Characteristics of the study population: Out of 10,047 participants in the RaNCD cohort study, 9,039 participants including T2DM (n = 785) and non-T2DM cases (n = 8254) were considered for the present study. Baseline characteristics of participants are presented in Table 1. The mean age of the study population was 47.4 ± 8.2 years old and around 46% of them were men with or without diabetes. There were significant differences in terms of smoking, sleep duration, and physical activity levels between diabetic and non-diabetic cases (P-values for all < 0.05). However, no considerable differences were found in socioeconomic status (SES) between the two groups (P = 0.06).
Table 1
Baseline characteristics of the study population (N = 9,039)
Parameters
|
Total
(n = 9,039)
|
Non-T2DM
(n = 8,254)
|
T2DM
(n = 785)
|
P value
|
Age (year)
|
47.48 ± 8.29
|
47.07 ± 8.23
|
51.70 ± 7.53
|
< 0.001
|
Gender, n (%)
|
Male
|
4140 (45.80)
|
3804 (46.09)
|
336 (42.80)
|
0.078
|
Female
|
4889 (54.20)
|
4450 (53.91)
|
449 (57.20)
|
Smoking, n (%)
|
Never
|
7234 (80.57)
|
6627 (80.85)
|
607 (77.62)
|
< 0.001
|
Current smoker
|
992 (11.05)
|
920 (11.22)
|
72 (9.21)
|
Former smoker
|
753 (8.39)
|
650 (7.93)
|
103 (13.17)
|
Physical activity, (Met hour per week), n (%)
|
Low
|
2784 (30.80)
|
2504 (30.34)
|
280 (35.67)
|
< 0.001
|
Moderate
|
4356 (48.19)
|
3966 (47.05)
|
390 (49.68)
|
Vigorous
|
1899 (21.01)
|
1784 (21.61)
|
115 (14.65)
|
Socioeconomic status, n (%)
|
Low
|
3024 (33.47)
|
2777 (33.66)
|
247 (31.51)
|
0.062
|
Moderate
|
3000 (33.20)
|
2710 (32.84)
|
290 (36.99)
|
High
|
3011 (33.33)
|
2764 (33.50)
|
247 (31.51)
|
DII score, Mean ± SD
|
-2.49 ± 1.59
|
-2.50 ± 1.59
|
-2.37 ± 1.59
|
0.022
|
Energy intake (kcal/day)
|
2492.71 ± 736.47
|
2503.66 ± 733.45
|
2377.48 ± 758.46
|
0.001
|
Carbohydrate (%E)
|
61.43 ± 6.20
|
61.51 ± 6.18
|
60.51 ± 6.35
|
< 0.001
|
Lipid (%E)
|
26.81 ± 5.94
|
26.79 ± 5.93
|
27.06 ± 5.99
|
0.201
|
Protein (%E)
|
13.75 ± 4.93
|
13.67 ± 2.16
|
14.56 ± 2.28
|
< 0.001
|
Sleep duration (hour/24)
|
7.10 ± 1.23
|
7.11 ± 1.22
|
6.70 ± 1.32
|
0.001
|
BMI (kg/m2)
|
27.49 ± 4.63
|
27.35 ± 4.31
|
28.93 ± 4.38
|
< 0.001
|
WHR
|
0.94 ± 0.06
|
0.94 ± 0.06
|
0.96 ± 0.06
|
< 0.001
|
WC (cm)
|
97.28 ± 10.50
|
96.93 ± 10.50
|
100.86 ± 9.82
|
< 0.001
|
VFA (cm2)
|
122.88 ± 51.53
|
121.25 ± 51.43
|
14014 ± 49.42
|
< 0.001
|
VAI (male)
|
0.05 ± 0.06
|
0.05 ± 0.06
|
0.07 ± 0.08
|
< 0.001
|
VAI (female)
|
0.07 ± 0.09
|
0.07 ± 0.08
|
0.11 ± 0.12
|
< 0.001
|
TG (mg/dl)
|
137.10 ± 82.64
|
