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Clin Nutr. 2018 May 24. pii: S0261-5614(18)30175-4. doi: 10.1016/j.clnu.2018.05.003. [Epub ahead of print]

Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies.

Collaborators (269)

Alonso A, Barrio Lopez MT, Basterra-Gortari FJ, Benito Corchon S, Bes-Rastrollo M, Beunza JJ, Carlos S, Cervantes S, de Irala J, de la Rosa PA, de la Fuente C, Donat-Vargas CL, Donazar M, Fernandez Montero A, Gea A, Goni-Ochandorena E, Guillen-Grima F, Lahortiga F, Llorca J, Lopez Del Burgo C, Mari-Sanchıs A, Marti A, Mendonça R, Nuñez-Cordoba JM, Pimenta AM, Rico A, Ruiz Zambrana A, Sayon-Orea C, Toledo-Atucha J, Vazquez Ruiz Z, Zazpe Garcıa I, Sánchez-Tainta A20, Buil-Cosiales P20, Díez-Espino J20, Sanjulian B20, Martínez JA20, Marti A20, Serrano-Martínez M20, Basterra-Gortari FJ20, Extremera-Urabayen JV20, Garcia-Pérez L20, Arroyo-Azpa C20, Barcena AF20, Oreja-Arrayago C20, Lasanta-Sáez MJ20, Cia-Lecumberri P20, Elcarte-Lopez T20, Artal-Moneva F20, Esparza-López JM20, Figuerido-Garmendia E20, Tabar-Sarrias JA20, Fernández-Urzainqui L20, Ariz-Arnedo MJ20, Cabeza-Beunza JA20, Pascual-Pascual P20, Martínez-Mazo MD20, Arina-Vergara E20, Macua-Martínez T20, Pascual Pascual P20, Garcés Ducar ML20, Martí Massó R20, Villanueva Moreno R20, Parra-Osés A20, Serra-Mir M21, Pérez-Heras A21, Viñas C21, Casas R21, Medina-Remon A21, Villanueva P21, Baena JM21, García M21, Oller M21, Amat J21, Duaso I21, García Y21, Iglesias C21, Simón C21, Quinzavos L21, Parra L21, Liroz M21, Benavent J21, Clos J21, Pla I21, Amorós M21, Bonet MT21, Martín MT21, Sánchez MS21, Altirriba J21, Manzano E21, Altés A21, Cofán M21, Valls-Pedret C21, Sala-Vila A21, Doménech M21, Bulló M22, Basora-Gallisa J22, González R22, Molina C22, Mena G22, Martínez P22, Ibarrola N22, Sorlí J22, García Roselló J22, Martin F22, Tort N22, Isach A22, Babio N22, Salas-Huetos A22, Becerra-Tomás N22, Rosique-Esteban N22, Hernandez P22, Canudas S22, Papandreou C22, Ferreira C22, Cabre M22, Mestres G22, Paris F22, Llauradó M22, Pedret R22, Basells J22, Vizcaino J22, Segarra R22, Giardina S22, Guasch-Ferré M22, Díaz-López A22, Fernández-Ballart J22, Balanza R22, Tello S23, Vila J23, de la Torre R23, Muñoz-Aguayo D23, Elosua R23, Marrugat J23, Schröder H23, Molina N23, Maestre E23, Rovira A23, Castañer O23, Farré M23, Sorli J24, Carrasco P24, Ortega-Azorín C24, Asensio EM24, Osma R24, Barragán R24, Francés F24, Guillén M24, González JI24, Sáiz C24, Portolés O24, Giménez FJ24, Coltell O24, Fernández-Carrión R24, Guillem-Sáiz P24, González-Monje I24, Quiles L24, Pascual V24, Riera C24, Pages MA24, Godoy D24, Carratalá-Calvo A24, Sánchez-Navarro S24, Valero-Barceló C24, Salaverria I25, Hierro TD25, Algorta J25, Francisco S25, Alonso A25, San Vicente J25, Casi A25, Sanz E25, Felipe I25, Rekondo J25, Loma-Osorio A25, Fernandez-Crehuet J26, Garcia-Rodriguez A26, Wärnberg J26, Benitez Pont R26, Bianchi Alba M26, Navajas R26, Gómez-Huelgas R26, Martínez-González J26, Velasco García V26, de Diego Salas J26, Baca Osorio A26, Gil Zarzosa J26, Sánchez Luque JJ26, Vargas López E26, Romaguera D27, García-Valdueza M27, Proenza A27, Prieto R27, Frontera G27, Munuera S27, Vivó M27, Bestard F27, Munar JA27, Coll L27, Fiol F27, Ginard M27, Jover A27, García J27, Santos-Lozano JM28, Ortega-Calvo M28, Leal M28, Martínez E28, Mellado L28, Miró-Moriano L28, Domínguez-Espinaco C28, Vaquero-Diaz S28, Iglesias P28, Román P28, Corchado Y29, Lozano-Rodríguez JM28, Lamuela-Raventós R30, López-Sabater MC30, Castellote-Bargalló AI30, Quifer-Rada P30, Tresserra-Rimbau A30, Alvarez-Pérez J30, Díez Benítez E30, Bautista Castaño I30, Maldonado Díaz I30, Sanchez-Villegas A30, Férnandez-Rodríguez MJ30, Sarmiendo de la Fe F31, Simón García C31, Falcón Sanabria I31, Macías Gutiérrez B31, Santana Santana AJ31, de la Cruz E32, Galera A32, Pintó-Salas X32, Trias F32, Sarasa I32, Rodríguez MA32, Corbella X32, Corbella E32, Goday A33, Muñoz MA33, Cabezas C33, Vinyoles E33, Rovira MA33, Garcia L33, Baby P33, Ramos A33, Mengual L33, Roura P33, Yuste MC33, Guarner A33, Rovira A33, Santamaria MI33, Mata M33, de Juan C33, Brau A33, Fernandez M33, Gutierrez E33, Murillo C33, Garcia J33, Tafalla M33, Bobe I33, Díaz A33, Araque M33, Solis E33, Cervello T33, Montull I33, Tur JA34, Portillo MP35, Sáez G36.

