Adequate 25(OH)D moderates the relationship between dietary inflammatory potential and cardiovascular health risk during the second trimester of pregnancy

Abstract

Background: Pro-inflammatory diets play an important role in developing cardiovascular disease (CVD). Vitamin D has been demonstrated to have an anti-inflammatory effect and promote cardiovascular health (CVH). However, it is unclear whether adequate vitamin D during pregnancy protects against poor CVH caused by pro-inflammatory diets.

Objective: To investigate the association of pro-inflammatory diets with the cardiovascular risk (CVR) among pregnant women and whether such association was modified by vitamin D status.

Methods: The study was based on a prospective birth cohort that included 3,713 pregnant women between 16 and 23 gestational weeks. In total, 25(OH)D concentrations and high-sensitivity C-reactive protein (hs-CRP) were measured from the collected blood. The dietary inflammatory potential was evaluated using the empirical dietary inflammatory pattern (EDIP) score based on a validated food frequency questionnaire. Gestational CVR was evaluated using the CVR score based on five "clinical" CVR metrics, including body mass index, blood pressure, total cholesterol, glucose levels, and smoking status.

Results: The proportion of women with a CVR score >0 was 54.3%. We observed a positive association between the EDIP score and CVR score. Compared with the lowest quartile, the CVR score (β = -0.114, 95% CI, -0.217, -0.011) and hs-CRP levels (β = -0.280, 95% CI, -0.495, -0.065) were lower in the highest quartile (P for trend <0.05). Increased CVR connected with high EDIP score was observed only in women with 25(OH)D concentrations <50 nmol/L (RR = 1.85; 95% CI: 1.35, 2.54). Mediation analysis revealed that the proportion of association between the EDIP score and CVR score mediated by 25(OH)D was 28.7%, and the proportion of the association between 25(OH)D and the CVR score mediated by hs-CRP was 21.9%.

Conclusion: The higher dietary inflammatory potential was associated with an increased CVR during pregnancy by promoting inflammation. Adequate vitamin D could exert anti-inflammatory effects and modify such association.

Keywords: cardiovascular health; dietary inflammatory potential; nutrients; pregnant women; vitamin D.

FIGURE 1

The association among EDIP scores, CVH, and hs-CRP. (A) A cubic curve-fitting model of the curvilinear association between EDIP and CVR score. (B) A restricted cubic spline hazard of the curvilinear association between EDIP and Increased CVR. (C) A cubic curve-fitting model of the curvilinear association between EDIP and hs-CRP. (D) A cubic curve-fitting model of the curvilinear association between hs-CRP and CVR score. All models were adjusted for age, residence, education, income, pre-pregnancy BMI, parity, gestational weight gain, family history of diabetes and hypertension, physical activity, outdoor time, sedentary time, and vitamin D supplementation frequency. Increased CVR, CVR score >0 points. CVR, cardiovascular risk, EDIP, Empirical dietary inflammation pattern.

FIGURE 2

The association of 25(OH)D concentrations with CVR scores and hs-CRP levels. 25(OH)D concentrations were divided into four groups by the quartile (Q1\Q2\Q3\Q4). All models were based on the multiple linear regression and adjusted for age, residence, education, income, pre-pregnancy BMI, parity, gestational weight gain, family history of diabetes and hypertension, physical activity, outdoor time, sedentary time, and vitamin D supplementation frequency. CVR, cardiovascular risk.

FIGURE 3

Mediation analysis among EDIP score, CVR score, and hs-CRP. All models adjusted for age, residence, education, income, pre-pregnancy BMI, parity, gestational weight gain, family history of diabetes and hypertension, physical activity, outdoor time, sedentary time, and vitamin D supplementation frequency. CVR, cardiovascular risk, EDIP, Empirical dietary inflammation pattern.