The Dietary Inflammatory Index is associated with elevated white blood cell counts in the National Health and Nutrition Examination Survey

Abstract

White blood cells (WBCs) are considered a reliable biomarker of inflammation. Elevations in both WBCs and pro-inflammatory cytokines are associated with several chronic conditions. Diet is a strong moderator of inflammation and WBCs. The purpose of this study was to examine the association between the Dietary Inflammatory Index (DII®) and WBCs using data from the United States National Health and Nutrition Examination Survey (NHANES). NHANES is a cross-sectional study that occurs in two-year cycles. Respondents from five cycles (n = 26,046) with available data on diet (collected through a single 24-h dietary recall [24HR]) and WBCs (derived using the Coulter method) were included. The DII (theoretical range is about -8 to +8) was derived from the micro and macronutrients calculated from the 24HR. Linear regression models, using survey design procedures, were used to estimate adjusted mean WBC (i.e., total, lymphocytes, monocytes, and neutrophils) counts and percentages by DII quartiles. Among all participants no statistically significant difference in WBCs were observed when comparing DII quartile 4 (most pro-inflammatory) to quartile 1 (most anti-inflammatory). However, a one-unit increase in the DII was associated with a 0.028 (1000 per µL) increase in total WBCs (p = .01). Additionally, a 0.024 increase in neutrophils (p < .01) was observed for a one-unit increase in the DII. In the group of participants with normal body mass index (BMI, 18.5-24.9 kg/m), those in DII quartile 4 had higher levels of total WBCs compared to subjects with normal BMI in DII quartile 1 (7.12 vs. 6.88, p = .01). Similar comparisons were observed for monocytes and neutrophils. However, these relationships were not observed for participants who were overweight or obese, which are pro-inflammatory conditions. Normal-weight individuals consuming more pro-inflammatory diets were more likely to have elevated WBCs. Because of its cross-sectional design, NHANES cannot inform directly on temporal relations, thus limiting causal inference. Future research is needed to examine the impact of anti-inflammatory diet adoption on lowering levels of WBCs, in addition to other inflammatory mediators.

Dietary Inflammatory Index and Biomarkers of Lipoprotein Metabolism, Inflammation and Glucose Homeostasis in Adults

“…Increasing evidence suggests that some foods, food components and nutrients may modulate inflammatory status [ 13 , 14 ]. Supporting that concept are the findings that the DII has been associated with circulating concentrations of CRP [ 16 , 17 , 18 ], IL-6 [ 19 , 20 ], TNF-α [ 19 ] and WBC counts [ 22 ]. Examination of pro-inflammatory cytokines, acute-phase response proteins, adipocytokines and WBC profiles of the study population stratified by E-DII median in the present work revealed higher C3, CRP, IL-6 and TNF-α concentrations and WBC counts (due to elevated neutrophils, monocytes and basophils), higher NLR and lower adiponectin levels among those with higher E-DII scores (top 50th percentile) relative to their counterparts with lower E-DII scores.…”

“…Limited data exist regarding the associations between dietary inflammatory potential, circulating biomarkers of cardiometabolic health and MetS risk. Thus far, the DII has been associated with C-reactive protein (CRP) [ 16 , 17 , 18 ], interleukin (IL)-6 [ 19 , 20 ], tumour necrosis factor (TNF)-α [ 19 ], fibrinogen [ 21 ] and more recently with white blood cell (WBC) counts [ 22 ]. To date, six studies have examined the association between the DII and MetS risk, with inconsistent relationships identified [ 16 , 18 , 23 , 24 , 25 , 26 ].…”

Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study)

“…This index is a useful tool to predict the level of inflammatory cytokines such as IL6, CRP, and health indices based on the score of dietary inflammation 29 . Studies have shown that higher levels of DII maybe correlate with elevated levels of serum inflammatory factors such as IL-6, CRP, fibrinogen, homocysteine, TNF-α 13,19,23,30 , and white blood cell count (WBC) 31 . In this regard, several studies have reported a significant relationship between diet and inflammatory factor 32 .…”

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

“…We also have tested effects on other markers of disease risk such as homocysteine, chemerin, fibrinogen, complement component C3, leukocytes/white blood cells, interferons, intercellular adhesion molecule, and vascular cell adhesion molecule 1 [31,33,41]. 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].…”