The association between dietary quality scores with C-reactive protein and novel biomarkers of inflammation platelet-activating factor and lipoprotein-associated phospholipase A2: a cross-sectional study

Carolyn J English; Anna E Lohning; Hannah L Mayr; Mark Jones; Helen MacLaughlin; Dianne P Reidlinger

doi:10.1186/s12986-023-00756-x

The association between dietary quality scores with C-reactive protein and novel biomarkers of inflammation platelet-activating factor and lipoprotein-associated phospholipase A2: a cross-sectional study

Nutr Metab (Lond). 2023 Sep 12;20(1):38. doi: 10.1186/s12986-023-00756-x.

Authors

Carolyn J English¹, Anna E Lohning¹, Hannah L Mayr^{1

2

3}, Mark Jones⁴, Helen MacLaughlin^{5

6}, Dianne P Reidlinger⁷

Affiliations

¹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia.
² Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
³ Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia.
⁴ Faculty of Health Sciences and Medicine, Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, Australia.
⁵ Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia.
⁶ Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia.
⁷ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia. dreidlin@bond.edu.au.

Abstract

Healthy dietary patterns are associated with lower inflammation and cardiovascular disease (CVD) risk and adherence can be measured using diet quality scores. Inflammation is traditionally measured with C-reactive protein (hsCRP), however there is interest in novel pro-inflammatory markers platelet-activating factor (PAF) and lipoprotein-associated phospholipase A2 (Lp-PLA₂) that are specifically involved in endothelial dysfunction and inflammation. This cross-sectional study investigated the association between PAF, Lp-PLA₂, hsCRP, and six diet scores. One hundred adults (49 ± 13 years, 31% male) with variable CVD risk were recruited. Fasting PAF, Lp-PLA₂ and hsCRP and usual dietary intake were measured. Adherence to Dietary Approaches to Stop Hypertension (DASH), Dairy-adjusted DASH, Vegetarian Lifestyle Index, Healthy Eating Index for Australians (HEIFA), Mediterranean Diet Adherence Screener (MEDAS) and PREDIMED-Plus (erMedDiet) scores were calculated. Correlations and multiple regressions were performed. hsCRP, but not PAF, independently correlated with several diet scores. Lp-PLA₂ independently correlated with Vegetarian Lifestyle Index only in unadjusted models. A one-point increase in adherence to the DASH Index, the Dairy-adjusted DASH Index and the Vegetarian Lifestyle Index was associated with a 30%, 30%, and 33% reduction in hsCRP levels, respectively. Smaller effects were seen with the other diet scores with a one-point increase in adherence resulting in a 19%, 22% and 16% reduction in hsCRP with HEIFA, MEDAS, erMedDiet scores, respectively. The lack of stronger associations between the novel markers of inflammation and diet scores may be due to confounding by COVID-19 infection and vaccination programs, which prevents any firm conclusion on the relationship between PAF, Lp-PLA₂ and healthy dietary patterns. Future research should aim to examine the relationship with these novel markers and healthy dietary patterns in a non-pandemic setting.

Keywords: Biomarker; COVID-19; Cardiovascular diseases; Diet Quality; Diet healthy; Diet vegetarian; Dietary approach to stop hypertension; Inflammation.