132.96 ± 77.01
|
180.01 ± 119.75
|
< 0.001
|
HDL-C (mg/dl)
|
46.53 ± 11.31
|
46.75 ± 11.33
|
44.14 ± 11.06
|
< 0.001
|
LDL-C (mg/dl)
|
102.01 ± 25.41
|
101.85 ± 25.12
|
103.68 ± 28.17
|
0.055
|
T-C (mg/dl)
|
185.25 ± 37.83
|
184.77 ± 37.18
|
190.34 ± 43.86
|
< 0.001
|
TG/ HDL (mg/dl)
|
3.29 ± 2.66
|
3.17 ± 2.48
|
4.54 ± 3.89
|
< 0.001
|
LDL/HDL (mg/dl)
|
2.29 ± 0.70
|
2.28 ± 0.69
|
2.44 ± 0.73
|
< 0.001
|
T-C/HDL (mg/dl)
|
4.16 ± 1.11
|
4.13 ± 1.10
|
4.49 ± 1.26
|
< 0.001
|
Anti-diabetic medications (%)
|
519 (85.41)
|
0 (0)
|
519 (84.53)
|
|
Hypertension, n (%)
|
1438 (15.91)
|
1181 (14.31)
|
257 (32.74)
|
0.012
|
Dyslipidemia, n (%)
|
3961 (43.82)
|
3444 (41.73)
|
517 (65.86)
|
< 0.001
|
CVDs, n (%)
|
1565 (17.31)
|
1227 (14.87)
|
338 (43.06)
|
< 0.001
|
Anti-CVDs medications (%)
|
1422 (39.98)
|
1102 (37.44)
|
320 (52.12)
|
< 0.001
|
Anti-Hypertension medications (%)
|
979 (23.74)
|
784 (22.52)
|
195 (30.33)
|
< 0.001
|
Anti- Dyslipidemia medications (%)
|
401 (11.27)
|
222 (7.54)
|
179 (29.15)
|
< 0.001
|
BMI: Body mass index; DII: Dietary inflammatory index; WHR: Waist hip ratio; WC: Waist circumference; VFA: Visceral fat area; SLM: Skeletal lean mass; TG: Triglycerides; HDL-C: high-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; T-C: Total cholesterol; CVDs: Cardiovascular diseases; VAI: Visceral Adiposity Index;
|
The total mean DII score was − 2.49 ± 1.59. As indicated in Table 1, this score among non-T2DM cases was significantly fewer (with more anti-inflammatory levels) than those with T2DM (mean − 2.50 vs. -2.37, P = 0.022). Regarding anthropometric indices, significant differences were found between the two groups. BMI, waist circumference (WC), Waist to Hip ratio (WHR) as well as VAI in patients with T2DM were greater than in non-diabetic ones (p-values < 0.01 for all). As was expected, percentages of subjects with metabolic disorders such as hypertension, dyslipidemia, and CVDs in diabetic patients were higher than non-T2DM ones (p-values < 0.01 for all).
Characteristics of participants in DII categories: In Table 2, characteristics of all participants regardless of T2DM are indicated. Based on findings, mean DII ranged from − 4 to -0.1 (Quartile 1 to Quartile 4) and most individuals (n = 2391) adhered to anti-inflammatory diets. In addition, the most percentage (about 35%) of subjects with low SES had the most anti-inflammatory diet. Regarding the level of physical activity, no significant differences were found among the quartiles of DII (p = 0.13).
