Design, Development and Construct Validation of the Children’s Dietary Inflammatory Index

Abstract

Objective: To design and validate a literature-derived, population-based Children’s Dietary Inflammatory Index (C-DII)TM. Design: The C-DII was developed based on a review of literature through 2010. Dietary data obtained from children in 16 different countries were used to create a reference database for computing C-DII scores based on consumption of macronutrients, vitamins, minerals, and whole foods. Construct validation was performed using quantile regression to assess the association between C-reactive protein (CRP) concentrations and C-DII scores. Data Sources: All data used for construct validation were obtained from children between six and 14 years of age (n = 3300) who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) (2005–2010). Results: The C-DII was successfully validated with blood CRP concentrations in this heterogeneous sample of 3300 children from NHANES (52% male; 29% African American, 25% Mexican American; mean age 11 years). The final model was adjusted for sex, age, race, asthma, body mass index (BMI), and infections. Children in level 3 (i.e., quartiles 3 and 4 combined) of the C-DII (i.e., children with the most pro-inflammatory diets) had a CRP value 0.097 mg/dL higher than that in level 1 (i.e., quartile 1) for CRP values at the 75th percentile of CRP using quantile regression (p < 0.05). Conclusion: The C-DII predicted blood CRP concentrations among children 6–14 years in the NHANES. Further construct validation with CRP and other inflammatory markers is required to deepen understanding of the relationship between the C-DII and markers of inflammation in children.

The inflammatory potential of diet impacts the association between air pollution and childhood asthma

“…However, other studies investigating the association between DII and asthma had similar exclusions related to anti‐inflammatory components . Nonetheless, not all parameters that DII encompasses, such as alcohol, are appropriate when performed in children . Fourthly, even though the avoidance of air pollution measurements during the summer, end‐of‐term vacations and weekends, the indoor assessment was limited to 5 days, which limited the identification of differences in previous months and years of exposure.…”

“…11,12 Nonetheless, not all parameters that DII encompasses, such as alcohol, are appropriate when performed in children. 26 Fourthly, even though the avoidance of air pollution measurements during the summer, end-of-term vacations and weekends, the indoor assessment was limited to 5 days, which limited the identification of differences in previous months and years of exposure. However, as already proposed by Annesi-Maesano et al, 27 despite the limited period of time evaluating indoor exposure, these results emphasized the potential role of school air quality on asthma.…”

Perspective: The Dietary Inflammatory Index (DII)—Lessons Learned, Improvements Made, and Future Directions

“…This realization also led to developing a children's DII (C-DII), with funding by the USDA. The C-DII represents a major methodologic improvement in accounting for macronutrient and micronutrients that affect inflammation and in using, for comparison, a composite database consisting of 16 data sets on children's dietary intake from around the world (123).…”

Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review

“…The DII or energy-adjusted DII (E-DII) have been construct validated against inflammatory biomarkers in different populations and under varying conditions [12,29,31,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. More recently the children’s DII (C-DII) has been developed and construct validated with hs-CRP in an American study [49].…”