The association between an energy-adjusted dietary inflammatory index and inflammation in rural and urban Black South Africans

Objective: To quantify the inflammatory potential of the diet of rural and urban Black South Africans using an adapted energy-adjusted dietary inflammatory index (AE-DII) and to investigate its relationship with inflammatory and cardio-metabolic disease risk markers. Dietary inflammatory potential has not been investigated in African populations. Design: Cross-sectional investigation. Setting: Rural and urban sites in the North West province of South Africa. Participants: 1885 randomly selected, apparently healthy Black South Africans older than 30 years. Results: AE-DII scores ranged from -3 center dot 71 to +5 center dot 08 with a mean of +0 center dot 37. AE-DII scores were significantly higher in men (0 center dot 47 +/- 1 center dot 19) than in women (0 center dot 32 +/- 1 center dot 29), and in rural (0 center dot 55 +/- 1 center dot 29) than urban participants (0 center dot 21 +/- 1 center dot 19). Apart from its dietary constituents, AE-DII scores are primarily associated with age, rural-urban status and education. Contrary to the literature, alcohol consumption was positively associated with AE-DII scores. Of the four tested inflammatory and thirteen cardio-metabolic biomarkers, the AE-DII was only significantly negatively associated with albumin and HDL cholesterol, and positively with waist circumference and fasting glucose, upon full adjustment. Conclusion: Rural men consumed the most pro-inflammatory diet, and urban women the least pro-inflammatory diet. The diet of the participants was not overtly pro- or anti-inflammatory and was not associated with measured inflammatory markers. The inflammatory potential of alcohol at different levels of intake requires further research. Understanding dietary inflammatory potential in the context of food insecurity, unhealthy lifestyle practices and lack of dietary variety remains limited.

Automated summary

The study found that rural men consumed the most pro-inflammatory diet, while urban women consumed the least pro-inflammatory diet. Dietary inflammatory potential was associated with age, rural-urban status, and education. Alcohol consumption was positively associated with pro-inflammatory diet potential, but diet was not associated with measured inflammatory markers.