Table 2
Characteristics of participants according to quartiles of the dietary inflammatory index score
Variable
|
Dietary inflammatory index (DII)
|
P value
|
Quartile 1: Most Anti-Inflammatory
|
Quartile 2
|
Quartile 3
|
Quartile 4: Most Pro-Inflammatory
|
Frequency, n
|
2,391
|
2,382
|
2,337
|
1,929
|
-
|
DII, mean ± SD
|
-4.03 ± 0.41
|
-3.12 ± 0.24
|
-2.10 ± 0.38
|
-0.10 ± 1.05
|
-
|
Age, mean ± SD
|
48.65 ± 8.46
|
47.62 ± 8.33
|
46.90 ± 8.16
|
46.54 ± 7.90
|
|
Gender, n (%)
|
Male
|
964 (23.29)
|
1051 (25.39)
|
1109 (26.79)
|
1016 (24.54)
|
< 0.001
|
Female
|
1427 (29.13)
|
1331 (27.17)
|
1228 (25.07)
|
913 (18.64)
|
Smoking, n (%)
|
Never
|
1905 (26.33)
|
1921 (26.56)
|
1871 (25.86)
|
1537 (21.25)
|
0.310
|
Current smoker
|
261 (26.31)
|
276 (27.82)
|
249 (25.10)
|
206 (20.77)
|
Former smoker
|
213 (28.29)
|
168 (22.31)
|
200 (26.56)
|
172 (22.84)
|
Socio-economic status, n (%)
|
Low
|
1132 (37.43)
|
815 (26.95)
|
593 (19.61)
|
484 (16.01)
|
< 0.001
|
Moderate
|
671 (22.37)
|
820 (27.33)
|
842 (28.07)
|
667 (22.23)
|
Vigorous
|
587 (19.50)
|
746 (24.78)
|
902 (29.96)
|
776 (25.77)
|
Physical activity (Met-h/week), n (%)
|
Light
|
707 (25.40)
|
776 (27.87)
|
723 (25.97)
|
578 (20.76)
|
0.133
|
Moderate
|
1183 (27.16)
|
1097 (25.18)
|
1163 (26.70)
|
913 (20.96)
|
High
|
501 (26.38)
|
509 (26.80)
|
451 (23.75)
|
438 (23.06)
|
Hypertension, n (%)
|
431 (29.97)
|
352 (24.48)
|
353 (24.55)
|
302 (21.00)
|
0.009
|
Dyslipidemia, n (%)
|
985 (24.87)
|
1006 (25.40)
|
1027 (25.93)
|
943 (23.81)
|
< 0.001
|
CVDs, n (%)
|
459 (29.33)
|
406 (25.94)
|
405 (25.88)
|
295 (18.85)
|
< 0.001
|
T2DM, n (%)
|
194 (24.71)
|
193 (24.59)
|
202 (25.73)
|
196 (24.97)
|
0.017
|
Insulin(yes/no) (%)
|
6 (20.69)
|
5 (17.24)
|
8 (27.59)
|
10 (34.48)
|
0.299
|
Anti-diabetic medications (%)
|
122 (23.51)
|
122 (23.51)
|
142 (27.36)
|
133 (25.63)
|
< 0.001
|
Anti-CVDs medications (%)
|
425 (29.89)
|
369 (25.95)
|
359 (25.25)
|
269 (18.92)
|
0.489
|
Anti-Hypertension medications (%)
|
269 (30.23)
|
257 (26.25)
|
240 (24.51)
|
186 (19.00)
|
0.433
|
Anti- Dyslipidemia medications (%)
|
93 (23.19)
|
100 (24.94)
|
101 (25.19)
|
107 (26.68)
|
0.001
|
BMI (kg/m2), mean ± SD
|
26.99 ± 4.68
|
27.41 ± 4.62
|
27.58 ± 4.60
|
27.96 ± 4.56
|
< 0.001
|
WHR, mean ± SD
|
0.93 ± 0.06
|
0.94 ± 0.06
|
0.94 ± 0.06
|
0.95 ± 0.06
|
< 0.001
|
WC (cm)
|
97.17 ± 10.64
|
97.46 ± 10.48
|
97.35 ± 10.44
|
97.08 ± 10.44
|
0.644
|
VFA (cm2)
|
119.70 ± 50.81
|
123.29 ± 51.84
|
123.90 ± 51.53
|
125.08 ± 51.90
|
0.003
|
VAI (male)
|
0.04 ± 0.05
|
0.05 ± 0.07
|
0.05 ± 0.06
|
0.05 ± 0.06
|
< 0.001
|
VAI (female)
|
0.07 ± 0.07
|
0.07 ± 0.10
|
0.07 ± 0.08
|
0.09 ± 0.09
|
< 0.001
|
Sleep duration(hour/24)
|
7.14 ± 1.22
|
7.12 ± 1.24
|
7.06 ± 1.21
|
7.07 ± 1.19
|
0.097
|
There were significant differences in BMI, WHR and VFA across quartiles of DII score. Compared with those in the lowest quartile, participants in the highest quartile of DII score had greater BMI (p < 0.001), WHR (p < 0.001), and VFA (p = 0.003). Regarding dietary intake, subjects with the most pro-inflammatory diets consumed greater total energy (p < 0.001) compared to those with the most anti-inflammatory diet (Table 3). The intake of all nutrients and food groups except carbohydrate (p = 0.98) and fat (p = 0.12) were significantly different among the categories of the DII score (Table 3).
