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Association between the Dietary Inflammatory Index (DII) and urinary enterolignans and C-reactive protein from the National Health and Nutrition Examination Survey-2003–2008

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Abstract

Background

Enterolignans are important biomarkers of microbiota diversity, with higher levels indicating greater diversity. Diet and inflammation have been shown to play a role in maintaining microbiota diversity. This study examined whether inflammatory potential of diet, as measured by the Dietary Inflammatory Index (DII®) has an impact on levels of urinary enterolignans in the National Health and Nutrition Examination Survey (NHANES) 2003–2008. We also carried out construct validation of the DII with C-reactive protein (CRP).

Methods

Data came from NHANES 2003–2008. Enterolignans [enterodiol (END) and enterolactone (ENL)] and CRP were assayed from urine and serum specimens, respectively. Energy-adjusted DII (E-DII) scores were calculated from food intakes assessed using 24-h dietary recalls and expressed per 1000 calories consumed. Associations were examined using survey-based multivariable linear and logistic regression for enterolignans, and logistic regression for CRP.

Results

After multivariable adjustment, higher E-DII scores (i.e., indicating a relatively more pro-inflammatory diet) were associated with lower levels of creatinine-normalized END [beta coefficient (b)DIIquartile4vs1 = − 1.22; 95% CI = − 0.69, − 1.74; Ptrend ≤ 0.001] and ENL (bDIIquartile4vs1 = − 7.80; 95% CI = − 5.33, − 10.26; Ptrend ≤ 0.001). A positive association was also observed when enterolignans were dichotomized based on the cut-off of the 75th percentile value. In this same sample, the E-DII also was associated with CRP ≥ 3 mg/l (ORDIIcontinuous = 1.12; 95% CI 1.05, 1.19).

Conclusion

In these NHANES data, there was an association between E-DII score and enterolignans. This study also provided construct validation of the E-DII using CRP in a nationally representative sample. The results indicate that dietary inflammatory potential is associated with urinary enterolignans, a potential marker for microbiota diversity. However, studies are required to understand the direct association between DII and microbiota.

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Funding

Drs. Shivappa, Wirth and Hébert were supported by grant number R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Room 233, Suite 200, Columbia, SC, 29208, USA

    Nitin Shivappa, Michael D. Wirth, Thomas G. Hurley & James R. Hébert

  2. Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC, 29208, USA

    Nitin Shivappa, Michael D. Wirth, Thomas G. Hurley & James R. Hébert

  3. College of Nursing, University of South Carolina, 915 Greene Street, Suite 200, Columbia, SC, 29208, USA

    Nitin Shivappa & Michael D. Wirth

  4. Connecting Health Innovations, LLC, 1417 Gregg Street, Columbia, SC, 29201, USA

    Michael D. Wirth & James R. Hébert

  5. Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC, 29209, USA

    E. Angela Murphy

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  1. Nitin Shivappa
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Contributions

The authors’ contributions were as follows: NS calculated DII, carried out analyses and wrote the first draft of the manuscript, MW, AM, JRH and TH provided suggestions and revised the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Nitin Shivappa.

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Conflict of interest

Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Drs. Nitin Shivappa and Michael Wirth are employees of CHI.

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Shivappa, N., Wirth, M.D., Murphy, E.A. et al. Association between the Dietary Inflammatory Index (DII) and urinary enterolignans and C-reactive protein from the National Health and Nutrition Examination Survey-2003–2008. Eur J Nutr 58, 797–805 (2019). https://doi.org/10.1007/s00394-018-1690-5

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