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Table 2 Characteristics of studies examined the association of Dietary Inflammatory Index with cardiometabolic diseases

From: Association of dietary inflammatory potential with cardiometabolic risk factors and diseases: a systematic review and dose–response meta-analysis of observational studies

Reference First author (year) Study design Country Age range/mean age Gender Sample size Diet assessment tool Number of subjects with CMDs Duration of follow-up (years) Number of used dietary factors in DII calculation Outcome variable Measure of outcome Comparison Type of DII variable (categorical/continuous) Type of effect size measure Effect size measure (95% CI) Study quality Confounders
15 Bodén et al. 2017 Case–control Sweden 30–73 F/M 6944
F (NR)
M (NR)
FFQ 1389 6.4 30 MI Morbidity Quartile 4 (NR) vs. Quartile 1 (NR) Categorical OR 1.37 (1.07, 1.73) 8 1, 2, 3, 4, 5, 6, 7, 8
29 Bondonno et al. 2017 Cohort Western Australia  ≥ 70 F 1304 FFQ 269 15 31 ASVD Mortality Quartile 4 (1.72, 5.80) vs. Quartile 1 (− 6.14, − 1.37) Categorical HR 2.02 (1.30, 3.13) 8 1, 2, 7, 9, 10, 11, 12, 13, 14, 15, 16
              Continues (per one SD (2.13 units))   1.36 (1.15, 1.60)   
         150    IHD   Quartile 4 (1.72, 5.80) vs. Quartile 1 (− 6.14, − 1.37) Categorical   2.51 (1.37, 4.62)   
              Continues (per one SD (2.13 units))   1.40 (1.13, 1.75)   
         107    Ischaemic cerebrovascular disease   Quartile 4 (1.72, 5.80) vs. Quartile 1 (− 6.14, − 1.37) Categorical   1.76 (0.92, 3.40)   
              Continues (per one SD (2.13 units))   1.30 (1.00, 1.69)   
511 Deng et al. 2017 Cohort USA 20–90 F/M 9631
F (5164)
M (4467)
24-h dietary recall 676 18 27 CVD Mortality Tertile 3 (> 2.0) vs. Tertile 1 (< − 0.20) Categorical HR 1.52 (1.18, 1.96) 9 2, 3, 4, 7, 9, 17, 18, 19
       2681
F (1,264)
M (1417)
  412         1.44 (1.02, 2.04)   
       968
F (451)
M (517)
  240         0.98 (0.57, 1.67)   
16 Garcia-Arellano et al. 2015 Cohort Spain 67.0 F/M 7216 FFQ 277 Median follow-up of 4.8 32 CVD Morbidity Quartile 4 (median = 1.17) vs. Quartile 1 (median = − 2.46) Categorical HR 1.73 (1.15, 2.60) 7 1, 3, 4, 6, 7, 9, 17, 20, 21, 22, 23, 24, 25, 26
              Continues (per one SD)   1.22 (1.06, 1.40)   
52 Neufcourt et al. 2016 Cohort France 35–60 F/M 7743
F (4546)
M (3197)
At least 3 valid 24-h dietary records 292 13 36 Overall CVD Morbidity Quartile 4 (mean(IQR) (3.1 (1.3)) vs. Quartile 1 (− 1.7 (1.1)) Categorical HR 1.16 (0.79, 1.69) 7 1, 2, 3, 7, 9, 17, 25, 27, 28, 29, 30
              Continues (per one unit)   1.03 (0.96, 1.11)   
         93    MI   Quartile 4 (mean(IQR) (3.1 (1.3))
vs. Quartile 1 (− 1.7 (1.1))
Categorical   2.26 (1.08, 4.71)   
              Continues (per one unit)   1.12 (0.98, 1.28)   
              Quartile 4 (mean (IQR)2.41 (1.00))vs. Quartile 1 (− 1.86 (1.20)) Categorical   1.62 (0.88, 2.97)   
              Continues (per one unit)   1.12 (0.98, 1.27)   
         58    Stroke   Quartile 4 (mean (IQR) (3.1 (1.3))vs. Quartile 1 (− 1.7 (1.1)) Categorical   1.22 (0.56, 2.65)   