Author information

1
Servicio Navarro de Salud (Osasunbidea), Pamplona, Spain; University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigacion Sanitario de Navarra (IdiSNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain. Electronic address: agarare@gmail.com.
2
University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigacion Sanitario de Navarra (IdiSNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA. Electronic address: mamartinez@unav.es.
3
Servicio Navarro de Salud (Osasunbidea), Pamplona, Spain; University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigacion Sanitario de Navarra (IdiSNA), Pamplona, Spain. Electronic address: raulramallal@gmail.com.
4
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Spain. Electronic address: jordi.salas@urv.cat.
5
Cancer Prevention and Control Program, University of South Carolina, Columbia, USA. Electronic address: jhebert@sc.edu.
6
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Department of Preventive Medicine, University of Valencia, Valencia, Spain. Electronic address: dolores.corella@uv.es.
7
Cancer Prevention and Control Program, University of South Carolina, Columbia, USA. Electronic address: shivappa@mailbox.sc.edu.
8
Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra - IdiSNA (Instituto de Investigación Sanitario de Navarra), Pamplona, Spain. Electronic address: lluis.forga.llenas@cfnavarra.es.
9
Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Spain. Electronic address: HSchoeder@imim.es.
10
Department of Public Health and Psychiatry, University of Malaga, Malaga, Spain. Electronic address: carlosmb@uma.es.
11
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Department of Internal Medicine, Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain. Electronic address: restruch@clinic.ub.es.
12
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain. Electronic address: miguel.fiol@ssib.es.
13
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Department of Family Medicine, Unit Research, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain. Electronic address: jlapetra@ono.com.
14
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Research Institute of Biomedical and Health Sciences (IUIBS), Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain. Electronic address: lluis.serra@ulpgc.es.
15
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain. Electronic address: eros@clinic.ub.es.
16
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Department of Cardiology, University Hospital Araba, Vitoria, Spain. Electronic address: javitxin74@gmail.com.
17
University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigacion Sanitario de Navarra (IdiSNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain. Electronic address: etoledo@unav.es.
18
University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigacion Sanitario de Navarra (IdiSNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain. Electronic address: crazquin@unav.es.
19
University of Navarra, Department of Preventive Medicine and Public Health, Instituto de Investigacion Sanitario de Navarra (IdiSNA), Pamplona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain. Electronic address: mcanela@unav.es.
20
University of Navarra, Primary Care Centers, Pamplona, Spain.
21
Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain.
22
University Rovira i Virgili, Reus, Spain.
23
Hospital del Mar Research Institute, Barcelona, Spain.
24
University of Valencia, Valencia, Spain.
25
University Hospital of Alava, Vitoria, Spain.
26
University of Malaga, Malaga, Spain.
27
Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Universitario Son Espases, Palma de Mallorca, Spain.
28
Department of Family Medicine, Unit Research, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain.
29
Department of Family Medicine, Unit Research, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain; Department of Family Medicine, Unit Research, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain.
30
School of Pharmacy, University of Barcelona, Barcelona, Spain.
31
Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain.
32
Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
33
Primary Care Division, Catalan Institute of Health, Barcelona, Spain.
34
University of Balearic Islands, Spain.
35
University of Basque Country, Spain.
36
University of Valencia, Spain.

Abstract

BACKGROUND:

Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet.

OBJECTIVE:

We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts.

DESIGN:

We assessed 18,566 participants in the "Seguimiento Universidad de Navarra" (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the "PREvencion con DIeta MEDiterránea" (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality.

RESULTS:

After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%-32%, for the highest vs lowest category of DII).

CONCLUSION:

Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively.

KEYWORDS:

CRP; Cohort studies; Dietary inflammatory index; Inflammation; Mediterranean diet; Mortality

PMID:
30651193
DOI:
10.1016/j.clnu.2018.05.003

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