12, 95% CI = 1.00-1.25), and positive associations were consistently identified for primary types and subtypes of anxiety disorders, with HRs ranging from 1.08 to 1.52, and were present in women only. Both additive and multiplicative interactions of current smoking and a proinflammatory diet on total anxiety risk were identified. A proinflammatory diet was associated with a higher incidence of anxiety disorders, and current smoking may synergize with a proinflammatory diet to promote anxiety risk, particularly among women.

The association between diet quality and all-cause mortality in Chinese population is unclear. We aimed to study the associations of three a priori diet quality indices-including the Diet Quality Index-International (DQI-I), Chinese Healthy Eating Index (CHEI), and energy-adjusted Dietary Inflammatory Index (E-DII)-and their included components with all-cause mortality. We used baseline data from the 2004, 2006, 2009, and 2011 waves of the China Health and Nutrition Survey (CHNS). We used a multivariable-adjusted Cox model to examine the associations between DQI-I, CHEI, and E-DII with all-cause mortality. During a mean of 7 years of follow-up, a total of 461 deaths occurred among 12,914 participants. For DQI-I, there were significant inverse associations with mortality for the variety score (HR Q4 vs . Q1 = 0.69, 95%CI = 0.52-0.92) and overall balance score (HR >0 vs . 0 = 0.81, 95%CI = 0.66-0.91). The adequacy score of CHEI was associated with 40% less risk of all-cause mortality (HR Q4 vs . Q1 = 0.60, 95%CI = 0.43-0.84). E-DII was not associated with mortality. An estimated 20.1%, 13.9%, and 31.3% of total mortality would be averted if the DQI-I variety score, DQI-I overall balance score, and CHEI adequacy score improved from the bottom to the top quartile, respectively. Improving diet quality, especially improving diet variety and adequacy, and having a more balanced diet may reduce all-cause mortality in Chinese adults.

Purpose: The Cancer Prevention and Control Research Network (CPCRN) is a national network focused on accelerating the translation of cancer prevention and control research evidence into practice through collaborative, multicenter projects in partnership with diverse communities. From 2003 to 2022, the CPCRN included 613 members., Methods: We: (1) characterize the extent and nature of collaborations through a bibliometric analysis of 20 years of Network publications; and (2) describe key features and functions of the CPCRN as related to organizational structure, productivity, impact, and focus on health equity, partnership development, and capacity building through analysis of 22 in-depth interviews and review of Network documentation., Results: Searching Scopus for multicenter publications among the CPCRN members from their time of Network engagement yielded 1,074 collaborative publications involving two or more members. Both the overall number and content breadth of multicenter publications increased over time as the Network matured. Since 2004, members submitted 123 multicenter grant applications, of which 72 were funded (59%), totaling more than $77 million secured. Thematic analysis of interviews revealed that the CPCRN's success-in terms of publication and grant productivity, as well as the breadth and depth of partnerships, subject matter expertise, and content area foci-is attributable to: (1) its people-the inclusion of members representing diverse content-area interests, multidisciplinary perspectives, and geographic contexts; (2) dedicated centralized structures and processes to enable and evaluate collaboration; and (3) focused attention to strategically adapting to change., Conclusion: CPCRN's history highlights organizational, strategic, and practical lessons learned over two decades to optimize Network collaboration for enhanced collective impact in cancer prevention and control. These insights may be useful to others seeking to leverage collaborative networks to address public health problems., (© 2023. The Author(s).)