              Continues (per one unit)   1.05 (0.89, 1.24)   
         128    AP/RI   Quartile 4 (mean (IQR) (3.1 (1.3))
vs. Quartile 1 (− 1.7 (1.1))
Categorical   0.73 (0.41, 1.30)   
              Continuous (per one unit)   0.97 (0.87, 1.09)   
         13    Sudden deaths   Quartile 4 (mean (IQR) (3.1 (1.3))vs. Quartile 1 (− 1.7 (1.1)) Categorical   NR   NR
              Continuous (per one unit)     
53 O’Neil et al. 2015 Cohort Australia 20–97 M 1363 FFQ 76 5 22 CVD Morbidity Pro-inflammatory (positive DII) vs. anti- inflammatory (negative DII) Categorical OR 2.00 (1.01, 3.96) 7 1, 3, 4, 6, 7, 9, 31, 32
17 Ramallal et al. 2015 Cohort Spain 38 F/M 18,794
F (NR)
M (NR)
FFQ 117 Median (8.9) 28 CVD Morbidity Quartile 4 (− 0.74, 3.97) vs. Quartile 1 (− 5.14, − 2.68) Categorical HR 2.03 (1.06, 3.88) 7 1, 2, 3, 6, 7, 9, 17, 22, 23, 24, 25, 33, 34, 35, 36
54 Shivappa et al. 2016 Cohort USA 55–69 F 28,677 FFQ 6528 Mean ± SD (20.7 ± 7.0) NR CVD Mortality Quartile 4 (0.64, 4.65) vs. Quartile 1 (− 5.75,  − 2.50) Categorical HR 1.09 (1.01, 1.18) 8 1, 2, 6, 7, 9, 22, 25, 33, 37, 38
              Continuous (per one unit)   1.04 (1.01, 1.07)   
         3381    CHD   Quartile 4 (0.64, 4.65) vs. Quartile 1 (− 5.75,  − 2.50) Categorical   1.17 (1.05, 1.30)   
              Continuous (per one unit)   1.07 (1.03, 1.11)   
         1439    Stroke   Quartile 4 (0.64, 4.65) vs. Quartile 1 (− 5.75,  − 2.50) Categorical   1.04 (0.88, 1.22)   
              Continuous (per one unit)   1.01 (0.95, 1.08)   
         417 0–4.99   CVD      1.06 (0.95, 1.19)   
         736 5–9.99        1.14 (1.05, 1.24)   
         1177 10.00–14.99        1.01 (0.94, 1.07)   
         1825 15.00–19.99        1.07 (1.01, 1.13)   
         2373 20.00–25.00        1.00 (0.96, 1.05)   
         260 0–4.99   CHD      1.13 (0.68, 1.31)   
         447 5–9.99        1.15 (1.03, 1.28)   
         681 10.00–14.99)        0.98 (0.90, 1.07)   
         918 15.00–19.99        1.12 (1.04–1.20)   
         1075 20.00–25.00        1.03 (0.96, 1.11)   
         54 0–4.99   Stroke      1.05 (0.77, 1.42)   
         129 5–9.99        1.07 (0.87, 1.32)   
         233 10.00–14.99)        1.06 (0.92, 1.23)   
         441 15.00–19.99        1.04 (0.93, 1.16)   
         582 20.00–25.00        0.96 (0.87, 1.06)   
55 Shivappa et al. 2016 Cohort Sweden NR F 33,747 FFQ 2399 15 27 CVD Mortality Quintile 5 (≥ 1.91) vs. Quintile 1 (≤ − 0.67) Categorical HR 1.26 (0.93, 1.70) 8 1, 2, 3, 7, 9, 25, 39
              Continues (per one unit)   1.04 (0.98, 1.12)   
30 Shivappa et al. 2017 Cohort Germany 45–64 M 1297 7-day dietary record 244 Survey1: median follow-up = 25.8
Survey 3: median follow-up = 16.7
NR CVD Mortality Quartile 4 (median (2.507)) vs. Quartile 1 (median (− 0.803)) Categorical HR 1.19 (0.76, 1.86) 7 1, 2, 3, 6, 7, 9, 22, 25, 40, 41, 42
              Continues (per one unit)   1.05 (0.92, 1.20)   
         155    CHD   Quartile 4 (median (2.507)) vs. Quartile 1 (median (− 0.803)) Categorical   1.02 (0.57, 1.82)   
              Continues (per one unit)   1.01 (0.86, 1.18)   
