Development and Validation of a Food‐Based Inflammation Score
Authors: Holmes Ashley Christine , Bostick Roberd M 
Published: November 2023

BackgroundProlonged, higher levels of systemic low‐grade inflammation are associated with risk for several chronic diseases, including heart disease, type‐2 diabetes, and some cancers.ObjectivesTo develop weights for a food‐based inflammation (FBI) score vis á vis associations of whole food dietary components with a panel of biomarkers of inflammation in a diverse population, and then create FBI scores and assess their associations with biomarkers of inflammation in three observational studies.Methods and ResultsAmong 590 chronic disease‐free participants at baseline (47% male, 53% female, 57% white, 43% black) in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, we estimated dietary intakes with a Block 98 Food Frequency Questionnaire (FFQ) and measured serum concentrations of four biomarkers of inflammation (plasma C‐reactive protein [CRP] and interleukins‐6, ‐8, and ‐10). To create a summary inflammation biomarker score, we calculated a z‐score for each biomarker and summed them. To create a food‐based inflammation score (FBI), first, based on biological plausibility and previous literature, we a priori selected the following dietary components to be included in the FBI: processed meats, red meat, white meat, fish, nuts, coffee, tea, high‐ and low‐fat dairy products, refined and whole grains, and 10 botanical categories. Next, using linear regression, we calculated the multivariable‐adjusted associations of the dietary components with the biomarker score. The beta coefficients for the associations were then used as weights for the contributions of the dietary components to an overall FBI. The FBI was then calculated as the sum of the weighted dietary component intakes of each participant in three study populations: the REGARDS population described above; a pooled, outpatient elective, colonoscopy population (MAP; n=513); and a population of colorectal adenoma patients in a chemoprevention trial (CCECP; n=174). In the REGARDS population, the odds ratio (OR) for the association of the highest FBI score quartile with the biomarker score was 1.96 (95% confidence interval [CI]: 1.12, 3.43) after adjusting for age, sex, hormone replacement therapy, race, education, regular non‐steroidal anti‐inflammatory drug (NSAID) use, total energy intake, a lifestyle inflammation score, and dietary supplementation. The association tended to be stronger among males and those who did not take NSAIDs regularly. In the MAP population, the multivariable‐adjusted OR for the association of the highest FBI score quartile with CRP (the only available inflammation biomarker in this population) was 1.59 (95% CI: 0.91, 2.81). In the CCECP population, the multivariable‐adjusted OR for the association of the highest FBI score quantile with the four‐component inflammation biomarker score was 1.30 (95% CI: 0.62, 2.72).ConclusionsThese results 1) suggest that multiple dietary components collectively are more strongly associated with systemic inflammation than are any individual food items, and 2) support the validity of a food‐based inflammation score for investigating associations of diet‐related contributions to systemic inflammation with risk for chronic diseases.Support or Funding Information1. Franklin Foundation, Cancer Risk Prediction and Prevention Program, Winship Cancer Institute, Emory University; 2. Burroughs Wellcome Fund, Molecules to Mankind Program, Laney Graduate School, Emory University