Geographic disparities of dietary inflammatory index and its association with hypertension in middle-aged and elders in China: results from a nationwide cross-sectional study

Abstract

Background: Geographic distribution of dietary inflammatory index (DII) in China has not been thoroughly evaluated and evidence on the association between DII and hypertension among Chinese middle-aged and older population was inadequate.

Objective: To investigate the geographic disparities of DII and its association with hypertension among Chinese middle-aged and elders.

Methods: Data was from the China Adults Chronic Diseases and Nutrition Surveillance (CACDNS 2015) for middle-aged and older participants. The DII for each participant was determined through a combination of 3 days 24 h dietary recall interviews and a food frequency questionnaire. Spatial analysis was employed to investigate the geographic distribution of DII in China. Restricted cubic spline models and binary logistic regression analysis were used to assess the relationship between DII and hypertension. The least absolute shrinkage and selection operator (LASSO) regression was applied for identifying key hypertension-related factors, which was then included in the establishment of a risk prediction nomogram model, with the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) being built to evaluate its discriminatory power for hypertension.

Results: A total of 52,087 middle-aged and older participants were included in the study, among whom 36.6% had hypertension. it revealed that a clear spatial correlation in the national distribution of DII scores (Moran I: 0.252, p = 0.001), with higher DII scores concentrated in the northwest region and lower DII scores concentrated in the southeast region. Hypertensive participants had higher DII scores compared to those without hypertension (OR: 1.507 vs. 1.447, p = 0.003). Restricted cubic spline models and binary logistic regression analysis demonstrated a positive association between DII and hypertension after adjusting for potential confounding factors. There was a significant increasing trend in the proportion of hypertensive individuals as DII scores increase (p for trend = 0.004). The nomogram model, constructed using key factors identified through LASSO regression, demonstrated a robust discriminative capacity, with an area under the curve (AUC) of 73.2% (95% CI, 72.4-74.0%). Decision curve analysis confirmed the reliability and effectiveness of the nomogram model. Sensitivity analysis conducted within the subpopulation aged under 45 years yielded results consistent with the primary analysis.

Conclusion: In Chinese adults middle-aged and older, geographic disparities in dietary inflammatory potential are notable, with lower levels observed in the southeastern coastal regions of China and higher levels in the northwestern regions. Meanwhile, there is a positive association between the inflammatory potential of the diet and hypertension. Additional research is needed to investigate regional disparities in dietary inflammatory potential and pinpoint specific dietary patterns associated with lower inflammation.

Keywords: LASSO regression; cross-sectional study; dietary inflammatory index; hypertension; restricted cubic spline; spatial statistical analysis.