Dietary inflammatory index of north Karnataka food pattern and its association with Coronary Artery Diseases

Abstract

Coronary artery disease (CAD) still remains as one of the chief causes of mortality and morbidity in the world.With a pooled prevalence of 11% noted for the young adult population in India, the statistics are intimidating. The major driving force in CAD is chronic, low grade systemic inflammation which is intrinsic to the activation, progression, plaque destabilization with eventual disruption of the coronary plaques leading to Major Adverse Cardiac Events (MACEs).The risk of CAD includes an intricate reciprocity between the genetic and the factors related to an individual’s lifestyle. Of the many emeging risk factors, incessant inflammation known to be contributed by lifestyle and diet are important and are more than amenable to modification. The current study used the Dietary Inflammatory Index (DII®) to know the inflammatory potential of an individual's overall dietsry intake as it is validated by numerous studies and against many inflammatory markers. Our study was aimed to investigate the association between DII, inflammatory biomarkers, CAD severity, and MACEs in a North Karnataka population with distinct dietary patterns. Methods: This prospective cohort study was conducted over a period of two years and enrolled 310 CAD patients between the age of 18-76 year from district of Vijayapura, Karnataka, India. Dietary intake were calculated by the use of Food Frequency Questionnaire developed and validated particulary to be used in north Karnataka population. After calculating the DII scores, the CAD patients were divided into quartiles based on the DII scores. Q4 had CAD patients with higher DII scores which indicated the diet as proinflamamtory and Q1 had CAD patients with lower scores whose dietary intake were considered anti-inflammatory.Baseline demographic, anthropometric, and clinical data of the CAD patients were noted and also Serum levels of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), and interleukin-10 (IL-10) were estimated as markers of chronic systemic inflammation in them. The patients were followed for 30 days to document MACEs. The software SPSS 26 (SPSS Inc., version 0.21, Chicago, IL) was employed for the statistical analyses. Our study considered p-values less than 0.05 as statistically significant.The results were analysed using statistical analyses like ANOVA, Chi-square tests, and binary conditional logistic regression, and were adjusted for the many potential confounders of CAD such as age, gender, Body MassIndex, smoking status, Hypertension, total serum cholesterol, Diabetes Mellitus(DM), physical inactivity to reduce the bias. Results: The mean DII score of the CAD cohort was 2.28 ± 1.75 which indicated a dietary pattern which is predominantly pro-inflammatory in nature. A statistically significant association was observed between higher DII quartiles (Q4) and increased prevalence of older age (p=0.01), Hypertension status (p=0.01) and status of type-2 DM (p=0.03), and serum HsCRP levels showed an increase and was statistically significant (p<0.001) and the serum levels of IL-10 levels significantly decreased (p<0.001) with increasing DII quartiles (Q1 to Q4), suggesting a direct relationship between dietary inflammatory potential (DII scores) and systemic inflammatory load. An increased incidence of MACEs (20.6% overall) was significantly associated with higher DII scores (p<0.001), particularly second MI and urgent revascularization procedures. Unadjusted analysis showed a nearly 5-fold increased risk of MACEs in the highest DII quartile (OR=4.82, 95% CI: 2.2-10.6, p<0.001). The odds of MACEs in the highest DII quartile (Q4) remained 2.52 times higher than in the lowest (Q1) even after adjusting for known confounders Conclusion: Diet with a higher DII score indicating a pro-inflammatory nature, is significantly correlated with increased systemic inflammation (higher hsCRP, lower IL-10) and a higher incidence of MACEs in CAD patients from North Karnataka. These findings underscore the crucial role inflammation associated with diet in the progression and adverse outcomes of CAD, highlighting the potential for dietary interventions as a personalized strategy for secondary prevention. Keywords: Dietary Inflammatory Index (DII), Cardiovascular Disease (CVD) Outcomes, Chronic Inflammation, Precision Nutrition, Indian Population.