Diet-Related Inflammation is Associated with Malnutrition-Inflammation Markers in Maintenance Hemodialysis Patients: Results of a Cross-Sectional Study in China Using Dietary Inflammatory Index

Abstract

Purpose This cross-sectional study aimed to explore the association between the inflammation potential of the diet and malnutrition-inflammation status in Chinese maintenance hemodialysis (MHD) patients. Methods Dietary Inflammatory Index (DII) was computed based on a semi-quantitative food frequency questionnaire. Malnutrition-inflammation status was assessed by six indexes, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), hemoglobin (HB), albumin (ALB) and malnutrition-inflammation score (MIS). Multivariable linear regression and logistic regression were employed adjusting for covariables including age, gender, body mass index and dialysis vintage. Results A total of 161 Chinese MHD patients with an average age of 60.0 ± 13.6 years were enrolled. The median (IQR) DII score among participants was 0.60 (−0.80, 2.32), revealing a generally pro-inflammatory diet. DII was positively associated with MIS score (β= 0.61, 95% CI: 0.51, 0.69, p < 0.0001) and CRP (β = 0.54, 95% CI: 0.46, 0.63, p < 0.0001). A negative relationship between DII and NLR (β = −0.37, 95% CI: −0.61, −0.13, p = 0.008) was found in the most anti-inflammatory diet. Multivariable logistic regression showed that each unit increase in DII was linked with 3.06 (95% CI: 1.39, 6.69, p = 0.005) times increased odds of MIS. Conclusion Diet with a higher DII score may act as a potential trigger contributing to the development of malnutrition-inflammation status. Further studies for verification and for developing strategies to decrease the dietary inflammation burden are warranted.

Energy-adjusted dietary inflammatory index is associated with chronic kidney disease-associated pruritus in hemodialysis patients: A cross-sectional study

“…In a crosssectional study of 109 HD patients, Kizil et al demonstrated that an increase in the DII category was associated with higher CRP levels (15). Similarly, another cross-sectional study with 160 HD patients reported a signi cant positive association between the DII score and CRP levels (14). Other studies conducted among different populations have also shown signi cant associations between DII and in ammatory biomarkers effective in CKD-aP, such as interleukin-6, interleukin-2, and tumor necrosis factor-α(36).…”

“…Previous studies have demonstrated the direct correlation between DII scores and chronic diseases such as chronic kidney disease (10), obesity (11), diabetes mellitus (12), and cardiometabolic risk (13). Furthermore, several cross-sectional studies have reported a positive correlation between DII scores and CRP levels in hemodialysis patients (14,15).…”

Relationship between diet-related inflammation and bone health under different levels of body mass index

“…Previous study showed that using 28 components did not influence the DII predictive capacity [ 24 ]. Details of the DII scoring algorithm have been described previously [ 19 ]. First, global daily mean intake was adopted to calculate every participant’s Z score.…”

“…Instead of focused on specific nutrients or dietary patterns, dietary inflammatory index (DII), a literature-based scoring algorithm based on the effort of 45 different food components on inflammatory biomarkers, was focused on quantitating the overall inflammatory potential of individual diets [16]. A higher DII score was independently linked with obese, malnutrition-inflammation status and cardiovascular disease [17][18][19].…”