Nutrients · 2026
The Dietary Inflammatory Index and Incident Risk of Type 2 Diabetes Mellitus: Interactions with Obesity and Dyslipidemia in a Prospective Cohort Study.
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Liang Jinliang, Fu Xueru, Wu Yuying, Chen Taifeng, Su Yaqin, Yang Li, Gu Minqi, Wen Liuding, Zhao Yang, Li Kexin, Shu Yihao, Chen Kaixin, Pang Jinyuan, Hu Dongsheng, Zhang Ming
Аннотация
OBJECTIVES: To explore the association between the dietary inflammatory index (DII) and type 2 diabetes mellitus (T2DM) risk and to evaluate potential interactions of obesity and dyslipidemia in the context of this association.
METHODS: This cohort study included 8055 adults. Dietary data from food frequency questionnaires were used to calculate DII, reflecting dietary inflammatory potential. T2DM was defined as fasting plasma glucose ≥7.0 mmol/L, HbA1c ≥6.5%, a documented T2DM history, or glucose-lowering therapy. Multivariate Cox regression models assessed the DII-T2DM association, with multiplicative interaction analysis via product terms and additive interactions evaluated using relative excess risk due to interaction (RERI) and attributable proportion due to interaction (AP).
RESULTS: After a median 5.01-year follow-up, 1034 incident T2DM cases had occurred. The highest versus lowest DII quartile showed an unadjusted HR of 1.20 (95% CI: 1.01-1.42), which attenuated after adjusting for demographic and clinical confounders. In women, the highest DII quartile had a significantly adjusted HR of 1.36 (1.03-1.81), with a 16% increased risk per 1-SD DII increase (adjusted HR:1.16, 95% CI:1.04-1.29); no association was observed in men. Positive multiplicative and additive interactions emerged in total participants between high DII and central obesity (measured by waist circumference/waist-to-hip ratio), accounting for 22% and 31% of excess T2DM risk, respectively. No interactions were found with dyslipidemia and other obesity metrics (BMI, waist-to-height ratio).
CONCLUSIONS: This study suggests that a highly pro-inflammatory diet may be associated with an increased incident risk of T2DM among women. Waist circumference and waist-to-hip ratio and a high DII are found to act synergistically in elevating T2DM risk.
METHODS: This cohort study included 8055 adults. Dietary data from food frequency questionnaires were used to calculate DII, reflecting dietary inflammatory potential. T2DM was defined as fasting plasma glucose ≥7.0 mmol/L, HbA1c ≥6.5%, a documented T2DM history, or glucose-lowering therapy. Multivariate Cox regression models assessed the DII-T2DM association, with multiplicative interaction analysis via product terms and additive interactions evaluated using relative excess risk due to interaction (RERI) and attributable proportion due to interaction (AP).
RESULTS: After a median 5.01-year follow-up, 1034 incident T2DM cases had occurred. The highest versus lowest DII quartile showed an unadjusted HR of 1.20 (95% CI: 1.01-1.42), which attenuated after adjusting for demographic and clinical confounders. In women, the highest DII quartile had a significantly adjusted HR of 1.36 (1.03-1.81), with a 16% increased risk per 1-SD DII increase (adjusted HR:1.16, 95% CI:1.04-1.29); no association was observed in men. Positive multiplicative and additive interactions emerged in total participants between high DII and central obesity (measured by waist circumference/waist-to-hip ratio), accounting for 22% and 31% of excess T2DM risk, respectively. No interactions were found with dyslipidemia and other obesity metrics (BMI, waist-to-height ratio).
CONCLUSIONS: This study suggests that a highly pro-inflammatory diet may be associated with an increased incident risk of T2DM among women. Waist circumference and waist-to-hip ratio and a high DII are found to act synergistically in elevating T2DM risk.