Epidemiology and Health

Original Articles

Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey: Dahyun Park, Hee Ju Jun, Garam Jo, Soyoung Kwak, Min-Jeong Shin; Epidemiol Health. 2025;47:e2025017. Published online April 9, 2025; DOI: https://doi.org/10.4178/epih.e2025017

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Abstract

OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.

METHODS

The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.

RESULTS

Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.

CONCLUSIONS

Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.

Summary

Korean summary
본 연구는 2007–2015년 국민건강영양조사-사망원인통계 연계 데이터를 바탕으로 한국 성인을 대상으로 식이염증지수(E-DII)와 전체, 암, 심혈관질환 사망률 간의 연관성을 분석하였음. 높은 식이염증지수는 전체 사망(HR, 1.45; 95% CI, 1.25–1.69), 암 사망(HR, 1.41; 95% CI, 1.09–1.81), 심혈관질환 사망(HR, 1.53; 95% CI, 1.07–2.18) 위험 증가와 유의하게 관련되었으며, 특히 대사질환 보유자에서 그 연관성이 두드러졌음.

Key Message
This prospective cohort study analyzed nationally representative data from the Korea National Health and Nutrition Examination Survey (2007–2015) to examine the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and mortality risk. A higher E-DII was significantly associated with increased risks of all-cause (HR, 1.45; 95% CI, 1.25–1.69), cancer mortality (HR, 1.41; 95% CI, 1.09–1.81), and cardiovascular mortality (HR, 1.53; 95% CI, 1.07–2.18), particularly among individuals with metabolic disorders.

Citations

Citations to this article as recorded by

Dietary Inflammatory Index and the Risk of Gastric Precancerous Lesions Among Korean Adults in a Rural Area
Yewon Cho, Dongkyu Lee, Chang Soo Eun, Dong Soo Han, Hyun Ja Kim
Nutrients.2025; 17(22): 3502. CrossRef

Importance of younger age group and high inflammatory status in the association between periodontal disease and diabetes mellitus: results from the Korea National Health and Nutrition Examination Survey 2012-2018: Hyunmin Lee, Myung-Hee Shin; Epidemiol Health. 2024;46:e2024088. Published online November 15, 2024; DOI: https://doi.org/10.4178/epih.e2024088

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Abstract Summary PDF

Abstract

OBJECTIVES
Although previous studies have demonstrated an association between periodontal disease (PD) and diabetes mellitus (DM), the influence of age and the mediating role of inflammation have seldom been explored. This study investigated this association while considering the modifying effects of age and inflammatory status.

METHODS

This study included 29,491 participants from the 2012-2018 Korea National Health and Nutrition Examination Survey. The community periodontal index (CPI) was assessed by trained dentists using the World Health Organization CPI probe. PD was defined as a CPI score of 3 or 4. Pre-existing and incident DM were identified based on serum glucose levels, a history of DM diagnosis, medication use, and insulin injections. Serum high-sensitivity C-reactive protein (hs-CRP) levels were utilized as an indicator of chronic inflammation.

RESULTS

PD and DM exhibited a significant association, which was more pronounced with incident DM than with pre-existing DM, particularly in individuals younger than 65 years. Among those aged 20-44 years, the odds ratio of incident DM for CPI=4 versus CPI=0 was 2.61 (95% confidence interval, 1.16 to 6.09). High hs-CRP levels (>3 mg/L) were also associated with DM, especially in individuals with PD. This association was stronger with incident DM than with pre-existing DM. A notable joint effect was observed in younger individuals and those with PD.

CONCLUSIONS

The association between PD and DM was more pronounced in younger age groups and those with higher levels of inflammation. Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Summary

Korean summary
- 치주 질환과 당뇨병 사이의 연관성은 젊은 연령과 염증 수치가 높게 나타난 대상에서 더 두드러지게 나타남 - 치주 질환과 높은 염증 수치를 동시에 가지고 있을 경우의 당뇨 오즈비는 각각의 오즈비 합보다 더 크게 나타나 시너지 효과를 보였음 - 젊은 치주 질환 환자에 대한 조기 개입은 당뇨병 예방에 중요하게 작용할 수 있음

Key Message
• The association between PD and DM was more pronounced in younger age groups and those with higher levels of in- flammation. • The odds of DM increased synergistically for those with both PD and high inflammatory status. • Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Citations

