Front. Nutr. Frontiers in Nutrition Front. Nutr. 2296-861X Frontiers Media S.A. 10.3389/fnut.2022.1067468 Nutrition Systematic Review Is there any association between dietary inflammatory index and quality of life? A systematic review Golmohammadi Mona 1 Kheirouri Sorayya 2 Ebrahimzadeh Attari Vahideh 3 Moludi Jalal 1 Sulistyowati Reny 4 Nachvak Seyed Mostafa 1 * Mostafaei Roghayeh 1 Mansordehghan Maryam 1 1Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran 2Department of Community Medicine, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran 3Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran 4Poltekkes Kemenkes Palangka Raya, Palangka Raya, Indonesia

Edited by: Daniela Caetano Gonçalves, Federal University of São Paulo, Brazil

Reviewed by: Everson Araujo Nunes, McMaster University, Canada; Evelyn Frias-Toral, Catholic University of Santiago de Guayaquil, Ecuador

 *Correspondence: Seyed Mostafa Nachvak, smnachvak@hotmail.com

This article was submitted to Clinical Nutrition, a section of the journal Frontiers in Nutrition

 22 12 2022 2022 9 1067468 11 10 2022 23 11 2022 Copyright © 2022 Golmohammadi, Kheirouri, Ebrahimzadeh Attari, Moludi, Sulistyowati, Nachvak, Mostafaei and Mansordehghan. 2022 Golmohammadi, Kheirouri, Ebrahimzadeh Attari, Moludi, Sulistyowati, Nachvak, Mostafaei and Mansordehghan

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 Background

The inflammatory potential of unhealthy diets can lead to the development of chronic diseases and also exacerbating their complications. Therefore, the present systematic review aimed to evaluate the association of dietary inflammatory index (DII) and quality of life (QOL) in human subjects.

 Methods

A systematic search was conducted in PubMed, Web of Science, and Scopus databases, using the combination of all search terms related to DII and QOL until May 2022. All eligible human studies published in English were included.

 Results

Three hundred twenty-seven studies were obtained from the first systematic search of the databases although, only eight studies were eligible for the evaluation. Seven studies reported that there was a significant reverse association between DII scores and overall QOL and/or its subscales in different populations including patients with asthma, osteoarthritis, hemodialysis patients, multiple sclerosis, obese women, and also in healthy subjects. While, one study on postmenopausal women found no evidence of this association.

 Conclusion

This systematic review demonstrated that an anti-inflammatory diet might be associated with better QOL. However, future well-designed clinical trials can provide better conclusions especially regarding the quantifying of this relationship.

 anti-inflammatory diet chronic disease dietary inflammatory index inflammation quality of life Introduction

The term Quality of Life (QOL) was first introduced in 1970s, as the multi-dimensional concept of well-being and health status regarding the physical, mental, emotional, and social aspects of life (1). QOL usually decreases during the aging and diseases (2, 3). It has been documented that low-grade inflammation, increasing pro-inflammatory cytokines in the body, is associated with different chronic disease (4–9), as well as impaired neurodevelopment (10) and adverse mental health outcomes (11), which can affect various aspects of patients’ QOL (12). Therefore, reversing the inflammatory pathways can increase QOL of patients.

Emerging evidence showed that healthy eating is associated with low inflammatory responses and can be a cost-effective intervention to improve the QOL. It was reported that a Western dietary pattern with high consumption of refined grains, processed meats, butter, and high-fat dairy products causes inflammation in the body. Whereas, a healthy diet like the Mediterranean diet which includes whole grains, vegetables, fish, and olive oil, can prevent inflammation or suppress inflammatory pathways (13–16). For this purpose, Shivappa et al. developed a tool to assess the inflammatory potential of the diet called the Dietary Inflammatory Index (DII) (17). Higher DII scores are associated with inflammatory cytokines such as interleukin (IL)-6, tumor necrosis factor (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) (18, 19). Studies have shown that DII is associated with various diseases such as breast cancer (20), colorectal cancer (21), osteoarthritis (22), metabolic syndrome (23), and asthma (24).

Therefore, this study was conducted with the hypothesis that the inflammatory potential of the diet can lead to the development or progression of chronic diseases complications and thus decreases patients’ QOL. To the best of our knowledge, this is the first systematic review that has summarized and concluded the outcomes of related studies to assess the impact of DII on QOL.

