Dietary inflammatory index is associated with serum C-reactive protein and protein energy wasting in hemodialysis patients: A cross-sectional study

Abstract

BACKGROUND/OBJECTIVEMalnutrition and inflammation are reported as the most powerful predictors of mortality and morbidity in hemodialysis (HD) patients. Diet has a key role in modulating inflammation and dietary inflammatory index (DII) is a new tool for assessment of inflammatory potential of diet. The aim of this study was to evaluate the application of DII on dietary intake of HD patients and examine the associations between DII and malnutrition-inflammation markers.SUBJECTS/METHODSA total of 105 subjects were recruited for this cross-sectional study. Anthropometric measurements, 3-day dietary recall, and pre-dialysis biochemical parameters were recorded for each subject. Subjective global assessment (SGA), which was previously validated for HD patients, and malnutrition inflammation score (MIS) were used for the diagnosis of protein energy wasting. DII was calculated according to average of 3-day dietary recall data.RESULTSDII showed significant correlation with reliable malnutrition and inflammation indicators including SGA (r = 0.28, P < 0.01), MIS (r = 0.28, P < 0.01), and serum C-reactive protein (CRP) (r = 0.35, P < 0.001) in HD patients. When the study population was divided into three subgroups according to their DII score, significant increasing trends across the tertiles of DII were observed for SGA score (P = 0.035), serum CRP (P = 0.001), dietary energy (P < 0.001), total fat (P < 0.001), saturated fatty acids (P < 0.001), polyunsaturated fatty acids (P = 0.006), and omega-6 fatty acids (P = 0.01) intakes.CONCLUSIONThis study shows that DII is a good tool for assessing the overall inflammatory potential of diet in HD patients.

Dietary inflammatory index: a potent association with cardiovascular risk factors among patients candidate for coronary artery bypass grafting (CABG) surgery

“…In our study, the BMI in the second quartile of DII was higher than the forth quartile ( P = 0.009). This contradictory finding was also in agreement of the findings of the Kizil et al study [ 53 ] reporting a negative association between DII and BMI. Similarly, in the study by Zamora-Ros et al [ 54 ], the BMI in the second quartile of DII was higher than forth quartile among patients with colorectal cancer.…”

“…In the study by Xu et al the higher adapted dietary inflammatory index (ADII) was associated with systemic inflammation and reduced kidney function demonstrated by higher CRP and lower glomerular filtration rate (GFR) in elderly adults [ 52 ]. Also, in another study by Kizil et al [ 53 ], dietary inflammatory index was associated with higher CRP and slightly higher creatinine concentrations in patients with hemodialysis.…”

Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine

“…In patients with ESRD, increased PEW is associated with poor prognosis. A nutritional composed scoring system or dietary inflammatory index shows a correlation between PEW and prognosis in patients with ESRD [ 15 , 16 ]. The pathophysiological mechanisms of PEW have been suggested to be complex including derangements in muscle, adipose tissue, and the gastrointestinal, hematopoietic, and immune systems, complications related to deficiencies of multiple micronutrients, and the maladaptive activation of the inflammatory cascade [ 17 ].…”

Lower Dietary Inflammatory Index Scores Are Associated with Lower Glycemic Index Scores among College Students

“…In previous cross-sectional studies conducted in middle-aged adults and the elderly, the DII was validated against inflammatory biomarkers, such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF)-α [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Furthermore, the DII has been shown to be positively related to lower cognitive functioning [ 12 ] and higher risk of insulin resistance [ 13 ], cardiovascular disease (CVD) [ 11 , 14 , 15 , 16 , 17 , 18 ], and metabolic syndrome [ 15 , 19 ].…”