Background: Diet quality is a moderator of cardiometabolic markers. The timing of dietary intake may be an important determinant; however, previous results have been mixed. Complex mechanisms may result in an interaction between diet timing and quality., Objectives: This study aimed to examine the association between fasting duration and first and last mealtime and inflammatory and lipid biomarkers. We also explored the interactions between Energy-density Dietary Inflammatory Index (E-DII) scores and meal-timing on inflammatory and lipid biomarkers., Methods: This study was a secondary data analysis of a dietary intervention. Assessments occurred at baseline and 3-months. Three unannounced 24-hour dietary recalls estimated diet for calculation of E-DII scores, nighttime fasting duration, and first and last mealtime. Cardiometabolic markers were obtained from a fasting blood sample. Multiple linear regression of baseline data was used for Aim 1. For Aim 2, the interaction between E-DII change over 3 months and the meal-timing metrics were used to estimate changes in cardiometabolic markers., Results: Most participants (n=95) were female (81%) and White (62%) and they had an average age of 46.9 ± 13.4 years and BMI of 31.4 ± 7.1 kg/m 2 . Every one-hour longer fasting duration was associated with increased total cholesterol (β=5.79, p=0.01), LDL-cholesterol (β=4.47, p=0.03), and LDL:HDL ratio (β=0.08, p=0.04). For every 30-minute later first mealtime, increases in total cholesterol, LDL-cholesterol and LDL:HDL ratios also were observed. Anti-inflammatory E-DII changes were associated with reduced total cholesterol and LDL-C (among participants with shorter fasting durations, later last mealtime, or earlier first mealtime) and C-reactive protein (CRP, among earlier first mealtime and shorter fasting duration)., Conclusions: This study provides evidence for interaction between dietary timing and quality on cardiometabolic biomarkers. Worsening lipid profiles seen with longer fasting durations may be an artifact of skipped or delayed breakfast, underlining the potential importance of food consumption early in the morning., Gov Identifier: NCT02382458 (https://clinicaltrials.gov/ct2/show/NCT02382458)., Competing Interests: Declaration of Interests Dr. James Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company licensing the right to his invention of the Dietary Inflammatory Index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. At the time of this work, in addition to their University of South Carolina appointments, Drs. Michael Wirth and Nitin Shivappa were employees of CHI., (Copyright © 2023. Published by Elsevier Inc.)

Background : High dietary inflammatory index (DII®) scores, representing pro-inflammatory diets, have been associated with increased risks for numerous cancers. However, the evidence for renal cancer is limited. In the present study, we aimed to assess the association between DII and renal cancer risk in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cohort. Methods : Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards model with adjustment for various potential confounders. Results : After a median 12.2 years of follow-up, this study recorded 443 renal cancer cases among 101 190 individuals. The DII score was positively associated with renal cancer risk in multivariable analyses. The HR in the highest DII tertile compared to the lowest tertile was 1.38 (95% CI 1.03-1.84). This was also true when DII was analyzed as a continuous variable. The HR of one-unit increment in DII for renal cancer risk was 1.07 (95% CI 1.01-1.12). Conclusion : In this large American cohort, pro-inflammatory diet, as estimated by higher DII scores, was significantly associated with a greater risk of renal cancer. Future large prospective studies are warranted to verify these preliminary findings.

Little is known about the inflammatory potential of diet and its relation to bone health. This cross-sectional study examined the association between the inflammatory potential of diet and bone-related outcomes in midwestern, post-menopausal women enrolled in the Heartland Osteoporosis Prevention Study (HOPS) randomized controlled trial. Dietary intake from the HOPS cohort was used to calculate Dietary Inflammatory Index (DII ® ) scores, which were energy-adjusted (E-DII TM ) and analyzed by quartile. The association between E-DII and lumbar and hip bone mineral density (BMD) and lumbar trabecular bone scores (TBS; bone structure) was assessed using ANCOVA, with pairwise comparison to adjust for relevant confounders (age, education, race/ethnicity, smoking history, family history of osteoporosis/osteopenia, BMI, physical activity, and calcium intake). The cohort included 272 women, who were predominately white (89%), educated (78% with college degree or higher), with a mean BMI of 27 kg/m 2 , age of 55 years, and E-DII score of -2.0 ± 1.9 (more anti-inflammatory). After adjustment, E-DII score was not significantly associated with lumbar spine BMD ( p = 0.53), hip BMD ( p = 0.29), or TBS at any lumbar location ( p > 0.05). Future studies should examine the longitudinal impact of E-DII scores and bone health in larger, more diverse cohorts.

