Dietary inflammatory index and cardiovascular risk and mortality: an updated systematic review and meta-analysis
Bibliographic record
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of death globally, and chronic inflammation is pivotal in CVDs development. Pro-inflammatory diets may exacerbate inflammation and thus increase CVDs risk. The Dietary Inflammatory Index (DII) is a validated measure of the inflammatory potential of diet. This updated systematic review and meta-analysis was conducted to clarify the association between DII and CVDs incidence and mortality. Methods A comprehensive search was conducted in Pub Med, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) until February 2025. Study quality was assessed using the Newcastle-Ottawa Scale ( N OS). Risk ratios (HR) and 95% confidence intervals (CI) were pooled using Review Manager 5.4, with subgroup analyses performed. Sensitivity and publication bias analyses were conducted using Stata 18.0. Results Thirty cohort studies (NOS ≥7) from nine countries, involving 669,205 participants, were included. Compared with the lowest DII category, the highest category was associated with increased risks of CVD incidence [HR = 1.23, 95% CI (1.14–1.33); I 2 = 54%] and mortality [HR = 1.29, 95% CI (1.24–1.35); I 2 = 16%]. Stratified analyses indicated higher incidence risk among men (HR = 1.51) and higher mortality risk among women (HR = 1.25). Subgroup analyses further revealed a significant positive association between elevated DII and myocardial infarction (HR = 1.41). In models stratified by diabetes history, unadjusted associations were stronger (HR = 1.40), while adjusted associations were attenuated but remained significant, with a significant interaction ( P = 0.002). Sensitivity and trim-and-fill analyses confirmed the robustness of these associations (all P < 0.001). Conclusion Higher DII scores, reflecting pro-inflammatory dietary patterns, are significantly associated with increased risks of CVD incidence and mortality. These findings underscore the clinical and public health importance of promoting anti-inflammatory dietary strategies to mitigate the global CVD burden. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420250654615 , PROSPERO, CRD420250654615.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.033 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".