Citations to this article as recorded by

Synergic Elevation of Systemic Inflammation by the Coexistence of Periodontitis and Diabetes Mellitus: A Nationwide Analysis of Korean Adults
Hye-Sun Shin
Biomedicines.2025; 13(10): 2441. CrossRef
Resveratrol supplementation as a non-surgical treatment in periodontitis and related systemic conditions
Caterina Vinciguerra, Loredana Bellia, Graziamaria Corbi, Sandro Rengo, Alessandro Cannavo
Journal of Traditional and Complementary Medicine.2024;[Epub] CrossRef

Association of the dietary inflammatory index with phenotypic age in the United States adults: Mengzi Sun, Jiaxin Fang, Wenhui Gao, Yue He, Yanan Ma, Lina Jin; Epidemiol Health. 2023;45:e2023051. Published online May 4, 2023; DOI: https://doi.org/10.4178/epih.e2023051

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet. Phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study aimed to explore the association between the dietary inflammatory index (DII) and PhenoAge.

METHODS

In total, 9,275 adults aged 20 years old and over in the National Health and Nutrition Examination Survey were involved in this study. Dietary patterns were classified as pro-inflammatory or anti-inflammatory according to the DII. PhenoAge was regarded as a continuous variable, and linear regression was used to explore its association with dietary inflammation. Stratified analyses by sex, age, race, physical exercise, smoking status, drinking status, and body mass index were used to test the sensitivity of these associations.

RESULTS

The median value of PhenoAge was 38.60 years and 39.76 years for the participants with anti-inflammatory and pro-inflammatory diets, respectively. A pro-inflammatory diet was positively associated with PhenoAge (β=0.73; 95% confidence interval, 0.31 to 1.14), compared with participants who had an anti-inflammatory diet. There was an interaction between dietary inflammation and age for PhenoAge (p<sub>interaction</sub><0.001). The strength of the association between a pro-inflammatory diet and PhenoAge was stronger as age increased.

CONCLUSIONS

A pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.

Summary

Key Message
One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet, and phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study found that a pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.

Citations

Citations to this article as recorded by

Association of dietary inflammatory index with ocular diseases: a population-based cross-sectional study
Xue Wang, Can Zhang, Haitao Jiang
European Journal of Medical Research.2025;[Epub] CrossRef
The L-shaped link between total antioxidant capacity and phenotypic age acceleration: evidence from NHANES 2003–2010
Yukun Wu, Mengxiang Xiang, Yangcheng Zhao, Yu Zhang, Wenxiang Cheng, Jiangbei Deng
Biogerontology.2025;[Epub] CrossRef
Associations of diet patterns with successful aging, longevity, and extreme longevity: a prospective cohort study among Chinese adults 65 years or older
Yingying Chen, Yaning Sun, Yinyin Chen, Yawen Cao, Wenbin Fang, Mohamed Sannoh, Guixia Pan
European Journal of Nutrition.2025;[Epub] CrossRef
The Association Between Sleep Disorder and Female Infertility: A Mediation Analysis of Inflammatory and Oxidative Markers
Qiaorui Yang, Jinfu Zhang, Zhenliang Fan, Jasbir Arora (RSS)
Mediators of Inflammation.2025;[Epub] CrossRef
Association Between Dietary Inflammatory Index and NAFLD: A Cross‐Sectional Study of the National Health and Nutrition Examination Survey
Yuan He, Yuhang Yang, Pengfei Cheng, Wei Zhang, Jinghan Jia, Dawei Ye, Jinxi Wang, Jasbir Arora (RSS)
Mediators of Inflammation.2025;[Epub] CrossRef
Dietary inflammatory index and depressive symptoms as mediators between social disadvantage and accelerated phenotypic aging
Mengke Chen, Qingmei Gao, Xinfang Zhu, Jun Zhang, Rong Xia, Qi Zhang
Journal of Affective Disorders.2025; 391: 119995. CrossRef
The association between methylmalonic acid, a biomarker of mitochondria dysfunction, and phenotypic age acceleration: A population-based study
Bing Cao, Yu Xue, Dan Liu
Archives of Gerontology and Geriatrics.2024; 117: 105176. CrossRef
Association of pro-inflammatory diet with increased risk of gallstone disease: a cross-sectional study of NHANES January 2017–March 2020
Jinnian Cheng, Qian Zhuang, Weiyi Wang, Ji Li, Lu Zhou, Ying Xu, Haiqin Zhang, Zixu Zhang, Fengli Zhou, Daming Yang, Yimin Chu, Haixia Peng
Frontiers in Nutrition.2024;[Epub] CrossRef