 Methods The search strategy

This study was performed according to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-

Analyses Protocols) 2015 statement. We searched through PubMed/Medline, Web of Science, and Scopus for relevant papers published in English until May 2022 using the following keywords: “dietary inflammatory score” OR “dietary inflammatory index” OR “DII” OR “inflammatory diet” OR “inflammatory potential of diet” OR “dietary inflammation potential” OR “potential inflammatory intake” OR “anti-inflammatory diet” OR “pro-inflammatory diet” in title/abstract AND “quality of life” OR “QOL” OR “health-related QOL” OR “HRQOL” OR “World Health Organization Quality of Life-Brief” OR “WHOQOL” OR “PedsQL” in the title/abstract.

 The screening of studies

All detected articles were saved in an EndNote software file and duplicate articles were removed. Then, unrelated articles were identified and deleted by reviewing the titles and abstracts. The full text of remaining articles was then screened for eligibility and data extraction by two independent researchers. Discrepancies between the two authors were resolved by a third researcher.

 Inclusion and exclusion criteria

Studies were included if they examined the association of a DII score and QOL. There was no restriction on study design and all English articles were eligible. Moreover, studies that assessed the association of DII with QOL in patients with knee osteoarthritis, multiple sclerosis (MS), asthma, and hemodialysis were included in this review.

 Data extraction and quality assessment

The data were collected according to a standard extraction form to obtain the information about the first author’s name, geographical area, study design, population/sample size, mean ages of participants, interventional/control diet, duration of intervention, QOL/DII/food intake assessment tools, and the main outcomes.

For assessment of the articles quality, the adapted version of the Newcastle–Ottawa Scale (NOS) checklist was used for cross-sectional studies as it was shown in Supplementary Table 1 (25) and the Jadad checklist was used for experimental studies as it was shown in Supplementary Table 2 (26). In the NOS checklist, the score of ≥7 was interpreted as a low risk of bias, scores between 4 and 6 were interpreted as a high risk of bias, and the score of <4 was interpreted as a very high risk of bias (27). In the Jadad checklist, the score of ≥3 was considered to have superior quality (26).

 Results Selection of studies

As it was shown in Figure 1, 327 potentially relevant articles were obtained by the search strategy. Of these records, 50 were excluded due to duplicate studies. Then, of 277 remained articles, 263 studies were excluded because they did not meet the inclusion criteria. Finally, 8 articles were included for analysis.

Flowchart of the studies search and selection.

 Characteristics of included studies

The study population of included studies were as follow: knee osteoarthritis (n = 1) (28), asthma (n = 1) (29), MS (n = 1) (30), hemodialysis patients (n = 1) (31), women with obesity or overweight (n = 1) (32), postmenopausal women (n = 1) (33), healthy people (n = 2) (34, 35). The details of each study are summarized in Table 1.

Summary of included studies.

References, country Type of study Population/ Sample size Age (year) Interventional diet Control diet Duration of intervention (weeks) Quality of life assessment tools DII assessment method Food intake assessment tools Main outcomes
Lycett et al. (35), Australia Cross-sectional Children n = 1,759 and adults n = 1,812 11.5 ± 0.5 and 43.7 ± 5.2 – – – Child and adult version of the Child Health Utility-9D 26 food parameters 60 items FFQ Higher DII scores were associated with lower QOL.
Song et al. (33), Korean Cross-sectional Postmenopausal women n = 132 45–70 – – – EQ-5D 38 food parameters 3-day food record QOL did not show a significant difference across the DII tertiles.
Kuczmarski et al. (34), USA Cross-sectional Urban African American and White adults n = 1,907 48.38 ± 0.21 – – – SF-12 35 food parameters 4-day 24-h dietary recalls Higher DII scores were associated with lower QOL.
Yaseri et al. (31), Iran Cross-sectional Hemodialysis patients n = 83 56.7 ± 12.6 – – – SF-36 45 food parameters 3-day 24-h dietary recalls Higher DII scores were associated with lower QOL.
Tabrizi et al. (32), Iran Cross-sectional Reproductive-aged women with obesity or overweight n = 278 31.40 ± 10.89 – – – SF-36 24 food parameters 168 items FFQ Higher DII scores were associated with lower QOL.
Toopchizadeh et al. (28), Iran Cross-sectional Knee osteoarthritis patients n = 220 ≥45 – – – SF-36 29 food parameters 168 items FFQ Highest DII score was associated with lower QOL in terms of physical function, role limitation due to physical health, social function, and pain scales and physical health subscale.
Yucel et al. (29), Turkey RCT Obese asthmatic patients Intervention (n = 29) Control (n = 26) Intervention.: 50.4 ± 10.4 Control.: 50.3 ± 10.0 – No dietary recommendation 10 weeks AQLQ 24 food parameters 2-day 24-h dietary recalls AQLQ scores increased in the intervention group.
Mousavi-Shirazi-Fard et al. (30), Iran RCT Relapsing-remitting MS patients Intervention (n = 50) Control (n = 50) Intervention: 35.20 ± 6.61 Control: 36.26 ± 7.23 Anti-inflammatory diet Healthy diet 12 weeks MSQOL-54 35 food parameters 147 items FFQ Physical and mental components of MSQOL-54 was improved between and within the two groups after the intervention.