Background: An association was observed between an inflammation-related risk score (IRRS) and worse overall survival (OS) among a cohort of mostly White women with invasive epithelial ovarian cancer (EOC). Herein, we evaluated the association between the IRRS and OS among Black women with EOC, a population with higher frequencies of pro-inflammatory exposures and worse survival., Methods: The analysis included 592 Black women diagnosed with EOC from the African American Cancer Epidemiology Study (AACES). Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of the IRRS and OS, adjusting for relevant covariates. Additional inflammation-related exposures, including the energy-adjusted Dietary Inflammatory Index (E-DII TM ), were evaluated., Results: A dose-response trend was observed showing higher IRRS was associated with worse OS (per quartile HR: 1.11, 95% CI: 1.01-1.22). Adding the E-DII to the model attenuated the association of IRRS with OS, and increasing E-DII, indicating a more pro-inflammatory diet, was associated with shorter OS (per quartile HR: 1.12, 95% CI: 1.02-1.24). Scoring high on both indices was associated with shorter OS (HR: 1.54, 95% CI: 1.16-2.06)., Conclusion: Higher levels of inflammation-related exposures were associated with decreased EOC OS among Black women., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

To investigate the dose-response associations of dietary inflammatory potential with all-cause mortality and incident cardiovascular disease (CVD) and cancer., Methods: This was a prospective cohort study of 198,265 UK Biobank participants who completed at least 1 dietary assessment. A web based 24 hours recall questionnaire was used to derive the energy-adjusted dietary inflammatory index (E-DII). All-cause mortality and incident CVD and cancer ascertained from linked records., Results: After adjusting for socio-demographic and lifestyle factors, there were J-shaped associations of E-DII with all-cause mortality and CVD, and a relatively linear association with cancer. When E-DII was <0, E-DII was not associated with any of the outcomes. When E-DII was ≥0, the linear associations were strongest in all-cause mortality (HR 1.09, 95% CI, 1.05-1.13), followed by CVD (HR 1.06, 95% CI, 1.03-1.09), and cancer (HR 1.03, 95%,CI, 1.01-1.05)., Conclusion: Dietary inflammatory potential was associated with mortality and CVD primarily when the diet is proinflammatory., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Bariatric surgery (BS) has several potential metabolic benefits. However, little is known about its impact on changes in the inflammatory potential of diet and its effect on inflammatory and metabolic markers. This study aimed to assess the short-term beneficial effects of BS on dietary inflammatory potential and inflammatory and metabolic markers., Materials and Methods: Participants (n = 20) were evaluated 3 months before and after BS. Body mass, body mass index, anthropometric measurements, fat mass, fat-free mass, visceral fat, skeletal muscle mass, basal metabolic rate, serum lipids, HOMA-IR, QUICKI and inflammatory markers, including leptin, adiponectin, adiponectin/leptin ratio and plasminogen activator inhibitor-1 (PAI-1), were evaluated. Diet data were collected using a 3-day diet record and the dietary inflammatory index (DII®) and energy-adjusted dietary inflammatory index (E-DII TM ) scores were computed., Results: There was a reduction in DII® (2.56 vs 2.13) and E-DII TM (2.18 vs 0.45) indicating an improvement in inflammatory nutritional profile. Moreover, there were increases in the adiponectin/leptin ratio (0.08 vs 0.21) and QUICKI scores (0.31 vs 0.37), and reductions in leptin (36.66 vs 11.41 ng/ml) and HOMA-IR scores (3.93 vs 1.50). There were also improvements in body composition and anthropometric parameters., Conclusions: BS promotes changes in metabolic profile, inflammatory state and food intake and these modifications appeared to be associated with improvements in diet-related inflammation, an increase in the adiponectin/leptin ratio and a reduction in leptin. These results contribute to knowledge on the contribution bariatric surgery can make to the treatment of obesity and the reduction of related comorbidities., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: The influence of maternal lifestyle behaviours on placental growth have been investigated individually, but with conflicting results, and their combined effect