Association of the inflammatory balance of diet and lifestyle with colorectal cancer among Korean adults: a case-control study: Shinyoung Jun, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim; Epidemiol Health. 2022;44:e2022084. Published online September 30, 2022; DOI: https://doi.org/10.4178/epih.e2022084

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Dietary and lifestyle exposures may affect the risk of colorectal cancer (CRC) by promoting chronic inflammation. Therefore, we assessed the separate and joint associations of dietary and lifestyle inflammation scores (DIS and LIS, respectively) with CRC.

METHODS

Data from 919 pathologically confirmed CRC cases and 1,846 age- and sex-matched controls recruited at the National Cancer Center Korea were analyzed. We calculated the DIS and LIS, which characterize the collective contributions of 19 dietary and 4 lifestyle factors, respectively, to systemic inflammation by applying weights based on high-sensitivity C-reactive protein. A higher score represented a higher balance of pro- to anti-inflammatory exposures. Unconditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for CRC risk compared across the DIS and LIS tertile categories, with the lowest tertile as the reference group.

RESULTS

The highest DIS tertile had significantly increased odds of having CRC (OR, 2.65; 95% CI, 2.10 to 3.36), and the odds increased with increasing DIS. The highest LIS tertile group had 1.28-fold higher odds of having CRC (95% CI, 1.03 to 1.58). In the cross-classification analysis, the odds of having CRC increased as the DIS and LIS jointly increased until the DIS reached the highest tertile, where the risk was very high (3-fold or more) regardless of the LIS.

CONCLUSIONS

In conclusion, a higher balance of pro-inflammatory relative to anti-inflammatory dietary and lifestyle factors, especially dietary factors, was associated with higher CRC risk among Korean adults.

Summary

Korean summary
본 연구는 국립암센터에서 수집한 대장암 환자-대조군 데이터를 활용하여, 새롭게 개발된 식이 염증 지수(Dietary Inflammation Score, DIS) 및 생활습관 염증 지수(Lifestyle Inflammation Score, LIS)와 대장암 발생 위험 간의 연관성을 탐색하였다. 분석 결과, 식이 염증 지수 혹은 생활습관 염증 지수가 높은 집단에서 대장암 위험이 더 높아, 식이와 생활습관이 체내 염증 수준을 높여 대장암 발생 위험을 높일 가능성이 제기되었다

Key Message
Dietary inflammation score (DIS) and lifestyle inflammation score (LIS) quantify the collective effect of dietary and lifestyle factors, respectively, on systemic inflammation. In this case-control study, we assessed the associations of DIS and LIS with colorectal cancer risk among Korean adults. Our results suggest that a higher balance of pro-to anti-inflammatory dietary and lifestyle factors may be associated with higher risk for colorectal cancer. The findings from our study support that reducing inflammation through dietary or lifestyle changes could potentially reduce the risk for colorectal cancer.

