Dietary inflammatory index scores are associated with blood inflammatory markers in healthy Koreans: Data from the Health Examinee Cohort (2012–2014)
Authors: Na Woori , Kim Misung , Sohn Choengmin 
Published: November 2023

Inflammation is known to be associated with chronic diseases such as cardiovascular disease and cancer. In particular, a high‐sensitivity C‐reactive protein (hs‐CRP) has been reported as a predictor of chronic disease induction. Dietary inflammatory index (DII) is a score used to determine the overall inflammatory potential of diet. There are limited studies which have shown the association between the DII score and inflammatory biomarkers in Korean. In this study we performed to analyze the association between two inflammatory biomarkers such as hs‐CRP and WBC and DII in healthy Korean.We performed cross‐sectional analysis of Health Examinee Cohort (2012–2014). Subjects were between the ages of 40 or 79 (8,332 males and 19,754 females). Information on food consumption was obtained using a 24 hour recall method which was used for calculating DII scores. Blood samples provided measurement of hs‐CRP and WBC counts. The dichotomous variable was entered into logistic regression models to measure odds ratios (ORs) of having higher hs‐CRP levels (>3mg/L) or WBC levels (>median) compared to lower levels (≤3mg/L or ≤median), with increasing DII, respectively.The DII scores of females (0.02 ± 2.50) were higher than males (−0.058 ± 2.48) (p<0.001). There was a positive correlation between DII and hs‐CRP and WBC (hs‐CRP; r=0.032, p=0.000, WBC; r=0.039, p=0.000). Odds of an elevated hs‐CRP or WBC were 1.181 times and 1.143 times higher in participants with the most proinflammatory diets compared to those with the most anti‐inflammatory diets, respectively [hs‐CRP; OR(95% CI) for T3 vs T1:1.181 (1.019,1.370); P trend=0.085, WBC; OR(95% CI) for T3 vs T1:1.143 (1.066,1.2261); P trend=0.001].The analysis of association between DII, hs‐CRP and WBC in Korean showed that the higher DII, the higher hs‐CRP and WBC. Therefore the DII can be used for assessing the inflammatory potential of diet in Korean. Furthermore, the DII can be applied to measure the association between diets and chronic diseases.Support or Funding InformationThis work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIP) (No. NRF‐2016R1A2B1014466)
Characteristics of subject

Characteristic
Total (n=28,086)
Men (n=8,332)
Women (n= 19,754)
p‐value

Age (years)*
52.47 ± 8.00
53.27 ± 8.422
52.14 ± 7.79
0.000

BMI (kg/m2)
23.58 ± 2.91
24.27 ± 2.74
23.29 ± 2.93
0.000

SBP (mmgh)
121.10 ± 14.82
124.18 ± 14.06
119.80 ± 14.94
0.000

DBP (mmgh)
74.73 ± 9.78
77.28 ± 9.65
73.65 ± 9.63
0.000

Fasting glucose (mg/dl)
91.87 ± 9.23
94.26 ± 9.83
90.86 ± 8.78
0.000

hS‐CRP
0.97 ± 1.19
1.13 ± 1.32
0.90 ± 1.13
0.000

WBC blood (Thous/uL)
5.60 ± 1.50
6.02 ± 1.61
5.42 ± 1.41
0.000

DII
−0.002 ± 2.49
−0.058 ± 2.48
0.02 ± 2.50
0.014

DII/1000 kcal
0.002 ± 2.28
0.190 ± 2.26
−0.076 ± 2.28
0.000

Smoker

Past, smoking
3778 (13.5)
3514 (42.2)
264 (1.3)
0.000

Yes
3123 (11.1)
2667 (32.0)
456 (2.3)

No
21185 (75.4)
2151 (25.8)
19034 (96.4)

Education

Uneducated
546 (2.0)
90 (1.1)
456 (2.3)
0.000

Elementary school
2781 (9.9)
524 (6.3)
2257 (11.5)

Middle school
3938 (14.1)
870 (10.5)
3068 (15.6)

High school
10855 (38.8)
2698 (32.4)
8157 (41.5)

University
8430 (30.2)
3308 (39.8)
5122 (26.1)

Graduate school
1408 (5.0)
826 (9.9)
582 (3.0)

Family income (10,000 won)

less than 100
2033 (7.4)
433 (5.2)
1600 (8.3)
0.000

100‐less than 200
11532 (41.8)
3148 (38.1)
8384 (43.4)

300‐less than 400
6252 (22.7)
1892 (22.9)
4360 (22.6)

400‐less than 600
5063 (18.4)
1679 (20.3)
3384 (17.5)

Over 600
2690 (9.8)
1101 (13.3)
1589 (8.2)