Table 3
Description of food parameters participants according to the dietary inflammatory index score
Food parameters
|
Quartile 1: Most Anti-Inflammatory
|
Quartile 2
|
Quartile 3
|
Quartile 4: Most Pro-Inflammatory
|
P value
|
Energy intake (kcal/d)
|
2136.31 ± 661.18
|
2332.87 ± 651.96
|
2622.40 ± 690.17
|
2974.70 ± 675.82
|
< 0.001
|
Carbohydrate intake (%E)
|
61.42 ± 6.64
|
61.50 ± 6.16
|
61.39 ± 6.01
|
61.39 ± 5.97
|
0.980
|
Protein intake (%E)
|
13.16 ± 2.01
|
13.53 ± 2.10
|
13.85 ± 2.12
|
14.60 ± 2.34
|
< 0.001
|
Fat intake (%E)
|
26.62 ± 6.40
|
26.73 ± 5.99
|
26.98 ± 5.74
|
26.92 ± 5.60
|
0.123
|
Saturated fat (g/d)
|
25.32 ± 12.80
|
26.57 ± 11.95
|
29.77 ± 12.68
|
32.96 ± 12.66
|
< 0.001
|
Monounsaturated fats (g/d)
|
15.99 ± 7.80
|
18.13 ± 7.64
|
20.95 ± 8.65
|
24.22 ± 9.06
|
< 0.001
|
Polyunsaturated fats (g/d)
|
7.99 ± 4.04
|
9.94 ± 4.21
|
12.11 ± 5.25
|
14.66 ± 5.57
|
< 0.001
|
Trans fat (g/d)
|
0.16 ± 0.23
|
0.24 ± 0.27
|
0.32 ± 0.35
|
0.42 ± 0.43
|
< 0.001
|
Cholesterol (mg/d)
|
223.32 ± 126.73
|
252.63 ± 125.50
|
293.64 ± 147.27
|
347.93 ± 156.48
|
< 0.001
|
Red meat (g/d)
|
19.73 ± 28.58
|
17.80 ± 24.19
|
22.37 ± 27.75
|
23.57 ± 29.15
|
< 0.001
|
Poultry (g/d)
|
31.38 ± 26.48
|
40.81 ± 32.39
|
47.15 ± 39.60
|
61.14 ± 47.98
|
< 0.001
|
Fish (g/d)
|
3.23 ± 5.60
|
4.89 ± 7.50
|
7.31 ± 9.79
|
10.91 ± 13.40
|
< 0.001
|
Vegetables (g/d)
|
146.99 ± 88.10
|
216.47 ± 108.76
|
300.44 ± 132.99
|
459.16 ± 201.88
|
< 0.001
|
Fruits(g/d)
|
142.49 ± 128.13
|
199.48 ± 144.56
|
277.25 ± 184.41
|
376.10 ± 236.44
|
< 0.001
|
Dairy product (g/d)
|
420.36 ± 426.97
|
404.77 ± 369.35
|
464.69 ± 395.38
|
500.06 ± 434.54
|
< 0.001
|
Legumes (g/d)
|
18.56 ± 14.53
|
26.65 ± 19.80
|
36.27 ± 26.74
|
57.23 ± 42.32
|
< 0.001
|
Egg (g/d)
|
15.23 ± 16.60
|
19.44 ± 18.20
|
21.99 ± 19.48
|
26.00 ± 22.49
|
< 0.001
|
Potato (g/d)
|
32.50 ± 27.56
|
42.05 ± 34.38