       1252   213    CHD Morbidity Quartile 4 (median (2.507)) vs. Quartile 1 (median (− 0.803)) Categorical   1.53 (0.93, 2.53)   
              Continues (per one unit)   1.11 (0.97, 1.27)   
56 Shivappa et al. 2017 Cohort USA  > 19 F/M 12,366
F (NR)
M (NR)
One in-person
24-h dietary recall
1235 Mean ± SD (13.5 ± 4.0) 27 CVD Mortality Tertile 3 (2.03, 4.83) vs. Tertile 1 (− 5.60, − 0.22) Categorical HR 1.46 (1.18, 1.81) 8 2, 3, 6, 7, 9, 17, 18, 22, 33, 43
              Continuous (1-unit increment in DII (corresponding to 0.5 standard deviation increase))   1.06 (1.02, 1.09)   
57 Shivappa et al. 2017 Case–control Italy Case (19–79)
Control (16–79)
F/M 1442
F (423)
M (1019)
FFQ 760 30 AMI Morbidity Quartile 4 (1.10, 5.45) vs. Quartile 1 (− 4.46,  − 1.38) Categorical OR 1.60 (1.06, 2.41) 7 1, 2, 3, 6, 7, 9, 17, 22, 23, 24, 25, 44
              Continuous (one unit increase in DII equals to ~ 9% range of DII in this study (− 6.22 to + 5.45)   1.14 (1.05, 1.24)   
31 Vissers et al. 2016 Cohort Australia 52 (1) F 6,972 FFQ 335 Mean ± SD (11 ± 1.6) 25 CVD Morbidity (DII ≥ 0) vs. (DII < 0) Categorical HR 1.03 (0.76, 1.42) 8 1, 2, 3, 6, 7, 9, 22, 25, 37, 39, 45
              Continuous (per one SD)   0.98 (0.84, 1.15)   
         191    IHD   (DII ≥ 0) vs. (DII < 0) Categorical   1.33 (0.86, 2.06)   1, 6, 7, 9, 22
              Continuous (per one SD)   1.08 (0.88, 1.33)   
         69    MI   (DII ≥ 0) vs. (DII < 0) Categorical   1.59 (0.72, 3.52)   
              Continuous (per one SD)   1.40 (0.97, 2.01)   
         59    Cerebrovascular disease   (DII ≥ 0) vs. (DII < 0) Categorical   0.57 (0.29, 1.15)   
              Continuous (per one SD)   0.72 (0.50, 1.02)   
         40    Stroke   (DII ≥ 0) vs. (DII < 0) Categorical   0.55 (0.24, 1.26)   
              Continuous (per one SD)   0.77 (0.51, 1.18)   
19 Wirth et al. 2016 Cross-sectional USA 20–80 F/M 15,613
F (8047)
M (7566)
24-h dietary recall 1734 27 Combined circulatory disorders Morbidity Quartile 4 (1.94, 4.83) vs. Quartile 1 (− 5.81, − 0.81) Categorical POR 1.30 (1.06, 1.58) 5 2, 7, 9, 46
              Continuous (per one unit)   1.05 (1.01, 1.08)   
       15,622   501    Congestive heart failure   Quartile 4 (1.94, 4.83) vs. Quartile 1 (− 5.81, − 0.81) Categorical   1.38 (1.09, 1.74)   
              Continuous (per one unit)   1.06 (1.02, 1.10)   
       15,623   634    CHD   Quartile 4 (1.94, 4.83) vs. Quartile 1 (− 5.81, − 0.81) Categorical   0.96 (0.72, 1.28)   
              Continuous (per one unit)   0.99 (0.94, 1.05)   
       15,643   423    AP   Quartile 4 (1.94, 4.83) vs. Quartile 1 (− 5.81, − 0.81) Categorical   0.83 (0.54, 1.28)   
              Continuous (per one unit)   0.95 (0.89, 1.02)   
       15,664   685    Heart Attack   Quartile 4 (1.94, 4.83) vs. Quartile 1 (− 5.81, − 0.81) Categorical   1.48 (1.12, 1.97)   
              Continuous (per one unit)   1.06 (1.01, 1.12)   
       15,666   604    Stroke   Quartile 4 (1.94, 4.83) vs. Quartile 1 (− 5.81, − 0.81) Categorical   1.56 (1.21, 2.01)   
              Continuous (per one unit)   1.09 (1.04, 1.15)   
32 Shivappa et al. 2017 Cohort England 35–55 F/M 7627