AQLQ, asthma quality of life questionnaire; DII, dietary inflammatory index; EQ-5D, EuroQOL-5D; FFQ, food frequency questionnaire; MS, multiple sclerosis; MSQOL-54, multiple sclerosis quality of life; QOL, quality of life; RCT, randomized control trial; SF-12, short-form 12; SF-36, short-form 36.

The population of studies were over 20 years of age, except for one research on children aged 11–12 (35). Of 8 included studies, 2 were randomized controlled trial (RCT) using the anti-inflammatory diets as the intervention for 10 (29) and 12 (30) weeks (see Table 1) and 6 articles were cross-sectional in design (28, 31–35).

Different questionnaires were used to assess QOL across the studies including Child and adult version of the Child Health Utility-9D (35), Short-Form 36 (SF-36) (28, 31, 32), Short-Form 12 (SF-12) (34), EuroQOL-5D (EQ-5D) (33), Asthma quality of life questionnaire (AQLQ) (29) and Multiple Sclerosis Quality of Life (MSQOL-54) (30).

There was also a heterogeneity in the assessment of dietary inflammatory index between studies. The food intake assessment tools were food frequency questionnaire (FFQ) (28, 30, 32, 35), 3-day food record (33), 3-day or 2-day 24-hour food recall (29, 31, 34).

 Quality of the articles

Using the NOS checklist, it was determined that four cross-sectional studies had a high risk of bias (28, 31–33) and two of them had a low risk of bias (34, 35). Jadad’s checklist also showed that all interventional studies had superior quality (29, 30). The scores obtained from the NOS and Jadad checklists are shown in Supplementary Tables 1, 2.

 Association between the dietary inflammatory index and quality of life

Five out of six cross-sectional studies found that higher DII scores were significantly associated with lower QOL (28, 31, 32, 34, 35). But the results of one cross-sectional study on post-menopausal women did not show any significant differences in QOL across the DII tertiles (33).

Moreover, the results of clinical trials showed that consumption of anti-inflammatory diet for 10 and 12 weeks significantly increased patients’ quality of life in terms of different physical and/or mental components (29, 30).

 Discussion

To the best of our knowledge, the present study is the first systematic review of the association between DII and QOL. The majority of the studies included in this review showed the negative relationship between DII with QOL and/or its domains, with the exception of one study showing no association (33).

Healthy dietary patterns such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) promote eating healthy foods, which can reduce inflammation in the body (36–39), while Western dietary pattern has inflammatory properties (40). The effect of dietary patterns on QOL have also been previously studied and our results are consistent with these studies. Results of a systematic review by Govindaraju et al. showed that healthy dietary patterns like Mediterranean diet were associated with better QOL (41). Another review study found that in contrast to the Western and unhealthy diet, the Mediterranean diet was associated with better QOL in both physical and mental domains (42). Wu et al. reported that diet quality and dietary behavior were positively associated with various aspects of QOL, including physical, psychosocial, school, and emotional functioning in children and adolescents (43). Results of a most recent study showed that adherence to the Mediterranean diet was positively associated with quality of life in children and adolescents (44). Moreover, adhering to the DASH pattern led to the improvement of QOL in patients with heart failure (HF) during 3 months (45). It was also reported that healthy dietary patterns were associated with better sleep status, sexual function, and physical activity (46–50).