|
48.61 ± 38.35
|
60.36 ± 49.56
|
< 0.001
|
Refined grains (g/d)
|
478.57 ± 180.67
|
495.54 ± 199.87
|
519.83 ± 210.28
|
544.68 ± 215.11
|
< 0.001
|
Whole grains (g/d)
|
6.04 ± 7.63
|
8.24 ± 9.83
|
10.96 ± 12.73
|
16.25 ± 17.31
|
< 0.001
|
Sweets & desserts (g/d)
|
49.25 ± 36.46
|
56.10 ± 38.50
|
61.19 ± 40.63
|
65.45 ± 43.29
|
< 0.001
|
Tea & coffee (g/d)
|
688.76 ± 490.21
|
726.04 ± 511.40
|
722.35 ± 480.41
|
753.19 ± 501.23
|
0.003
|
Caffeine (mg/d)
|
139.10 ± 98.20
|
146.99 ± 102.58
|
146.86 ± 96.56
|
153.40 ± 100.86
|
< 0.001
|
Alcohol consumption (g/d)
|
0.02 ± 0.04
|
0.03 ± 0.06
|
0.04 ± 0.08
|
0.05 ± 0.10
|
< 0.001
|
Iron (mg/d)
|
14.60 ± 5.04
|
15.93 ± 5.55
|
17.98 ± 5.73
|
21.28 ± 6.03
|
< 0.001
|
Zinc (mg/d)
|
7.62 ± 2.95
|
8.61 ± 2.78
|
10.13 ± 3.20
|
12.18 ± 3.44
|
< 0.001
|
Folate (mcg/d)
|
459.92 ± 162.29
|
499.50 ± 181.77
|
558.52 ± 184.46
|
668.11 ± 190.01
|
< 0.001
|
Vitamin A (mcg/d)
|
460.20 ± 262.85
|
589.10 ± 270.82
|
796.31 ± 347.10
|
1157.31 ± 518.76
|
< 0.001
|
Vitamin C (mg/d)
|
63.71 ± 36.76
|
88.58 ± 40.61
|
119.46 ± 50.42
|
176.93 ± 75.11
|
< 0.001
|
Vitamin D (mcg/d)
|
0.85 ± 0.60
|
1.10 ± 0.67
|
1.36 ± 0.83
|
1.73 ± 1.02
|
< 0.001
|
Vitamin E (mg/d)
|
5.17 ± 2.38
|
6.56 ± 253
|
8.24 ± 3.51
|
10.56 ± 3.65
|
< 0.001
|
Omega − 3 fatty acids (g/d)
|
0.03 ± 0.02
|
0.04 ± 0.02
|
0.05 ± 0.03
|
0.06 ± 0.04
|
< 0.001
|
Omega − 6 fatty acids (g/d)
|
3.19 ± 2.60
|
4.11 ± 2.76
|
5.12 ± 3.21
|
6.17 ± 3.60
|
< 0.001
|
The association between DII and the risk of T2DM: Logistic regression analysis revealed that the risk of T2DM in subjects who consumed the most pro-inflammatory diet was 28% (95% CI: (1.03, 1.57) greater than those with the most anti-inflammatory ones. After adjustment for confounding factors including age, sex, energy intake, BMI, physical activity, and dyslipidemia, the risk reached 61% (95% CI: 1.27 to 2.05).
