Review Article

Assessment of Dietary Patterns Represents a Potential, Yet Variable, Measure of Inflammatory Status: A Review and Update

Table 1

Macronutrient distribution, dietary patterns, and inflammatory markers.

Authors, country & yearStudy design/durationParticipantsDiet evaluatedInflammatory markers/adipokines (measured in fasting plasma)Results

Juanola-Falgarona, et al. [57] Spain, 2014RCT, weight loss study/6 mo.
GLYNDIET study
, men and women, aged 30 and 60 yrs.
BMI range 27-35
Moderate CHO and high glycemic index vs. moderate CHO and LGI vs. a low-fat and HGI diet.
500 kcal/d subtracted of total energy for each participant
PAI-1, CRP, IL-6, MCP-1, ICAM-1, and adiponectin(1) No differences in any of the inflammatory markers between groups.
(2) A reduction in CRP values for the LGI group pre vs. postintervention, likely driven by the greater weight loss.

Jonasson et al. [55] Sweden, 2014Clinical trial. Weight loss intervention with control group/24 mo. intervention group (T2D) and control group (healthy)LFD aiming 30% from fat vs. a LCD aiming 20% CHOIL-1β, IL-1Ra, IL-6, TNFRs, and CRP at baseline and 6 mo.(1) Both diets led to similar reductions in body weight; however, only the LCD improved insulin sensitivity.
(2) After 6 mo., IL-1Ra and IL-6 were lower in the LCD.

Santiago Torres et al. [58] US, 2015Cohort. Subset sample of the Women’s Health Initiative study, middle-aged women of Mexican descentAdherence to a “created traditional Mexican diet”hsCRP(1) At follow-up, (15 y) hsCRP was 22% lower in women who had high compared to low or moderate MexD scores.
(2) Women with high MexD scores were more likely to be normal weight at baseline.

Dias et al. [40] Sweden, 2015Cross-sectional. Data from the Malmo Diet and Cancer study,
aged 63-68 yrs.
Diet quality index, adherence to the Swedish Nutrition RecommendationIL1-beta, IL-8, TNF-α, and hsCRP. Mononuclear leukocytes. Inflammatory protein S100A8/9Those who reported a higher quality diet had lower levels of TNF-α, hsCRP, nonclassical monocytes, and inflammatory protein S100A8/9, after adjusting for age, gender, smoking, PA, total energy, WC, and season of the diet reported.

Marques-Rocha et al. [41] Spain, 2016RCT, weight loss intervention/8 weeks, obese with MetS. Subsample of the RESMENA-SHypocaloric diet based on the Mediterranean diet, 30% energy restriction, increased meal frequency, and 7 d menu plan provided. Healthy Eating Index was calculated.MDA, CRP, IL-6, PAI-1, and TNF-α expression of inflammation-related genes: IL-6, IL-18, TNF-α, and sICAM, SERPINE 1, VCAM-1 GAPDH, and miRNAs in WBC(1) No changes in plasma CRP, IL-6, and TNF-α, but there was a reduction in MDA and PAI-1 after 8 weeks.
(2) Lower consumption of lipids and saturated fat was associated with increased let-7b after nutritional intervention.

Song et al. [59] US, 2016Parallel design/6 weeks. RCT feeding study, healthy, aged 21-76 yrs., BMI 19.2-35.5Eucaloric moderate fat diet (36% fat/46% CHO vs. eucaloric low-fat/high CHO (18% fat/64% CHO vs. low calories 33% reduction of the LFD)IL-6, TNFRs, CRP, leptin, and adiponectin at baseline and 6 weeks(1) No changes in plasma inflammatory markers after 6 weeks of MFD, LFD, and low-calorie LFD. A modest weight reduction was observed in the restricted calorie diet and adiponectin reduction was reported for the eucaloric LFD vs. MFD.

Mayr et al. [51] Australia, 2018Multicenter, parallel design, randomized, 6-month intervention and 12-month follow-up. AUSMED Study for MedDiet and for low-fat diet. Patients with CADMedDiet vs. low-fat diet. fat (at least 50% was from MUFA and 25% from PUFA, <10% saturated fatty acids), 35% CHO
Low-fat total fat, <7% saturated fat, 45–65% CHO
hsCRP and IL-6(1) There were no changes in plasma hsCRP or IL-6 after 6 months for either diet.
(2) Following the MedDiet, but not the low-fat diet, leads to significant reduction in the DII score.

Sakhaei et al. [52] Iran, 2018Cross-sectional, Yazdi female teachers, aged 25-50 yrs. Sample stratified in tertilesAdherence to DASH diet and the Mediterranean diet based on published scoring methodhsCRP and IL-17AAdherence to the DASH diet was significantly associated with reduced serum hsCRP only. Adherence to the Mediterranean diet might be associated with lower circulating IL-17A concentrations, but not hsCRP levels in this group of females.

Shivappa et al. [60] Italy, 2018Cross-sectional. Data from Moli-sani study, adults, aged over 35 yrs., 48% male without acute inflammationDII calculated using data on only 34 nutrients and other food components derived from the FFQ.INFLA-score includes platelet and leukocyte counts, the granulocyte to lymphocyte ratio, and CRP.There was a positive association between DII and INFLA-score, among those aged 50 to 65 yrs., but not for those older than 65 yrs.
No association between DII and CRP alone.

Abbreviations. AUSMED: Australian Mediterranean diet heart trial; DII: dietary inflammatory index; FFQ: food frequency questionnaire; HGI: high glycemic index; LCD: low carbohydrate diet; LFD: low-fat diet; LGI: low glycemic index; MedDiet: Mediterranean diet; MexD: Mexican diet; MFD: moderate-fat diet; RESMENA-S: the metabolic syndrome reduction in Navarra study; WC: waist circumference.