AUTHOR=Ni Yu , Yao Qian , Xu Ting , Li Xiuchuan 

TITLE=Dietary inflammatory index and cardiovascular risk and mortality: an updated systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1626523

DOI=10.3389/fcvm.2025.1626523

ISSN=2297-055X

ABSTRACT=BackgroundCardiovascular diseases (CVDs) are the leading cause of death globally, and chronic inflammation is pivotal in CVDs development. Pro-inflammatory diets may exacerbate inflammation and thus increase CVDs risk. The Dietary Inflammatory Index (DII) is a validated measure of the inflammatory potential of diet. This updated systematic review and meta-analysis was conducted to clarify the association between DII and CVDs incidence and mortality.MethodsA comprehensive search was conducted in Pub Med, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) until February 2025. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Risk ratios (HR) and 95% confidence intervals (CI) were pooled using Review Manager 5.4, with subgroup analyses performed. Sensitivity and publication bias analyses were conducted using Stata 18.0.ResultsThirty cohort studies (NOS ≥7) from nine countries, involving 669,205 participants, were included. Compared with the lowest DII category, the highest category was associated with increased risks of CVD incidence [HR = 1.23, 95% CI (1.14–1.33); I2 = 54%] and mortality [HR = 1.29, 95% CI (1.24–1.35); I2 = 16%]. Stratified analyses indicated higher incidence risk among men (HR = 1.51) and higher mortality risk among women (HR = 1.25). Subgroup analyses further revealed a significant positive association between elevated DII and myocardial infarction (HR = 1.41). In models stratified by diabetes history, unadjusted associations were stronger (HR = 1.40), while adjusted associations were attenuated but remained significant, with a significant interaction (P = 0.002). Sensitivity and trim-and-fill analyses confirmed the robustness of these associations (all P < 0.001).ConclusionHigher DII scores, reflecting pro-inflammatory dietary patterns, are significantly associated with increased risks of CVD incidence and mortality. These findings underscore the clinical and public health importance of promoting anti-inflammatory dietary strategies to mitigate the global CVD burden.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420250654615, PROSPERO, CRD420250654615.