The most important mechanism for the health effects of the aforementioned healthy dietary patterns can be justified by reducing inflammation, suppressing pro-inflammatory responses, and the antioxidant effects. In this regard, focusing on the effect of diet in modulation of inflammation caused to the development of DII first in 2009 (51). DII is a validated dietary score that was introduced to assess the potential effects of people’s diet on their inflammatory status and health outcomes. Accordingly, a high DII score reflects the pro-inflammatory potential of diet, while the low scores of DII reflect the anti-inflammatory effect of diet (52).

It was reported that high DII scores were positively associated with systemic inflammation and also decreased lung function in people with asthma (24). Moreover, it was reported that consumption of a pro-inflammatory diet may have important role in knee osteoarthritis pathology (53). Studies showed a positive association between DII scores with postmenopausal complications such as osteoarthritis (33), lower bone density (54, 55), higher menopause-specific somatic score (56), hip fracture risk (54), increased risk of breast cancer (20), and proximal colorectal cancer (21).

Bohlouli et al. showed that adherence to an anti-inflammatory diet such as the Mediterranean diet improved fatigue severity in relapsing-remitting MS (57). Cross-sectional studies showed that the body composition and anthropometric measurements were directly associated with DII scores (58, 59). There are evidence that high DII scores have been positively associated with an increased risk of obesity in non-obese individuals and also the prevalence of overweight and obesity (60). Recently, Ferreira et al. showed that the comorbidities of obesity decreased after improving the DII scores of participants (61).

Dietary inflammatory index can trigger inflammatory responses in the body (24, 62) and the inflammatory cytokines are related to low QOL due to physical disability, psychosocial burdens, pain, mood, and sexual function (63–72) in different conditions and diseases like respiratory tract diseases (24, 73–75), osteoarthritis and synovitis (76, 77), MS (78), obesity (79, 80), postmenopausal women (81, 82), and hemodialysis patients (83).

However, Song et al. showed that there was no significant relationship between DII scores and QOL in post-menopausal women, which may be due to the low sample size of the study (33).

Figure 2 shows the association between pro-inflammatory diets and quality of life in different conditions.

Association between pro-inflammatory diets and quality of life. Pro-inflammatory diets like Western diets (98) affect the inflammatory cytokines (99, 100), oxidative stress (101), gut microbiota composition (102), insulin resistance (IR) (103), cortisol (104), and brain derived neurotropic factor (BDNF) (105) levels, causing decrease in quality of life through its effects on different dimensions. BDNF, brain derived neurotropic factor; DII, dietary inflammatory index; hs-CRP, high-sensitivity C-reactive protein; IL, interleukin; IR, insulin resistance; QOL, quality of life; ROS, reactive oxygen species; TNF, tumor necrosis factor.

Healthy dietary patterns with low DII scores can also change the gut microbiota composition and correct the gut dysbiosis (84). These diets emphasize the consumption of vegetables, fruits, whole grain, beans, legumes, nuts, seeds, and olive oil (85) and improve the microbiome diversity by increasing growth of Bacteroides, Lactobacili, Bifidobacteria, Faecalibacterium, Oscillospira, Roseburia, Ruminococci, and their metabolic activities and decreasing growth of Firmicutes and Proteobacteria (86). Therefore, the production of short-chain fatty acids (SCFAs) will increase in the feces (84). SCFAs, especially butyrate bind to epithelial and immune cell G protein-coupled receptors (GPCRs) which leads to maintaining the integrity of the intestine and preventing inflammation, oxidative stress, and insulin resistance (87), while the western diets lead to metabolic endotoxemia by increasing intestinal permeability (86). Indeed, gut dysbiosis can affect various aspects of QOL, including physical and mental health (88–92).

The antidepressant effect of healthy diets with low DII score can also be explained through decreasing cortisol (93) and increasing brain derived neurotropic factor (BDNF) (94–97). Several limitations in the present study should be clarified when interpreting the results of this review including: (a) The number of studies on the association of DII and QOL was limited. (b) There was heterogeneity between studies’ populations (different diseases or conditions) and also questionnaires which assessed the QOL, DII, and food intake. (c) The majority of included studies in this systematic review were cross-sectional studies, which did not show causal and temporal associations. (d) The instruments used to examine diet and quality of life were both self-reported, which may be subject to recall and reporting biases.

 Conclusion

This systematic review demonstrated that an anti-inflammatory diet might be associated with better QOL. However, future well-designed clinical trials on various disease can provide better conclusions especially regarding the quantifying of this relationship.

 Data availability statement

The original contributions presented in this study are included in this article/Supplementary material, further inquiries can be directed to the corresponding author.