F (2319)
M (5308)
FFQ 264 22 27 CVD Mortality Tertile 3 (0.74–3.82) vs. Tertile 1 (− 3.08–0.39) Categorical HR 1·46 (1·00, 2·13) 7 1, 2, 3, 6, 9, 7, 17, 18, 22, 29, 33, 39, 47, 48, 49, 50
              Continuous (per one SD (1.3 units))   1.23 (1.04, 1.47)   
77 Hodge et al. 2018 Cohort Australia 40–69 F/M 39,532
F (16,051)
M (23,481)
FFQ 2,081 19 29 CVD Mortality Quintile 5 (0.7, 4.9) vs. Quintile 1 (− 5.0, − 2.4) Categorical HR 1.16 (1.01, 1.33) 8 6, 17, 24, 33, 39, 51, 52
78 Mark Park et al. 2018 Cohort USA 20–90 F/M 3733
F (1553)
M (2180)
24-h dietary recall 252 18.5 27 CVD Mortality Tertile 3 (1.97, 4.55) vs. Tertile1 (− 5.08, − 0.24) Categorical HR 2.50 (1.60, 3.91) 8 2, 3, 7, 9, 17, 18, 25, 53
              Continuous (per one SD)   1.32 (1.10, 1.58)   
79 Park et al. 2018 Cohort USA 45–75 F 83,054 FFQ 7811 18.2 ± 4.9 28 CVD Mortality Quintile 5 (− 0.06, 4.95) vs. Quintile 1) − 6.64, − 3.91) Categorical HR 1.29 (1.17–1.42) 8 1, 2, 3, 6, 7, 9, 18, 25, 29, 37, 39
              Continues (per one unit)   1.04 (1.03,1.06)   
      M 67,351   8401      Quintile 5 (− 0.06, 4.95) vs. Quintile 1 (− 6.64, − 3.91) Categorical   1.13 (1.03, 1.23)   
              Continues (per one unit)   1.03 (1.01, 1.04)   
  1. 1—total energy intake, 2—body mass index, 3—physical activity, 4—systolic blood pressure, 5—total cholesterol, 6—diabetes, 7—smoking, 8—postsecondary academic education, 9—age, 10—energy expended in physical activity, 11—socioeconomic status, 12—use of low-dose aspirin, 13—use of antihypertensive medication, 14—use of statins, 15—prevalent atherosclerotic vascular disease, 16—treatment code, 17—sex, 18—race, 19—HbA1c, 20—overweight/obesity, 21—waist to height ratio, 22—hypertension, 23—dyslipidemia, 24—family history of premature cardiovascular disease, 25—educational level, 26—stratified by intervention group and center, 27—supplementation, 28—number of 24-h records, 29—marital status, 30—treatment allocation group (placebo or active), 31—diastolic blood pressure, 32—waist circumference, 33—previous history of other cardiovascular diseases, 34—following a special diet, 35—hours spent sitting down, 36—hours spent watching television, 37—hormone replacement therapy use, 38—prevalent cancer (yes/no), 39—alcohol intake, 40—survey number, 41—place of residence, 42—ratio of total cholesterol and high density lipoprotein cholesterol, 43—poverty index, 44—coffee consumption, 45—menopausal status, 46—family member, 47—occupational grade, 48—use of lipid-lowering drugs, 49—high density lipoprotein cholesterol, 50—longstanding illness, 51—country of birth, 52—socio-economic indexes for areas quintile, 53—income
  2. F female, M male, FFQ food frequency questionnaire, MI myocardial infarction, AMI acute myocardial infarction, ASVD atherosclerotic vascular disease, IHD ischaemic heart disease, CVD cardiovascular diseases, AP/RI angina pectoris/revascularization intervention, CHD coronary heart disease, OR odds ratio, POR prevalence odds ratio, HR hazard ratio, NR not reported
  3. 1Participants included three groups of normal, pre-diabetic and diabetic adults