The relationship between Dietary Inflammatory Index and disease severity and inflammatory status: a case–control study of COVID-19 patients
Moludi et al.
, The relationship between Dietary Inflammatory Index and disease severity and inflammatory status: a..
, British Journal of Nutrition, doi:10.1017/S0007114521003214
Retrospective 60 COVID-19 hospitalized patients and 60 controls in Iran, showing pro-inflammatory diets associated with COVID-19 cases and severity. IR.KUMS.REC.1399·444, IR.TBZMED.REC.1399·225.
risk of case, 91.6% lower, OR 0.08, p < 0.001, inverted to make OR<1 favor higher quality diet, case control OR, model 3, E-DII tertile 1 vs. tertile 3.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Moludi et al., 23 Aug 2021, retrospective, Iran, peer-reviewed, 7 authors, study period June 2020 - July 2020.
Abstract: British Journal of Nutrition, page 1 of 9
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society
The relationship between Dietary Inflammatory Index and disease severity and
inflammatory status: a case–control study of COVID-19 patients
Jalal Moludi1,2,3, Shaimaa A. Qaisar4, Mohammad Alizadeh5*, Hamed Jafari Vayghan6, Mohammad Naemi5,
Akram Rahimi3 and Rihaneh Mousavi5
Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical
Sciences, Kermanshah, Iran
Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences,
Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
Chemistry Department, College of Education, University of Garmian, Sulimmania, Iraq
Nutrition Research Center, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Nutrition, School of Health, Arak University of Medical Sciences, Arak, Iran
(Submitted 9 March 2021 – Final revision received 1 August 2021 – Accepted 18 August 2021)
Numerous studies have revealed strong relationships between COVID-19 and inflammation. However, the imminent link between diet-related
inflammation and the COVID-19 risk has not been addressed before. So, we explored the capability of the Energy-Adjusted Dietary Inflammatory
Index (E-DII) to predict the inflammatory markers, incidence and severity of COVID-19. We conducted a case-control study consisting of 120
adults; they had been admitted for COVID-19 at hospital during June and July, 2020. The E-DII score was calculated based on the dietary intake,
which was evaluated by a 138-item semi-quantitative food frequency questionnaire. Serum levels of inflammatory markers including the
Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and White blood cells (WBCs) differential were measured. Severity of disease
was assessed by chest radiology criteria. Patients with the maximum pro-inflammatory energy adjusted E-DII score had 7·26 times greater odds of
developing COVID-19, as compared to those in tertiles 1 (E-DII T3 v. E-DII T1: OR = 7·26; 95 % CI 2·64 to 9·94, P < 0·001). Also, a positive association between E-DII and C-reactive protein (CRP) was observed (BE-DII = 1·37, 95 % CI 0·72, 2·02), such that with each unit increase in E-E-DII,
the CRP levels were increased by 1·37 units. Furthermore, a significant association was found between E-DII and the severity of disease
(BE-DII = 0·03, 95 % CI 0·01, 0·06. 0·024). Patients consuming a diet with a higher pro-inflammatory potential were at a greater risk of
COVID-19 occurrence; also, the severity of disease was elevated with a high score inflammatory diet.
Key words: Dietary Inflammatory Index: Severity: Inflammation: COVID-19
The outbreak of the novel coronavirus disease, also named
‘COVID-19’, has led to a devastating pandemic, threatening all
humans throughout the world.(1) Currently, the number of confirmed cases is rising very quickly globally; it is an immense
threat to the public health.(2) Similar to the Middle East respiratory syndrome corona virus (MERS-CoV) and severe acute respiratory syndrome corona virus (SARS-CoV), COVID-19 is
characterised by the lower respiratory infection, causing acute
respiratory distress syndromes.(3) Typical clinical symptoms of
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