The association between DII and cardiometabolic risk factors: The risk of cardiometabolic disorders in both crude and adjusted models were compared between patients with T2DM and non-T2DM cases and provided in Table 4. Generally, the risk of obesity/overweight (84 vs.42%), dyslipidemia (67 vs.29%), hypertension (20 vs.2%), and CVDs (65 vs.1%) in subjects with T2DM who consumed the most pro-inflammatory diets was considerably greater than non-diabetic ones who followed such diets (adjusted model). In addition, no significant association was found between DII, MetS, and hypertension in either of the groups.
Table 4
Association between cardio-metabolic risk factors and dietary inflammatory index in populations with and without type 2 diabetes mellitus
Cardio-metabolic risk factors
|
DII
|
Crude
|
Adjusted
|
Non-T2DM
|
T2DM
|
Non-T2DM
|
T2DM
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
Obesity & Overweight *
|
Quartile 1
|
1
|
-
|
1
|
-
|
1
|
-
|
1
|
-
|
Quartile 2
|
1.15 (1.01, 1.30)
|
0.028
|
1.45 (0.88, 2.40)
|
0.146
|
1.13 (0.99, 1.29)
|
0.056
|
1.35 (0.80, 2.29)
|
0.259
|
Quartile 3
|
1.27 (1.12, 1.44)
|
< 0.001
|
1.30 (0.80, 2.12)
|
0.289
|
1.19 (1.04, 1.36)
|
0.012
|
1.17 (0.69, 1.99)
|
0.555
|
Quartile 4
|
1.51 (1.32, 1.74)
|
< 0.001
|
2.27 (1.30, 3.94)
|
0.004
|
1.42 (1.22, 1.67)
|
< 0.001
|
1.84 (1.03, 3.39)
|
0.049
|
Dyslipidemia **
|
Quartile 1
|
1
|
-
|
1
|
-
|
1
|
-
|
1
|
-
|
Quartile 2
|
1.04 (0.92, 1.18)
|
0.494
|
1.06 (70., 1.61)
|
0.779
|
1.02 (0.90, 1.16)
|
0.692
|
1.10 (0.71, 1.68)
|
0.658
|
Quartile 3
|
1.13 (1.01, 1.28)
|
0.044
|
0.95 (0.62, 1.41)
|
0.751
|
1.10 (0.97, 1.25)
|
0.148
|
1.04 (0.68, 1.61)
|
0.836
|
Quartile 4
|
1.34 (1.18, 1.52)
|
< 0.001
|
1.45 (0.94, 2.22)
|
0.090
|
1.29 (1.11, 1.50)
|
0.001
|
1.67 (1.03, 2.69)
|
0.036
|
Hypertension **
|
Quartile 1
|
1
|
-
|
1
|
-
|
1
|
-
|
1
|
-
|
Quartile 2
|
0.77 (0.66, 0.91)
|
0.003
|
0.85 (0.56, 1.31)
|
0.470
|
0.83 (0.96, 0.99)
|
0.044
|
0.92 (0.58, 1.45)
|
0.732
|
Quartile 3
|
0.77 (0.66, 0.91)
|
0.003
|
0.98 (0.65, 1.49)
|
0.937
|
0.92 (0.76, 1.10)
|
0.382
|
1.21 (0.76, 1.90)
|
0.421
|
Quartile 4
|
0.81 (0.68, 0.97)
|
0.022
|
0.86 (0.56, 1.31)
|
0.473
|
1.02 (0.83, 1.26)
|
0.841
|
1.20 (0.74, 1.96)
|
0.459
|
Metabolic syndrome *
|
Quartile 1
|
1
|
-
|
1
|
-
|
1
|
-
|
1
|
-
|
Quartile 2
|
0.98 (0.87, 1.12)
|
0.852
|
0.78 (0.47, 1.31)
|
0.351
|
0.99 (0.87, 1.15)
|
0.974
|
0.75 (0.42, 1.35)
|
0.339
|
Quartile 3
|
1.01 (0.89, 1.15)
|
0.873
|
0.70 (0.42, 1.14)
|
0.153
|
1.01 (0.87, 1.17)
|
0.477
|
0.83 (0.46, 1.49)
|
0.529
|
Quartile 4
|
1.02 (0.89, 1.17)
|
0.743
|
0.64 (0.39, 1.10)
|
0.090
|
1.03 (0.87, 1.21)
|
0.277
|
0.72 (0.39, 1.33)
|
0.295
|
CVDs **
|
Quartile 1
|
1
|
-
|
1
|
-
|
1
|
-
|
1
|
-
|
Quartile 2
|
0.84 (0.71, 0.99)
|
