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


Based on the inclusion criteria, a total of 4434 subjects, 46.5% men and 53.5% women, were included from NHANES 2013 to 2014 for this study. The percentages of subjects with no diabetes, prediabetes, and diabetes were 59.4%, 26.5%, and 14.1% respectively. As showed in Table 1, subjects who were black, older, nonsmoker, not alcohol user, and having higher BMI, less education, health insurance, and less than 150 minutes exercise per week, were more likely to have diabetes.

Table 2 presents the comparison in mean DII scores between people with no diabetes, prediabetes, and with diabetes. Mean (SD) DII for the whole sample were 0.65 (1.50), with ranges between −3.41 to 9.05 (higher number is more inflammation). The least square means of DII scores for the no diabetes, prediabetes, and diabetes participants were 0.50, 0.50, and 0.79, respectively. The results of the regression analyses indicated that subjects with diabetes had significantly higher DII scores than those without diabetes (P = .01) and those with prediabetes (P = .03). Among individuals with diabetes, those who had higher HgbA1c (>9%) had higher DII scores than those with lower HgbA1c between 6.5% and 9% (1.37 vs 0.55, P = .0002).

After adjusting for age, sex, race, BMI, physical activity, smoking status, alcohol use, and socioeconomic status, we found a significant association between the incidence of diabetes and DII scores (Table 3). With 1 point increment in the DII score, odds of having diabetes increased by 13% (95% CI, 1.02 to 1.24).

We also examined severity of diabetes. Among the individuals with diabetes, we observed a significant association between severity of diabetes and DII scores, using a linear regression and continuous variables for HgbA1c and DII (P < .04). For each 1-point increment in DII score, the odds of having HgbA1c higher than 9% increased by 43% (95% CI, 1.21 to 1.68). When examining DII and HgbA1c as continuous variables, each 1 point increase in DII score was associated with an increase of 0.03 in HgbA1c (P = .04). There was negative correlation (−0.57) between DII scores and dietary fiber intake.