Citations

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Colorectal Cancer Risk in Korean Patients with Inflammatory Bowel Disease: A Nationwide Big Data Study of Subtype and Socioeconomic Disparities
Kyeong Min Han, Ho Suk Kang, Joo-Hee Kim, Hyo Geun Choi, Dae Myoung Yoo, Nan Young Kim, Ha Young Park, Mi Jung Kwon
Journal of Clinical Medicine.2025; 14(15): 5503. CrossRef
Therapeutic Colorectal Cancer Vaccines: Emerging Modalities and Translational Opportunities
Palaniyandi Muthukutty, Hyun Young Woo, So Young Yoo
Vaccines.2025; 13(7): 689. CrossRef
Development and Validation of Comprehensive Inflammatory Lifestyle Score and Association with Colorectal Cancer Risk
Jiali Zheng, Longgang Zhao, Jingwen Dong, Edward Giovannucci
Cancer Epidemiology, Biomarkers & Prevention.2025; 34(10): 1810. CrossRef
The association of diet-dependent acid load with colorectal cancer risk: a case–control study in Korea
Tao Thi Tran, Madhawa Gunathilake, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim
British Journal of Nutrition.2024; 131(2): 333. CrossRef
Protein nutritional support: The prevention and regulation of colorectal cancer and its mechanism research
Duo Feng, Di Han, Mengjie Li, Hu Li, Na Li, Tianxin Liu, Jing Wang
Food Frontiers.2024; 5(6): 2515. CrossRef
Gout and Colorectal Cancer Likelihood: Insights from a Nested Case-Control Study of the Korean Population Utilizing the Korean National Health Insurance Service-National Sample Cohort
Mi Jung Kwon, Kyeong Min Han, Joo-Hee Kim, Ji Hee Kim, Min-Jeong Kim, Nan Young Kim, Hyo Geun Choi, Ho Suk Kang
Cancers.2023; 15(23): 5602. CrossRef
Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies
Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim
Epidemiology and Health.2023; 45: e2023102. CrossRef

Exploring the associations between cardiovascular health measured with the CANHEART model and early cognitive impairment in a middle-aged population in Korea: Ye Jin Jeon, Ji Heon Lee, Hyeon Chang Kim, Sun Jae Jung; Epidemiol Health. 2021;43:e2021044. Published online July 13, 2021; DOI: https://doi.org/10.4178/epih.e2021044

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Both cardiovascular health (CVH) and inflammation are associated with cognition, and inflammation is also associated with CVH. However, limited information has been reported on these factors in the Korean population. The objective of our study was to investigate the influence of inflammation on the association between CVH and cognition using a cross-sectional design.

METHODS

Data were obtained from the Cardiovascular and Metabolic Diseases Etiology Research Center baseline study. Participants who completed fasting serum analysis, questionnaires, and cognitive function tests were included in the analysis, whereas those with a history of autoimmune disease were excluded. The CVH in Ambulatory Care Research Team health index metrics, including smoking, physical activity, healthy diet, obesity, history of hypertension, and diabetes, were used to assess CVH. Cognitive function was evaluated with the Korean version of the Mini-Mental State Estimation for Dementia Screening. Inflammatory status was assessed based on a high-sensitivity C-reactive protein (hs-CRP) test.

RESULTS

Among 2,622 total participants (mean age, 57.2 years; 1,792 women), 13%, 58%, and 29% had poor, intermediate, and ideal CVH, respectively. Logistic regression analysis demonstrated that CVH was significantly associated with cognitive function only in women. A stratified analysis showed that cognitive impairment due to CVH was not associated with hs-CRP levels. When the same analyses were conducted for each CVH component, the only component affecting the association was hypertension history in men.

CONCLUSIONS

CVH is not significantly associated with cognitive decline in the middle-aged Korean population. Inflammation did not play a significant modifying role in this relationship.

Summary

Korean summary
• 본 연구는 심뇌혈관 및 대상질환원인연구센터(Cardiovascular and Metabolic Diseases Etiology Research Center, CMERC) 코호트의 기반조사 데이터를 활용하여, 심혈관계건강과 인지기능 사이의 연관성을 한국 도시거주 중년인구에서 확인하고, 염증 지표인 고감도C반응단백 (high-sensitivity C-reactive protein, hs-CRP) 수준에 따른 차이를 탐색하였다. • 남성과 여성 모두에서 CANHEART health index가 낮은 집단에서 인지기능이 평균적으로 더 낮았으나, 통계적으로 유의하지는 않았다. • 염증 수준에 따른 심혈관계건강과 인지기능 사이의 연관성은 해당 연구에서는 확인할 수 없었다.

Key Message
In the Korean middle-aged population, poor cardiovascular health (CVH) assessed by CANHEART health index was associated with low cognitive function, but not statistically significant. Further investigation is suggested to develop CVH index specified in Korean populations and to estimate the association between CVH and cognitive function in larger population.

Citations

Citations to this article as recorded by

Cardiovascular disease risk models and dementia or cognitive decline: a systematic review
Ruirui Jia, Qing Wang, Hengyi Huang, Yanli Yang, Yuet Foon Chung, Tao Liang
Frontiers in Aging Neuroscience.2023;[Epub] CrossRef

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