0.036
|
0.99 (0.66, 1.48)
|
0.885
|
0.95 (0.79, 1.13)
|
0.569
|
1.17 (0.75, 1.82)
|
0.490
|
Quartile 3
|
0.85 (0.72, 1.01)
|
0.062
|
0.95 (0.64, 1.41)
|
0.803
|
1.12 (0.94, 1.35)
|
0.202
|
1.38 (0.87, 2.16)
|
0.166
|
Quartile 4
|
0.67 (0.56. 1.02)
|
0.060
|
0.94 (0.63, 1.40)
|
0.770
|
1.01 (0.79, 1.23)
|
0.205
|
1.65 (1.02, 2.65)
|
0.045
|
Waist circumference *
|
Quartile 1
|
1
|
-
|
1
|
-
|
1
|
-
|
1
|
-
|
Quartile 2
|
099 (0.85, 1.15)
|
0.922
|
0.73 (0.33, 1.58)
|
0.426
|
1.10 (0.91, 1.28)
|
0.354
|
0.74 (0.31, 1.75)
|
0.495
|
Quartile 3
|
0.93 (0.81, 1.08)
|
0.381
|
0.41 (0.20, 0.83)
|
0.013
|
1.01 (0.84, 1.20)
|
0.957
|
0.41 (0.18, 0.94)
|
0.036
|
Quartile 4
|
0.78 (0.67, 0.91)
|
0.001
|
0.45 (0.22, 0.92)
|
0.030
|
0.89 (0.72, 1.05)
|
0.145
|
0.45 (0.19, 1.08)
|
0.075
|
*Adjusted for age, sex, energy intake, physical activity and smoking |
**Adjusted for age, sex, energy intake, physical activity, smoking and body mass index |
The association between DII and CVDs was significant in only patients with T2DM at 1.65 (95%CI: 1.02 to 2.65). Considering the role of T2DM as an effect modifier, we found that this factor has an interaction with the association between DII and CVDs.
As indicated in Table 4, there were significant associations between DII and overweight/obesity in patients with T2DM 1.84; (95%CI: 1.03, 3.39) and non-diabetic 1.42 (95%CI: 1.22, 1.67) cases even after adjustment for confounding factors. However, T2DM showed interaction in the association. Participants with/without T2DM who adhered to a more pro-inflammatory diet had greater abdominal obesity compared to whom consumed a less inflammatory diet. However, after adjustment, no significant associations remained (P = 0.14, P = 0.07, respectively). No effect modifier roles were observed for T2DM on this association.
In terms of dyslipidemia, the risk in non-diabetic cases classified in the fourth quartile of DII was 34% (95%CI: 1.18, 1.52) greater than those in the first quartile. After the adjustment, the risk decreased to 29% (95%CI: 1.67; 1.03, 2.69), but in diabetic patients, in only one adjusted model, a significant association was observed. In addition, an interaction was obtained for T2DM and dyslipidemia plays an effect modifier on the association. Hypertension, in only the non-diabetic population, was statistically significant; however, after adjustment, no significant association remained. No interaction was also found for T2DM on the association between DII and hypertension. The association between DII and an atherogenic index (TG/HDL-C) for both groups is shown in Fig. 2. In both diabetic and non-diabetic cases, direct associations were found between DII and TG/HDL-C, while the association in T2DM was greater than in non-diabetic ones.