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The Impact of Gender, Race, Ethnicity, and Socioeconomic Status on Diet-Associated Inflammation and Chronic Disease Risk
- Publication Year :
- 2021
-
Abstract
- In the U.S., 45% of adults have at least one chronic condition, and the burden disproportionately affects females, individuals with low socioeconomic status, and certain racial/ethnic minority groups. Obesity is the leading risk factor for many chronic conditions such as diabetes, heart disease, and cancer. Accumulating evidence suggests that chronic inflammation, due to obesity and other stressors, may underlie the initiation and progression of various chronic conditions. The energy-adjusted dietary inflammatory index (E-DII) was developed to assess the inflammatory potential of diet and serve as a tool to study the associations between diet-associated inflammation and development and progression of chronic conditions. Since 2014, over 250 papers have been published describing associations between the E-DII and many mental and physical health conditions. Yet, there is lack of investigation on potential differences in associations between the E-DII and health outcomes by gender, race, ethnicity, and socioeconomic status.The overall goal of this dissertation was to investigate differences in E-DII scores and potential differences in association with health outcomes by gender, race, ethnicity, and socioeconomic status. This research can help inform further studies by demonstrating that gender, race, ethnicity, and socioeconomic status may act as effect measure modifiers for associations that are commonly reported in the literature. For this dissertation, cross-sectional data from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) was used. NHANES is nationally representative of the civilian, noninstitutionalized U.S. population and is the only national-level study with nutrient information on dietary intake from foods, beverages, and dietary supplements. This dissertation compared E-DII scores and associations with allostatic load and undiagnosed hyperglycemia among the following groups: (1) females and males, (2) non-Hispanic White, non-Hispanic Black, and Hispanic (3) low, middle, and high income according to family income poverty ratios (i.e., ≤100%, 101 – 399%, ≥ 400%), (4) education level (i.e., less than high school, high school graduate/GED, some college or associate degree, college graduate or above), and (5) occupation group (i.e., management and professional, service, sales and office, manual labor, and not working or retired). Multiple imputation was performed to impute missing values for all aims.For Aim 1, we used linear regression to compare E-DII scores by gender, race/ethnicity, and socioeconomic status. Overall, 63% of U.S. adults reported consuming pro-inflammatory diets. The highest E-DII scores were observed among non-Hispanic Black males, males at or below the poverty level, those with less than high school education, and those working manual labor jobs. In adjusted models within socioeconomic status categories, racial/ethnic differences in E-DII score were attenuated among non-Hispanic Black males and Hispanic individuals compared to non-Hispanic White adults. However, E-DII scores among non-Hispanic Black females remained significantly higher compared to non-Hispanic White females.For Aim 2, we used logistic regression to estimate associations between E-DII and high-risk allostatic load scores among gender, race/ethnicity, and socioeconomic status groups. High E-DII scores were associated with 19-74% higher odds of high-risk allostatic load with variation by groups. Higher E-DII scores were significantly associated with higher odds of high-risk allostatic load among non-Hispanic White individuals and Hispanic males (p0.05). Racial/ethnic differences were attenuated within models stratified by socioeconomic status variables, and significant associations between E-DII and allostatic load were only observed among those with higher levels of education, income, and occupation. For Aim 3, we used logistic regression to estimate associations between E-DII and undiagnosed hyperglycemia among age, gender, race/ethnicity, and socioeconomic status groups. Overall, higher E-DII scores were associated with higher odds of undiagnosed hyperglycemia among females (OR=1.52 [95% CI: 1.25, 1.85]) and males (OR=1.49 [95% CI: 1.22, 1.82]). In adjusted strata-specific models, higher E-DII score was significantly associated with higher odds of undiagnosed hyperglycemia among non-Hispanic White males only and males ages 30-39 years, 50-59 years, and 60-69 years (p < 0.05). By socioeconomic status indicators, higher E-DII score was significantly associated with higher odds of undiagnosed hyperglycemia mainly among males with higher levels of education, income, and occupation (p < 0.05).This dissertation demonstrated differences in E-DII scores by gender, race/ethnicity, and socioeconomic status. Effect modification was observed for the associations between the E-DII and allostatic load and undiagnosed hyperglycemia. Not all associations were statistically significant, but effect sizes by groups differed by 19-120%. Observed differences in effect sizes of associations by sociodemographic factors may help explain the heterogeneity observed in the current E-DII literature. Further studies are warranted to investigate differences in health effects from diet-associated inflammation among groups that tend to have higher levels of sustained chronic inflammation due to disadvantage, adversity, and stress (e.g., females, racial/ethnic minorities, individuals with low socioeconomic status). Prospective designs to determine temporality can better inform the impact of anti-inflammatory diets on health outcomes.
- Subjects :
- Public Health
Epidemiology
Subjects
Details
- Language :
- English
- Database :
- OpenDissertations
- Publication Type :
- Dissertation/ Thesis
- Accession number :
- ddu.oai.etd.ohiolink.edu.osu1617092568083759