A J-shaped association between Dietary Inflammatory Index (DII) and depression: A cross-sectional study from NHANES 2007–2018

The association between dietary intake and chronic diseases has received increasing attention in recent years, and studies have shown that different dietary patterns can have different effects on physical health (Cena and Calder, 2020; Guzek et al., 2022; Krznaric et al., 2021). For example, the Western dietary pattern characterized by a high intake of sugar and fat and a low intake of vegetables and fruits, is often associated with the development and exacerbation of hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease, and cancer (Pavillard et al., 2018; Quan et al., 2021; Shi, 2019). In comparison, the Mediterranean diet, which is rich in vegetables and fruits, with preferential consumption of seafood rather than animal meat, moderate alcohol intake, high amounts of olive oil, and low intake of red meat and butter, contributes to the prevention and improvement of chronic diseases such as obesity, hypertension, cardiovascular disease (CVD), diabetes, and metabolic syndrome (Bizzozero-Peroni et al., 2022; Galbete et al., 2018; Tsigalou et al., 2020). Numerous studies have shown that the development or worsening of many chronic diseases, such as CVD, metabolic diseases, and neurological diseases, is closely related to the persistence of chronic inflammation (Ferrucci and Fabbri, 2018; Leuti et al., 2020). In addition, the onset of depression is often accompanied by an altered inflammatory state (Huang et al., 2019; Kohler et al., 2016; Miller and Raison, 2016).

Depression is a psychological disorder characterized by a continuous and prolonged depressed mood, along with lack of interest, feeling guilty, difficulty concentrating, decreased appetite, suicidal ideation, and other abnormalities in cognitive, behavioral, and social functioning, with high prevalence, recurrence, and disability (McCarron et al., 2021). According to the World Health Organization statistics, an estimated 300 million people worldwide are suffering from depression, and the prevalence is increasing year by year (Collaborators, 2021). Among the top ten disabling diseases in the world, depression causes the most losses due to disability, and it tops the list of global disease burdens (Vigo et al., 2022). Recent studies have found that depression is associated with psychoneuroimmunity and that chronic inflammation and cell-mediated immune activation play an important role in its pathogenesis (Beurel et al., 2020; Ge et al., 2015; Hunt et al., 2020). Patients with major depressive disorder have elevated levels of inflammatory markers in their blood and cerebrospinal fluid, such as C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin (IL)-1, and IL-6 (Czysz et al., 2021; Yang et al., 2022).

Numerous studies have demonstrated that dietary intake plays a significant regulatory function in the development of chronic inflammation. Inflammatory responses can be triggered by various dietary patterns and components (Bolte et al., 2021; Sureda et al., 2018). The Western dietary pattern has typically been linked to higher levels of inflammatory markers in the body (Tayyem et al., 2021). By contrast, the Mediterranean diet is related to reduced inflammation levels (Wang et al., 2022). The Dietary Inflammatory Index (DII) is a dietary index summarized from the literature that has been used to characterize habitual diets that contribute to the likelihood of inflammation. The relationship between DII and depression has been investigated before (Wang et al., 2018), but the results are mostly inconsistent, as incomprehensive stratified analyses have been conducted. Therefore, we explored the association between DII and depression after adjusting for potential confounders and further investigated the stability of the relationship in various subgroups of the population.

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