Research paperThe relationship between the dietary inflammatory index (DII®) and incident depressive symptoms: A longitudinal cohort study
Introduction
Depression is a chronic condition with an estimated lifetime prevalence of 14.6% and 11.1% in high- and lower-and-middle-income countries, respectively. (Bromet et al., 2011, Kessler and Bromet, 2013). Moreover, it is estimated that depression is one of the leading sources of disability worldwide (Global Burden of Disease Study, 2015, Ferrari et al., 2013), being associated with reduced quality of life and medical morbidity (Ferrari et al., 2013, Kessler and Bromet, 2013, Rackley and Bostwick, 2012). Increasing evidence also shows that depression might confer a higher risk for several non-communicable diseases (e.g., diabetes (Rotella and Mannucci, 2013a), obesity (Luppino et al., 2010), metabolic syndrome (Vancampfort et al., 2015), cardiovascular disease (Correll et al., 2017), stroke (Tsilidis et al., 2015), acute myocardial infarction (Wu and Kling, 2016), dementia (Cherbuin and Kim, 2015) and physical health co-morbidities (Read et al., 2017)). At the same time, these chronic health conditions appear to increase the likelihood of developing depression (Bennett and Thomas, 2014, Hackett and Pickles, 2014, Lichtman et al., 2014, Luppino et al., 2010, Rotella and Mannucci, 2013b).
There is now robust evidence to suggest that inflammation plays a pivotal role in the development of depression, and that people with confirmed depression have elevated levels of various inflammatory markers, including c-reactive protein, interlueking-6 and tumor necrosis factor (Kohler et al., 2017a, Kohler et al., 2017b) Increasing evidence has been accumulating linking diet to inflammation (Aeberli et al., 2011, Cavicchia et al., 2009). The Dietary Inflammatory Index (DII®) is a literature-derived dietary tool, useful for assessing the overall inflammatory potential of individual's diet.(Shivappa et al., 2014a) Higher DII® values are strongly associated with serum inflammatory markers, including IL-6, hs-C-Reactive Protein (CRP), fibrinogen, homocysteine and Tumor Necrosis Factor (TNF)-α (Ramallal et al., 2015, Shivappa et al., 2014b, Tabung et al., 2015b, Wirth et al., 2016, Wirth et al., 2014b), suggesting a close relationship between this index and bio-humoral inflammatory parameters. The DII® has also has been used to assessed the relationship between diet quality related to inflammation and several chronic inflammation-related outcomes, such as metabolic and respiratory diseases, frailty, cancer and fractures.(Orchard et al., 2016, Shivappa et al., 2017, Tabung et al., 2015a, Wirth et al., 2014a, Wood et al., 2015) Two cross-sectional (Phillips et al., 2017, Wirth et al., 2017) and four longitudinal (Adjibade et al., 2017, Akbaraly et al., 2016, Sanchez-Villegas et al., 2015, Shivappa et al., 2016) studies have investigated the association between DII® scores and depression, showing consistent data supporting such an association from both cross-sectional and longitudinal data. DII® has not been associated with incident depression or depressive symptoms in a prospective study in American population.
Given this background, we aimed to investigate if higher DII® scores were associated with a higher risk of depressive symptoms during follow-up period (assessed through CES-D score ⩾16) in a large cohort of American people at high risk of osteoarthritis (OA), over 8 years of follow-up.
Section snippets
Data source and subjects
Data were included from the Osteoarthritis Initiative (OAI) database. The OAI is freely available (http://www.oai.ucsf.edu/). Within the OAI, potential participants were recruited across four clinical sites in the United States of America (Baltimore, MD; Pittsburgh, PA; Pawtucket, RI; and Columbus, OH) between February 2004 and May 2006. In this database, we identified people who either: (1) had knee OA with knee pain for a 30-day period in the past 12 months or (2) were at high risk of
Sample selection
The OAI dataset initially included a total of 4796 individuals. A total of 264 participants were excluded due to missing baseline data regarding CES-D and 462 were excluded for having depressive symptoms (i.e., CES-D > 16) at baseline. In addition, we were not able to compute DII® scores for another 278 individuals (80 participants had too many missing data for us to compute a DII® score, and another 198 participants reported consuming total energy outside of the protocol-required acceptable
Discussion
In this longitudinal study, we found that a more pro-inflammatory diet intake (indicated by higher DII® scores) was associated with greater incidence of depressive symptoms as defined by CES-D ⩾16. During a follow-up period of 8 years, after adjusting for several potential confounders at baseline, individuals with the highest DII® score (i.e., having a more pro-inflammatory diet) had a 24% higher risk of depressive symptoms (p = 0.04) compared with those with the lowest DII® score.
At baseline,
Acknowledgments
Funding sources: The OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the
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