The Dietary Inflammatory Index Is Associated With Diabetes Severity

Dana E. King, MD, MS; Jun Xiang, MS, MA


J Am Board Fam Med. 2019;32(6):801-806. 

In This Article

Abstract and Introduction


Objective: The Dietary Inflammatory Index (DII) is a recently developed dietary inflammation assessment tool. The current study examined the association between DII and the presence and severity of diabetes in adults age ≥20 years.

Research Design and Methods: Cross-sectional analysis of 4434 adult participants in the National Health and Nutrition Examination Survey (NHANES 2013 to 2014). The DII was calculated based on 24-hour dietary recall data. Linear and logistic regression models were used to estimate the relationship and control for possible confounding factors.

Results: Among 4434 participants, mean age was 49.4 years, mean BMI (body mass index) was 29.3 kg/m2, and mean DII (higher is more inflammatory) was 0.65 (range, −3.41 to +9.05). The mean DII scores in participants with and without diabetes were 0.79 and 0.50, respectively (P = .0098). Participants with Hemoglobin A1c (HgbA1c) >9% had higher DII scores than those with 6.5% to 9% HgbA1c (1.37 vs 0.54, P = .0002) and those with <6.5% HgbA1c (1.37 vs 0.50, P < .0001). With 1 point increase in the DII score, odds of having diabetes increased by 13% (95% CI, 1.02 to 1.24). Among the individuals with diabetes, we also observed a significant association between severity of diabetes and DII scores; with 1 point increase in DII score, the odds of having HgbA1c higher than 9% increased by 43% (95% CI, 1.21 to 1.68).

Conclusions: The DII had a significant association with diabetes and a stronger association when HgbA1c >9%. Further research will help clarify the association between inflammation and diet and the utility of the DII as a tool in risk assessment and management of patients with diabetes.


The Dietary Inflammatory Index (DII) has emerged as a possibly important tool in assessing diet quality and inflammation in the setting of high-risk medical conditions. The DII is a measure derived from analysis of multiple databases to measure the impact of 45 specific types of food on inflammatory biomarkers including IL-1β, IL-4, IL-6, IL-10, TNF-α, and C-reactive protein (CRP).[1] Following the initial study that described the DII, subsequent studies have explored the association of the DII and a variety of chronic medical conditions, including chronic kidney disease,[2] cardiovascular disease,[3] depression,[4] and metabolic syndrome.[5]

Diabetes has not been studied extensively in relation to the DII, but it represents an important medical condition that has been associated with inflammation[6–9] and diet[10–12] in a variety of studies. Determining further information about the DII and diabetes could facilitate its use in the clinical setting, and might provide a tool for the assessment of the risk of diabetes. However, there has been limited experience in studying the association of the DII and diabetes.

The goal of this study was to evaluate the relationship between DII and the presence of diabetes in a nationally representative sample of adults in the U.S population. A second goal was to explore the relationship between DII and the severity of diabetes.