 Author contributions

MG and SN contributed to designing the study, searching for resources, and writing the manuscript. MG, SK, VE, and JM cooperated in writing the manuscript. RS contributed to English revising of the manuscript. RM and MM cooperated in literature search. All authors contributed to the article and approved the submitted version.

We express our appreciation to the Research Vice-Chancellor of Tabriz and Maragheh University of Medical Sciences.

 Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fnut.2022.1067468/full#supplementary-material

 Abbreviations

AQLQ, asthma quality of life questionnaire; BDNF, brain derived neurotropic factor; DASH, dietary approaches to stop hypertension; DII, dietary inflammatory index; EQ-5D, EuroQOL-5D; FFQ, food frequency questionnaire; GPCRs, G protein-coupled receptors; HF, heart failure; 24HR, 24-hour food recall; hs-CRP, high-sensitivity C-reactive protein; IL, interleukin; IR, insulin resistance; MS, multiple sclerosis; MSQOL-54, multiple sclerosis quality of life; P, pain; PF, physical function; PH, physical health; PRISMA-P, preferred reporting items for systematic reviews and meta-analyses protocols; QOL, quality of life; RCT, randomized control trial; ROS, reactive oxygen species; RP, role limitation due to physical health; SCFAs, short-chain fatty acids; SF, social function; SF-12, short-form 12; SF-36, short-form 36; TNF-α, tumor necrosis factor.