is under-researched. Therefore, we examined associations between a composite maternal healthy lifestyle score (HLS), and its individual components, during early pregnancy with placental outcomes., Methods: Participants included Lifeways Cross-Generational Cohort mother-child pairs (n = 202). A composite HLS based on a less inflammatory diet (bottom 40% of the energy-adjusted Dietary Inflammatory Index (E-DII™)), moderate-to-vigorous physical activity (MVPA), healthy pre-pregnancy BMI (18.5-24.9 kg/m 2 ), never smoking, and non-/moderate alcohol intake was calculated. Quantile regression analysed HLS (and individual components) associations with measures of placental development (untrimmed placental weight (PW)) and function (birth weight:placental weight (BW:PW) ratio) at the 10th, 25th, 50th, 75th and 90th centiles., Results: A more pro-inflammatory diet was positively, and smoking and heavy alcohol consumption were negatively, associated with PW at median centiles (B: 41.97 g, CI: 3.71, 80.22, p < 0.05; B: -58.51 g, CI: -116.24, -0.77, p < 0.05; B: -120.20 g, CI: -177.97, -62.43, p < 0.05 respectively). Low MVPA was inversely associated with BW:PW ratio at the 10th and 90th centiles (B: -0.36, CI: -0.132, -0.29, p < 0.01 and B: -0.45, CI: -0.728, -0.182, p < 0.01, respectively). Heavy alcohol intake was positively associated with BW:PW ratio at the 10th centile (B: 0.54, CI: 0.24, 0.85, p < 0.01). Results of sex-stratified analysis provide evidence of sexual dimorphism., Discussion: Associations of certain lifestyle factors, but not the composite HLS, during early pregnancy with measures of placental development (PW) and function (BW:PW ratio) varied by quantiles and by sex., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This quantitative study examined the presence of culturally relevant health messages for African-Americans based on a preexisting dataset from 21 African-American churches in South Carolina (USA). Content analysis served as the primary methodological approach to code printed media messages based on their cultural relevance among African-Americans (Cohen's kappa = .74). Within the dataset (n = 2166), 477 (22%) items were identified as culturally relevant. A low prevalence of culturally relevant messages was found across the three message topics, two media types, and one media source. Due to the limited presence of culturally relevant messages, researchers should collaborate with African-American churches to design health promotion messages., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Diet quality is a critical modifiable factor related to health, including the risk of cardiometabolic complications. Rather than assessing the intake of individual food items, it is more meaningful to examine overall dietary patterns. This study investigated the adherence to common dietary indices and their association with serum/metabolic parameters of disease risk., Methods: Dietary intakes of the general adult population (n = 1404, 25-79 years) were assessed by a validated food-frequency questionnaire (174 items). The French ANSES-Ciqual food composition database was used to compute nutrient intakes. Seven indicators were calculated to investigate participants' diet quality: the Alternative Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension Score (DASH-S), Mediterranean Diet Score (MDS), Diet Quality Index-International (DQI-I), Dietary Inflammatory Index (DII), Dietary Antioxidant Index (DAI), and Naturally Nutrient-Rich Score (NNRS). Various serum/metabolic parameters were used in the validity and association analyses, including markers of inflammation, blood glucose, and blood lipid status., Results: Following linear regression models adjusted for confounders, the DASH-S was significantly associated with most metabolic parameters (14, e.g., inversely with blood pressure, triglycerides, urinary sodium, uric acid, and positively with serum vitamin D), followed by the DQI-I (13, e.g., total cholesterol, apo-A/B, uric acid, and blood pressure) and the AHEI (11, e.g., apo-A, uric acid, serum vitamin D, diastolic blood pressure and vascular age)., Conclusion: Food-group-based indices, including DASH-S, DQI-I, and AHEI, were good predictors for serum/metabolic parameters, while nutrient-based indices, such as the DAI or NNRS, were less related to biological markers and, thus, less suitable to reflect diet quality in a general population., (© 2023. The Author(s).)

