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Nutrition. 2018 Oct 19;61:32-37. doi: 10.1016/j.nut.2018.09.036. [Epub ahead of print]

Dietary inflammatory index and parameters of diet quality in normal weight and obese patients undergoing hemodialysis.

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Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Epidemiology and Biostatistics and the Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina, USA; Connecting Health Innovations, LLC, Columbia, South Carolina, USA.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:



Better nutritional reserves are proposed as a mechanism for the protective role of obesity in hemodialysis. Little is known about the quality of diet as a major contributor to nutritional status, specifically body mass index and obesity. The aim of this study was to assess dietary inflammatory index (DII®) score and other parameters of diet in normal-weight and obese patients undergoing hemodialysis to understand whether there is a benefit for obese patients.


This cross-sectional study included 85 hemodialysis patients (44 obese and 41 normal-weight). Four-day 24-h dietary recalls and anthropometric measurements were collected. DII, energy-adjusted DII (E-DII), dietary energy density (DED), mean adequacy ratio (MAR), and malnutrition inflammation score (MIS) were calculated.


Median E-DII score (1 [0.29-1.47] versus 0.42 [0.12-1.27]; P = 0.047) was higher and DII score (1.18 [0.03-2.26] versus 1.79 [0.47-2.49]; P = 0.046) was lower in the obese group. Obese patients had higher DED (1.52 ± 0.23 versus 1.43 ± 0.28; P = 0.034) and lower MIS (6.3 ± 2.5 versus 10.5 ± 3.1; P < 0.001) compared with the normal weight group. There was no significant difference in MAR between groups (P = 0.358). E-DII had significant positive correlation with weight (r = 0.226; P = 0.037), triceps skinfold thickness (r = 0.239; P = 0.035), and DED (r = 0.227; P = 0.036). MAR had significant negative correlation with MIS (r = -0.287; P = 0.008).


Observed higher diet inflammatory potential and energy density and lower wasting in the obese group, along with similar adequacy of nutrients intake between groups, indicates that lower wasting, but not other indicators of nutritional status, are involved in better prognosis of obese patients with hemodialysis. Further studies are required to assess the potential dietary factors involved in determining wasting in advanced kidney failure.


Diet quality; Dietary inflammatory index; Hemodialysis; Malnutrition inflammation score; Obesity


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