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. 2023 Oct;62(7):2723-2737.
doi: 10.1007/s00394-023-03191-z. Epub 2023 Jun 22.

The association between diet quality, plant-based diets, systemic inflammation, and mortality risk: findings from NHANES

Yoko Brigitte Wang  1   2   3 , Amanda J Page  4   5 , Tiffany K Gill  6 , Yohannes Adama Melaku  5   6   7   8
Affiliations

The association between diet quality, plant-based diets, systemic inflammation, and mortality risk: findings from NHANES

Yoko Brigitte Wang et al. Eur J Nutr. 2023 Oct.

Abstract

Purpose: To our knowledge, no studies have examined the association of diet quality and plant-based diets (PBD) with inflammatory-related mortality in obesity. Therefore, this study aimed to determine the joint associations of Healthy Eating Index-2015 (HEI-2015), plant-based dietary index (PDI), healthy PDI (hPDI), unhealthy PDI (uPDI), pro-vegetarian dietary index (PVD), and systemic inflammation with all-cause, cardiovascular disease (CVD), and cancer mortality risks by obesity status.

Methods: Participants from NHANES were included in cross-sectional (N = 27,915, cycle 1999-2010, 2015-2018) and longitudinal analysis (N = 11,939, cycle 1999-2008). HEI-2015, PDI, hPDI, uPDI, and PVD were constructed based on the 24-h recall dietary interview. The grade of inflammation (low, moderate, and high) was determined based on C-reactive protein (CRP) values and multivariable ordinal logistic regression was used to determine the association. Cox proportional hazard models were used to determine the joint associations of diet and inflammation with mortality.

Results: In the fully adjusted model, HEI-2015 (ORT3vsT1 = 0.76, 95% CI 0.69-0.84; p-trend = < 0.001), PDI (ORT3vsT1 = 0.83, 95% CI 0.75-0.91; p trend = < 0.001), hPDI (ORT3vsT1 = 0.79, 95% CI 0.71-0.88; p trend = < 0.001), and PVD (ORT3vsT1 = 0.85, 95% CI 0.75-0.97; p trend = 0.02) were associated with lower systemic inflammation. In contrast, uPDI was associated with higher systemic inflammation (ORT3vsT1 = 1.18, 95% CI 1.06-1.31; p-trend = 0.03). Severe inflammation was associated with a 25% increase in all-cause mortality (ORT3vsT1 = 1.25, 95% CI 1.03-1.53, p trend = 0.02). No association was found between PDI, hPDI, uPDI, and PVD with mortality. The joint association, between HEI-2015, levels of systemic inflammation, and all-cause, CVD and cancer mortality, was not significant. However, a greater reduction in mortality risk with an increase in HEI-2015 scores was observed in individuals with low and moderate inflammation, especially those with obesity.

Conclusion: Higher scores of HEI-2015 and increased intake of a healthy plant-based diet were associated with lower inflammation, while an unhealthy plant-based diet was associated with higher inflammation. A greater adherence to the 2015 dietary guidelines may reduce the risk of mortality associated with inflammation and may also benefit individuals with obesity who had low and moderate inflammation.

Keywords: C-reactive protein; Healthy Eating Index; Inflammation; Obesity; Plant-based dietary index; Pro-vegetarian diet.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the study design. CRP C-reactive protein, FPIR family poverty to income ratio, BMI body mass index, CVD cardiovascular diseases
Fig. 2
Fig. 2
Odds ratio of the association between different dietary indices and systemic inflammation in a fully adjusted model. HEI-2015 Healthy Eating Index-2015, PDI plant-based dietary index, HPDI healthy plant-based dietary index, UPDI unhealthy plant-based dietary index, PVD pro-vegetarian dietary pattern, CI confidence interval. Total participants (N = 27,915), individuals without obesity (N = 18,454), individuals with obesity (N = 9461)
Fig. 3
Fig. 3
Joint association between HEI-2015, systemic inflammation and A all-cause mortality risk in the total population; B all-cause mortality risk in the non-obesity group; C all-cause mortality risk in the obesity group; D) CVD mortality risk; and E cancer mortality risk. Total participants (N = 11,939), individuals without obesity (N = 8596), individuals with obesity (N = 3343). T1, T2, T3 HEI-2015 categories, low moderate, severe hs-CRP categories. Number of death/total participants is presented for hs-CRP categories. CI confidence interval
See this image and copyright information in PMC

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