 References Felce D Perry J. Quality of life: its definition and measurement. Res Dev Disabil. (1995) 16:51–74. 10.1016/0891-4222(94)00028-8 Megari K. Quality of life in chronic disease patients. Health Psychol Res. (2013) 1:e27. 10.4081/hpr.2013.e27 26973912 Tourani S Behzadifar M Martini M Aryankhesal A Taheri Mirghaed M Salemi M Health-related quality of life among healthy elderly Iranians: a systematic review and meta-analysis of the literature. Health Qual Life Outcomes. (2018) 16:1–9. 10.1186/s12955-018-0845-7 29347951 Kay A. Asthma and inflammation. J Allergy Clin Immunol. (1991) 87:893–910. 10.1016/0091-6749(91)90408-G Cachofeiro V Goicochea M De Vinuesa SG Oubiña P Lahera V Luño J. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease: new strategies to prevent cardiovascular risk in chronic kidney disease. Kidney Int. (2008) 74:S4–9. 10.1038/ki.2008.516 19034325 Frischer JM Bramow S Dal-Bianco A Lucchinetti CF Rauschka H Schmidbauer M The relation between inflammation and neurodegeneration in multiple sclerosis brains. Brain. (2009) 132:1175–89. 10.1093/brain/awp070 19339255 Goldring MB Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. (2011) 23:471. 10.1097/BOR.0b013e328349c2b1 21788902 Ellulu MS Patimah I Khaza’ai H Rahmat A Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. (2017) 13:851. 10.5114/aoms.2016.58928 28721154 Guo Q Wang Y Xu D Nossent J Pavlos NJ Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. (2018) 6:1–14. 10.1038/s41413-018-0016-9 29736302 Jiang NM Cowan M Moonah SN Petri WA Jr. The impact of systemic inflammation on neurodevelopment. Trends Mol Med. (2018) 24:794–804. 10.1016/j.molmed.2018.06.008 30006148 Peirce JM Alviña K. The role of inflammation and the gut microbiome in depression and anxiety. J Neurosci Res. (2019) 97:1223–41. 10.1002/jnr.24476 31144383 Pengpid S Peltzer K. The impact of chronic diseases on the quality of life of primary care patients in Cambodia, Myanmar and Vietnam. Iran J Public Health. (2018) 47:1308. 30320005 Giugliano D Ceriello A Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. (2006) 48:677–85. 10.1016/j.jacc.2006.03.052 16904534 Bulló M Casas-Agustench P Amigó-Correig P Aranceta J Salas-Salvadó J. Inflammation, obesity and comorbidities: the role of diet. Public Health Nutr. (2007) 10:1164–72. 10.1017/S1368980007000663 17903326 Galland L. Diet and inflammation. Nutr Clin Pract. (2010) 25:634–40. 10.1177/0884533610385703 21139128 Saghafi-Asl M Mirmajidi S Asghari Jafarabadi M Vahid F Shivappa N Hébert JR The association of dietary patterns with dietary inflammatory index, systemic inflammation, and insulin resistance, in apparently healthy individuals with obesity. Sci Rep. (2021) 11:1–8. 10.1038/s41598-021-86993-7 33824355 Shivappa N Steck SE Hurley TG Hussey JR Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. (2014) 17:1689–96. 10.1017/S1368980013002115 23941862 Tabung FK Steck SE Zhang J Ma Y Liese AD Agalliu I Construct validation of the dietary inflammatory index among postmenopausal women. Ann Epidemiol. (2015) 25:398–405. 10.1016/j.annepidem.2015.03.009 25900255 Na W Kim M Sohn C. Dietary inflammatory index and its relationship with high-sensitivity C-reactive protein in Korean: data from the health examinee cohort. J Clin Biochem Nutr. (2018) 62:83–8. 10.3164/jcbn.17-22 29371758 Shivappa N Blair CK Prizment AE Jacobs DR Hébert JR. Prospective study of the dietary inflammatory index and risk of breast cancer in postmenopausal women. Mol Nutr Food Res. (2017) 61:1600592. 10.1002/mnfr.201600592 27860246 Tabung FK Steck SE Ma Y Liese AD Zhang J Caan B The association between dietary inflammatory index and risk of colorectal cancer among postmenopausal women: results from the women’s health initiative. Cancer Causes Control. (2015) 26:399–408. 10.1007/s10552-014-0515-y 25549833 Veronese N Shivappa N Stubbs B Smith T Hébert JR Cooper C The relationship between the dietary inflammatory index and prevalence of radiographic symptomatic osteoarthritis: data from the osteoarthritis initiative. Eur J Nutr. (2019) 58:253–60. 10.1007/s00394-017-1589-6 29209774 Wirth M Burch J Shivappa N Violanti JM Burchfiel CM Fekedulegn D Association of a dietary inflammatory index with inflammatory indices and the metabolic syndrome among police officers. J Occup Environ Med. (2014) 56:986. 10.1097/JOM.0000000000000213 25046320 Wood LG Shivappa N Berthon BS Gibson PG Hebert JR. Dietary inflammatory index is related to asthma risk, lung function and systemic inflammation in asthma. Clin Exp Allergy. (2015) 45:177–83. 10.1111/cea.12323 24708388 Herzog R Álvarez-Pasquin M Díaz C Del Barrio JL Estrada JM Gil Á. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. (2013) 13:154. 