Prospective associations between empirical dietary inflammatory pattern score and cardiovascular diseases and cancer

Inflammation plays an important role in cardiovascular diseases (CVDs) and cancer development, and dietary factors can modulate inflammation. Several studies have shown an association between Empirical Dietary Inflammatory Pattern (EDIP) and CVDs and cancer, but there are limited prospective studies in Asian populations. We aimed to prospectively investigate the association between the inflammatory potential of the diet, as measured by an EDIP score adapted to an Asian population (EDIP-A) and the risks of CVDs, cancer, and mortality from CVDs and cancer in a large multi-ethnic Asian cohort.

We used data from the Multi-Ethnic Cohort (n = 10,640), a prospective study comprising ethnic Chinese, Malay, and Indian adults aged 21-65 years, recruited between 2004 and 2010. The EDIP-A score was calculated using a validated food-frequency questionnaire. Outcomes including incidence of nonfatal stroke, nonfatal acute myocardial infarction (AMI), CVDs mortality, cancer incidence and cancer mortality were ascertained through data linkage with national registries. Cox proportional hazards models were used to evaluate the association between the EDIP-A score and these outcomes.

During 887,505 person-years of follow-up, 435 nonfatal AMI cases, 317 nonfatal strokes, and 188 CVD deaths were documented. For cancer outcomes, 653 incident cases and 176 cancer deaths were recorded. Participants in the highest quintile of EDIP-A score had a higher risk of nonfatal stroke [hazard ratio (HR) = 1.64, 95 % CI 1.06, 2.55, P-trend = 0.01] than participants in the lowest quintile. These associations remained significant after further adjustment for body mass index. These associations were modified by smoking status (P-interaction <0.05). No significant associations were observed between EDIP-A score and risk of nonfatal AMI, CVD mortality, cancer incidence and cancer mortality.

Dietary patterns with a higher proinflammatory potential were associated with higher stroke risk, particularly among smokers. These findings suggest that reducing the inflammatory potential of the diet may be a promising strategy for prevention of CVDs.