Context: While evidence suggests that chronic, low-grade inflammation is a risk factor for bone loss and fractures, the potential relation between an inflammatory dietary profile and greater fracture risk is uncertain., Objective: We examined whether a more inflammatory diet, consumed during pre- and early perimenopause, is associated with more incident fractures starting in the menopause transition (MT) and continuing into postmenopause., Methods: Dietary inflammatory potential was quantified using 2 energy-adjusted dietary inflammatory index scores: one for diet only (E-DII), and one for diet plus supplements (E-DII-S). We included 1559 women from the Study of Women's Health Across the Nation, with E-DII and E-DII-S scores from the baseline visit (during pre- or early perimenopausal), and up to 20 years of follow-up. We excluded women using bone-beneficial medications at baseline; subsequent initiators were censored at first use. The associations of E-DII or E-DII-S (each tested as separate exposures) with incident fracture were examined using Cox proportional hazards regression., Results: Adjusted for age, BMI, cigarette use, diabetes, MT stage, race/ethnicity, prior fracture, bone-detrimental medication use, aspirin or nonsteroidal anti-inflammatory drug use, and study site, greater E-DII and E-DII-S (tested separately) were associated with more future fractures. Each SD increment in E-DII and E-DII-S predicted 28% (P = .005) and 21% (P = .02) greater fracture hazard, respectively. Associations were essentially unchanged after controlling for bone mineral density., Conclusion: A more pro-inflammatory diet in pre- and early perimenopause is a risk factor for incident fracture. Future studies should consider whether reducing dietary inflammation in midlife diminishes fracture risk., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disease predisposing patients to life-threatening conditions, including cirrhosis. There is evidence that the incidence of NAFLD is related to the individuals' dietary patterns; however, it is still remaining unknown whether the inflammatory potential of various foods/dietary patterns can directly predict a higher incidence of NAFLD., Methods: In this cross-sectional cohort study, we investigated the relationship between the inflammatory potential of various food items and the incidence/odds of NAFLD. We used data from Fasa PERSIAN Cohort Study comprising 10,035 individuals. To measure the inflammatory potential of diet, we used the dietary inflammatory index (DII®). Fatty liver index (FLI) was also calculated for each individual to identify the presence of NAFLD (cut-off = 60)., Results: Our findings showed that higher DII is significantly associated with increased incidence/odds of NAFLD (OR = 1.254, 95% CI: 1.178-1.334). Additionally, we found out that higher age, female gender, diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, and hypertension are other predictors of developing NAFLD., Conclusions: It can be concluded that consuming foods with a higher inflammatory potential is associated with a greater risk of developing NAFLD. Additionally, metabolic diseases, including dyslipidemia, diabetes mellitus, and hypertension, can also predict the incidence of NAFLD., (© 2023. The Author(s).)

Background: Since the first version of the dietary inflammatory index (DII®) developed in the past decade, several other versions have been developed. However, to date no study has attempted to compare these versions with respect to their associations with biomarkers of inflammation., Objective: We aimed to investigate the relationship between four dietary inflammatory scores [DII, two energy-adjusted derivatives (E-DII and E-DII r ), and the Inflammatory Score of the Diet (ISD)], and circulating levels of several inflammatory markers and adipokines., Methods: This study included 17 637 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort with at least one marker of inflammation measured in blood. Associations between the four scores and C-reactive protein (CRP), interleukin (IL)6, IL10, IL1RA, tumor necrosis factor-α (TNFα), soluble tumor necrosis factor receptor-1 (sTNFR1), sTNFR2, leptin, soluble leptin receptor (sLeptin R), adiponectin, and High Molecular Weight (HMW) adiponectin were evaluated using multivariable linear regressions adjusted for potential confounders., Results: Positive associations were observed between the four dietary inflammatory scores and levels of CRP, IL6, sTNFR1, sTNFR2 and leptin. However, only the DII and the ISD were positively associated with IL1RA levels and only the DII and the E-DII r were positively associated with TNFα levels. The proportion of variance of each biomarker explained by the scores was lower than 2%, which was equivalent to the variance explained by smoking status but much lower than that explained by body mass index., Conclusions: Our results suggest that the four dietary inflammatory scores were associated with some biomarkers of inflammation and could be used to assess the inflammatory potential of diet in European adults but are not sufficient to capture the inflammatory status of an individual. These findings can help to better understand the inflammatory potential of diet, but they need to be replicated in studies with repeated dietary measurements., Competing Interests: Conflicts of Interest Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smartphone applications for patient counseling and dietary intervention in clinical settings. Dr. Nitin Shivappa is an employee of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has CHI-related activity exerted any influence on this project., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)