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

Abstract

The literature on the role of inflammation in health has grown exponentially over the past several decades. Paralleling this growth has been an equally intense focus on the role of diet in modulating inflammation, with a doubling in the size of the literature approximately every 4 y. The Dietary Inflammatory Index (DII) was developed to provide a quantitative means for assessing the role of diet in relation to health outcomes ranging from blood concentrations of inflammatory cytokines to chronic diseases. Based on literature from a variety of different study designs ranging from cell culture to observational and experimental studies in humans, the DII was designed to be universally applicable across all human studies with adequate dietary assessment. Over the past 4 y, the DII has been used in >200 studies and forms the basis for 12 meta-analyses. In the process of conducting this work, lessons were learned with regard to methodologic issues related to total energy and nutrient intake and energy and nutrient densities. Accordingly, refinements to the original algorithm have been made. In this article we discuss these improvements and observations that we made with regard to misuse and misinterpretation of the DII and provide suggestions for future developments.

Food Combinations in Relation to the Quality of Overall Diet and Individual Meals in Japanese Adults: A Nationwide Study

“…Thus, these diet quality measures are not optimal for assessing the overall quality of Japanese diet, but rather the best available [40]. The use of other diet quality scores, such as the Dietary Inflammatory Index [1], which is not culture bound, would be of interest in future studies. Nevertheless, in our recent systematic review of Japanese studies which obtained dietary patterns using principal component analysis, we found that those food groups which contributed to dietary patterns termed healthy (fruits, vegetables, potatoes, mushrooms, seaweeds, and pulses) are at least partly similar to those often observed in Western countries (fruits, vegetables including mushrooms, poultry, fish, low-fat dairy, legumes, and whole grains) [60].…”

“…Efforts to overcome the limitations of evaluating single nutrients and foods in isolation have led to a gradual shift in nutrition research to the evaluation of dietary patterns [1,2]. Although the investigation of dietary patterns is generally performed in terms of the daily intake of individual foods or food groups [3][4][5][6], an increasing number of studies have focused on dietary intake at the level of each eating occasion (i.e., breakfast, lunch, dinner, and snack) or meal patterns [7][8][9].…”

Dietary inflammatory index, risk of incident hypertension, and effect modification from BMI

“…Evidence for interaction between BMI and DII on incidence of hypertension was observed (p for interaction = 0.0002). Models were strati ed on BMI, in the following groups: BMI < 18 In sensitivity analysis excluding participants diagnosed within 5 and 10 years, results were similar (data not tabulated). Results were unchanged when assessing the calibrated DII score, which showed near perfect correlation with the score calculated for the whole population (r = 0.999).…”

“…Recently, the dietary in ammatory index (DII) (18,19) has been developed to re ect in ammatory potential of the diet and categorises an individual's diet on a continuum from anti to pro-in ammatory (20). The DII has been shown to be associated with diseases such as diabetes (21), obesity (22), asthma (23), cancer (24,25), myocardial infarction, stroke and CVD mortality (26)(27)(28).…”

Inflammatory potential of diet in association with breast cancer risk: A matched case-control study

“…It should be noted, however, that according to ndings by Shivappa et al, the range of DII is more dependent on the amount of consumed food rather than the number of available food items (42). This is an important issue that we have discussed previously and which needs to be kept in mind as we designed and analyzed data from additional studies on this important subject (43) It is important to note that the DII score estimated in our population represented more AI potencies of the (24). The relatively low DII/E-DII scores of this study population re ect the contents of the Iranian diet, proportionally consisting of large quantities of food items with anti-in ammatory effects, such as black tea, Persian saffron, onion (raw and cooked), garlic and plant-derived avonoid contents (45)(46)(47).…”