10.1186/1471-2458-13-154 23421987 Jadad AR Moore RA Carroll D Jenkinson C Reynolds DJM Gavaghan DJ Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. (1996) 17:1–12. 10.1016/0197-2456(95)00134-4 Lo CKL Mertz D Loeb M. Newcastle-Ottawa scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. (2014) 14:45. 10.1186/1471-2288-14-45 24690082 Toopchizadeh V Dolatkhah N Aghamohammadi D Rasouli M Hashemian M. Dietary inflammatory index is associated with pain intensity and some components of quality of life in patients with knee osteoarthritis. BMC Res Notes. (2020) 13:448. 10.1186/s13104-020-05277-x 32958008 Yucel U Ucar A Soezener Z Balaban S Mungan D Misirligil Z Effects of dietary intervention on diet inflammatory index and asthma characteristics in obese asthmatic individuals: randomized controlled trial. Eur J Pulmonol. (2021) 23:145–51. Mousavi-Shirazi-Fard Z Mazloom Z Izadi S Fararouei M. The effects of modified anti-inflammatory diet on fatigue, quality of life, and inflammatory biomarkers in relapsing-remitting multiple sclerosis patients: a randomized clinical trial. Int J Neurosci. (2021) 131:657–65. 10.1080/00207454.2020.1750398 32249637 Yaseri M Alipoor E Hafizi N Maghsoudi-Nasab S Shivappa N Hebert JR Dietary inflammatory index is a better determinant of quality of life compared to obesity status in patients with hemodialysis. J Renal Nutr. (2021) 31:313–9. 10.1053/j.jrn.2020.07.006 32952007 Tabrizi FPF Farhangi MA. Is there any mediatory association between health-related quality of life and eating behaviors to affect dietary inflammatory index (DII) among reproductive-aged women? A structural equation modeling approach. Nutr Clin Metab. (2021) 35:288–96. 10.1016/j.nupar.2021.06.003 Song D Kim J Kang M Park J Lee H Kim DY Association between the dietary inflammatory index and bone markers in postmenopausal women. PLoS One. (2022) 17:e0265630. 10.1371/journal.pone.0265630 35298570 Kuczmarski MF Orsega-Smith E Mode NA Rawal R Evans MK Zonderman AB. Healthy behaviors associated with changes in mental and physical strength in urban African American and white adults. Nutrients. (2021) 13:1824. 10.3390/nu13061824 34071874 Lycett KM Wijayawickrama DJ Liu MJ Grobler A Burgner DP Baur LA Does an inflammatory diet affect mental well-being in late childhood and mid-life? A cross-sectional study. Br J Nutr. (2022) 127:939–47. 10.1017/S0007114521001616 33998415 Giugliano D Esposito K. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. (2008) 19:63–8. 10.1097/MOL.0b013e3282f2fa4d 18196989 Asemi Z Samimi M Tabassi Z Sabihi S-S Esmaillzadeh A. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition. (2013) 29:619–24. 10.1016/j.nut.2012.11.020 23466048 Saneei P Hashemipour M Kelishadi R Esmaillzadeh A. The dietary approaches to stop hypertension (DASH) diet affects inflammation in childhood metabolic syndrome: a randomized cross-over clinical trial. Ann Nutr Metab. (2014) 64:20–7. 10.1159/000358341 24686130 Nani A Murtaza B Sayed Khan A Khan NA Hichami A. Antioxidant and anti-inflammatory potential of polyphenols contained in mediterranean diet in obesity: molecular mechanisms. Molecules. (2021) 26:985. 10.3390/molecules26040985 33673390 Christ A Lauterbach M Latz E. Western diet and the immune system: an inflammatory connection. Immunity. (2019) 51:794–811. 10.1016/j.immuni.2019.09.020 31747581 Govindaraju T Sahle BW Mccaffrey TA Mcneil JJ Owen AJ. Dietary patterns and quality of life in older adults: a systematic review. Nutrients. (2018) 10:971. 10.3390/nu10080971 30050006 Vajdi M Farhangi MA. A systematic review of the association between dietary patterns and health-related quality of life. Health Qual Life Outcomes. (2020) 18:1–15. 10.1186/s12955-020-01581-z 33046091 Wu XY Zhuang LH Li W Guo HW Zhang JH Zhao YK The influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents: a systematic review and meta-analysis. Qual Life Res. (2019) 28:1989–2015. 10.1007/s11136-019-02162-4 30875010 Romero-Robles MA Ccami-Bernal F Ortiz-Benique ZN Pinto-Ruiz DF Benites-Zapata VA Casas Patiño D. Adherence to Mediterranean diet associated with health-related quality of life in children and adolescents: a systematic review. BMC Nutr. (2022) 8:57. 10.1186/s40795-022-00549-0 35739603 Rifai L Pisano C Hayden J Sulo S Silver MA. Impact of the DASH diet on endothelial function, exercise capacity, and quality of life in patients with heart failure. Proc (Bayl Univ Med Cent). (2015) 28:151–6. 10.1080/08998280.2015.11929216 25829641 Idelson PI Scalfi L Valerio G. Adherence to the mediterranean diet in children and adolescents: a systematic review. Nutr Metab Cardiovasc Dis. (2017) 27:283–99. 