Energy-Adjusted Dietary Inflammatory Index and Diabetes Risk in Postmenopausal Hispanic Women

Monica D Zuercher; Danielle J Harvey; Lauren E Au; Aladdin H Shadyab; Margarita Santiago-Torres; Simin Liu; Nitin Shivappa; James R Hébert; John A Robbins; Lorena Garcia

doi:10.1016/j.jand.2023.08.002

Energy-Adjusted Dietary Inflammatory Index and Diabetes Risk in Postmenopausal Hispanic Women

J Acad Nutr Diet. 2023 Aug 5:S2212-2672(23)01310-2. doi: 10.1016/j.jand.2023.08.002. Online ahead of print.

Authors

Affiliations

¹ University of California Davis, Davis, CA.
² Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA.
³ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
⁴ Public Health and Medicine, Brown University, Providence, RI.
⁵ Cancer Prevention and Control Program & Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, & Department of Nutrition, Connecting Health Innovations, LLC, Columbia, SC.
⁶ University of California Davis, Davis, CA. Electronic address: lgarcia@ucdavis.edu.

PMID: 37544374
PMCID: PMC10839112 (available on 2025-02-05)
DOI: 10.1016/j.jand.2023.08.002

Abstract

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.

Keywords: Diabetes; Hispanic or Latinos; Inflammatory diet.

Abstract

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