Association of dietary inflammatory index with severity and mortality among adults with cardiovascular-kidney-metabolic syndrome.

BACKGROUND AND AIMS: Cardiovascular-kidney-metabolic (CKM) syndrome is driven by chronic inflammation. The impact of the energy-adjusted dietary inflammatory index (E-DII) on CKM severity and mortality remains unclear. We evaluated E-DII's association with advanced CKM and mortality, quantifying the mediating role of systemic inflammatory markers.

METHODS AND

RESULTS

Analyzing data from the National Health and Nutrition Examination Survey (NHANES,1999-2018),we employed weighted logistic regression and Cox regression to evaluate the associations of the E-DII with advanced CKM and mortality. Weighted linear regression assessed associations between E-DII and systemic inflammatory markers, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and neutrophil-to-lymphocyte ratio (NLR). Finally, mediation analyses quantified the mediating effects of these markers on E-DII-related mortality and CKM severity.During a median follow-up of 116 months, among 12016 participants (7.46% with advanced CKM), 1425 all-cause deaths and 356 cardiovascular deaths were documented. Multivariable analyses confirmed E-DII as an independent risk factor for advanced CKM (OR 1.10; 95% CI 1.02-1.18; P = 0.01) and a significant predictor of increased all-cause (HR 1.10; 95% CI 1.05-1.14; P < 0.001). Additionally, weighted linear regression showed positive associations between E-DII and systemic inflammatory markers, and mediation analyses revealed that systemic inflammation partially mediated the impact of E-DII on both mortality risks and CKM severity.

CONCLUSIONS

Elevated E-DII is significantly associated with advanced CKM and higher mortality, an association partially mediated by systemic inflammatory markers.