Mediating effect of insulin resistance in the relationship between dietary inflammatory index and cardiovascular–kidney–metabolic syndrome stage in US adults, 2007–2018

Ying Xiao; Hongzhao You; Tianjie Wang; Yan Zeng; Yingxuan Zhu; Rui Zhang; Dong Liu; Yanyan Zhao; Yilu Liu; Shijie You; Bokang Qiao; Jiansong Yuan; Weixian Yang

doi:10.29219/fnr.v70.13744

Ying Xiao Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Hongzhao You Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Tianjie Wang Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Yan Zeng Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Yingxuan Zhu Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Rui Zhang Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Dong Liu Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Yanyan Zhao Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Yilu Liu Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Shijie You Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Bokang Qiao Beijing Institute of Heart, Lung and Vessel Disease, Capital Medical University Affiliated Anzhen Hospital
Jiansong Yuan Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases
Weixian Yang Fuwai hospital

DOI: https://doi.org/10.29219/fnr.v70.13744

Keywords: Cardiovascular–kidney–metabolic syndrome, Dietary Inflammatory Index, Insulin resistance, Dietary intervention

Abstract

Background: Cardiovascular–kidney–metabolic (CKM) syndrome is a progressive, five-stage disease framework driven by interrelated cardiovascular, renal, and metabolic dysfunction, with chronic inflammation and insulin resistance (IR) playing key roles. The dietary inflammatory index (DII) quantifies overall dietary inflammatory potential, but its role in CKM staging remains unclear.

Objective: This study aimed to evaluate the association between DII and CKM syndrome stage and to assess the potential mediating effect of IR.

Design: This cross-sectional study used data from the National Health and Nutrition Examination Survey (2007–2018). DII was derived from 24-h dietary recall. CKM stages were defined by the American Heart Association criteria. IR was assessed using the triglyceride–glucose index (TyG), Metabolic Score for IR (METS-IR), and Homeostatic Model Assessment for IR (HOMA-IR). Statistical analyses were performed after accounting for the complex survey design.

Results: Of the 27,635 participants, 94.08% had CKM syndrome (Stage 1 or higher). Compared with Stage 0, stepwise increases in the adjusted odds ratios for a higher DII score were observed across CKM stages (Q4 vs. Q1: 1.67 [1.31–2.15] for Stage 1; 2.11 [1.63–2.73] for Stage 2; 2.32 [1.08–4.98] for Stage 3; and 4.19 [2.65–6.63] for Stage 4). Restricted cubic splines models confirmed the positive linear association between DII and each CKM stage (all P_overall < 0.05; P_non-linear > 0.05), with increasingly steep slopes at higher stages. TyG, METS-IR, and HOMA-IR mediated 30.7, 45.0, and 25.3% of the association between DII and CKM syndrome stage, respectively.

Conclusions: Pro-inflammatory diet, as indicated by a higher DII score, was positively associated with more advanced CKM syndrome stage, partly mediated by IR. The DII may serve as a practical measure of dietary inflammation in CKM management.

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