Characteristics of subject by tertile of DII

Characteristic
Tertile 1 (n=9,391)
Tertile 2 (n=9,359)
Tertile 3 (n=9,336)
p‐value

DII
−2.78 ± 1.117
−0.013 ± 0.687
2.81 ± 1.138
0.000

(−7.21–1.22)
(−1.21–1.18)
(−1.19–7.34)

Age (years)*
53.26 ± 7.892
52.35 ± 7.986
51.81 ± 8.070
0.000

Sex

0.111

Men
2843 (30.3)
2791 (29.8)
2698 (28.9)

Women
6548 (69.7)
6568 (70.2)
6638 (71.1)

BMI (kg/m2)
23.4782 ± 2.79658
23.5991 ± 2.90675
236848 ± 3.02237
0.000

SBP (mmgh)
121.282 ± 14.7331
120.943 ± 14.7769
121.088 ± 14.9594
0.290

DBP (mmgh)
74.619 ± 9.8040
74.624 ± 9.6909
7.4960 ± 9.8503
0.024

Fasting glucose (mg/dl)
91.973 ± 9.2174
91.912 ± 9.2024
91.739 ± 9.2971
0.199

hs‐CRP
0.9381 ± 1.16046
0.9658 ± 1.17561
1.0222 ± 1.25450
0.000

WBC blood(Thous/uL)
5.5230 ± 1.46777
5.6034 ± 1.49021
5.6749 ± 1.54109
0.000

Smoker

Past. smoking
1344 (14.3)
13.7 (14.0)
1127 (12.1)
0.000

Yes
874 (9.3)
1023 (10.9)
1226 (13.1)

Ho
7173 (76.4)
7029 (75.1)
6983 (74.8)

chronic disease(n)

0
8252 87.9%
8384 89.6%
8374 89.7%
0.000

1
1097 11.7%
954 10.2%
933 10.0%

2
42 0.4%
21 0.2%
29 0.3%

exercise practice (for a week)

0
3865 41.2%
4527 48.4%
5088 54.5%
0.000

1–2
1260 13.4%
1159 12.4%
1073 11.5%

3–4
2094 22.3%
1834 19.6%
1564 16.8%

5–6
1225 13.0%
1044 11.2%
861 9.2%

7
947 10.1%
795 8.5%
750 8.0%

Education

Uneducated
131 (1.4)
169 (1.8)
246 (2.7)
0.000

Elementary school
858 (9.2)
938 (10.1)
985 (10.6)

Middle school
1317 (14.1)
1281 (13.7)
1340 (14.5)

High school
3609 (38.6)
3646 (39.1)
3600 (38.8)

University
2919 (31.2)
2816 (30.2)
2695 (29.1)

Graduate school
524 (5.6)
478 (5.1)
406 (4.4)

Family income (10,000 won)

less than 100
583 (6.3)
640 (7.0)
810 (8.9)
0.000

100‐les* than 200
3840 (41.3)
3820 (41.5)
3872 (42.7)

300‐less than 400
2074 (22.3)
2125 (23.1)
2053 (22.6)

400‐less than 600
1794 (19.3)
1686 (18.3)
1583 (17.4)

Over 600
1003 (10.8)
928 (10.1)
759 (8.4)

Correlation between anthropometric and dietary inflammatory index with inflammatory markers(hs‐CRP, WBC)

Variable
log hs‐CRP
WBC

r
P
r
P

Age
0.151
0.000
−0.042
0.000

BMI
0.328
0.000
0.154
0.000

SBP
0.150
0.000
0.108
0.000

DBP
0.152
0.000
0.112
0.000

Exercise practice
−0.026
0.000
−0.078
0.000

Chronic disease
0.036
0.000
−0.034
0.000

DII
0.032
0.000
0.039
0.000

by spearman's correlation coeffients.

Associations between the dietary inflammatory index and hs‐CRP

Variable
Tertile 1
Tertile 2 OR (95% CI)
Tertile 3 OR (95% CI)
p‐value

hs‐CRP

Crude
1(reference)
1.135(0.999–1.290)1)
1.282(1.131–1.452)
0.001

Adjusted 1
1
1.134(0.997–1.290)
1.277(1.125–1.449)
0.001

Adjusted 2
1
1.084(0.947–1.240)
1.181(1.019–1.370)
0.085

WBC

Crude
1(reference)
1.071(1.011–1.134)
1.169(1.104–1.238)
0.000

Adjusted 1
1
1.053(0.993–1.117)
1.144(1.079–1.214)
0.000

Adjusted 2
1
1.059(0.995–1.126)
1.143(1.066–1.226)
0.001

OR(95% CI): Odds ratios (95% confidence Interval)