10.1016/j.numecd.2017.01.002 28254269 La J Roberts NH Yafi FA. Diet and men’s sexual health. Sex Med Rev. (2018) 6:54–68. 10.1016/j.sxmr.2017.07.004 28778698 Towe M La J El-Khatib F Roberts N Yafi FA Rubin R. Diet and female sexual health. Sex Med Rev. (2020) 8:256–64. 10.1016/j.sxmr.2019.08.004 31669123 Martinovic D Tokic D Martinovic L Kumric M Vilovic M Rusic D Adherence to the mediterranean diet and its association with the level of physical activity in fitness center users: Croatian-based study. Nutrients. (2021) 13:4038. 10.3390/nu13114038 34836293 Scoditti E Tumolo MR Garbarino S. Mediterranean diet on sleep: a health alliance. Nutrients. (2022) 14:2998. 10.3390/nu14142998 35889954 Hébert JR Shivappa N Wirth MD Hussey JR Hurley TG. Perspective: the dietary inflammatory index (DII)—lessons learned, improvements made, and future directions. Adv Nutr. (2019) 10:185–95. 10.1093/advances/nmy071 30615051 Kotemori A Sawada N Iwasaki M Yamaji T Shivappa N Hebert JR Dietary inflammatory index is associated with inflammation in Japanese men. Front Nutr. (2021) 8:604296. 10.3389/fnut.2021.604296 33898494 El-Ali Z El-Kassas G Ziade FM Shivappa N Hébert JR Zmerly H Evaluation of circulating levels of interleukin-10 and interleukin-16 and dietary inflammatory index in lebanese knee osteoarthritis patients. Heliyon. (2021) 7:e07551. 10.1016/j.heliyon.2021.e07551 34337179 Orchard T Yildiz V Steck SE Hébert JR Ma Y Cauley JA Dietary inflammatory index, bone mineral density, and risk of fracture in postmenopausal women: results from the women’s health initiative. J Bone Miner Res. (2017) 32:1136–46. 10.1002/jbmr.3070 28019686 Li R Zhan W Huang X Wang J Lv S Liang L Associations between dietary inflammatory index (DII) and bone health among postmenopausal women in the United States. Int J Gynaecol Obstet. (2022) 158:663–70. 10.1002/ijgo.14024 34767250 Aslani Z Abshirini M Heidari-Beni M Siassi F Qorbani M Shivappa N Dietary inflammatory index and dietary energy density are associated with menopausal symptoms in postmenopausal women: a cross-sectional study. Menopause. (2020) 27:568–78. 10.1097/GME.0000000000001502 32068687 Bohlouli J Namjoo I Borzoo-Isfahani M Poorbaferani F Moravejolahkami AR Clark CC Modified Mediterranean diet v. traditional Iranian diet: efficacy of dietary interventions on dietary inflammatory index score, fatigue severity and disability in multiple sclerosis patients. Br J Nutr. (2022) 128:1274–84. 10.1017/S000711452100307X 34392854 Ruiz-Canela M Zazpe I Shivappa N Hébert JR Sanchez-Tainta A Corella D Dietary inflammatory index and anthropometric measures of obesity in a population sample at high cardiovascular risk from the PREDIMED (PREvencion con DIeta MEDiterranea) trial. Br J Nutr. (2015) 113:984–95. 10.1017/S0007114514004401 25720588 Gholamalizadeh M Ahmadzadeh M Bourbour F Vahid F Ajami M Majidi N Associations between the dietary inflammatory index with obesity and body fat in male adolescents. BMC Endocr Disord. (2022) 22:115. 10.1186/s12902-022-01001-x 35501761 Wang YB Shivappa N Hébert JR Page AJ Gill TK Melaku YA. Association between dietary inflammatory index, dietary patterns, plant-based dietary index and the risk of obesity. Nutrients. (2021) 13:1536. 10.3390/nu13051536 34063221 Ferreira YAM Kravchychyn ACP Vicente SDCF Campos RMDS Tock L Oyama LM An interdisciplinary weight loss program improves body composition and metabolic profile in adolescents with obesity: associations with the dietary inflammatory index. Front Nutr. (2019) 6:77. 10.3389/fnut.2019.00077 31214594 Cavicchia PP Steck SE Hurley TG Hussey JR Ma Y Ockene IS A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr. (2009) 139:2365–72. 10.3945/jn.109.114025 19864399 Amato M Ponziani G Rossi F Liedl C Stefanile C Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler J. (2001) 7:340–4. 10.1177/135245850100700511 11724451 Janardhan V Bakshi R. Quality of life in patients with multiple sclerosis: the impact of fatigue and depression. J Neurol Sci. (2002) 205:51–8. 10.1016/S0022-510X(02)00312-X Van Schoor N Smit J Twisk J Lips P. Impact of vertebral deformities, osteoarthritis, and other chronic diseases on quality of life: a population-based study. Osteoporos Int. (2005) 16:749–56. 10.1007/s00198-004-1744-9 15480572 Drayer RA Piraino B Reynolds Iii CF Houck PR Mazumdar S Bernardini J Characteristics of depression in hemodialysis patients: symptoms, quality of life and mortality risk. Gen Hosp Psychiatry. (2006) 28:306–12. 10.1016/j.genhosppsych.2006.03.008 16814629 Tepavcevic D Kostic J Basuroski I Stojsavljevic N Pekmezovic T Drulovic J. The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler J. (2008) 14:1131–6. 10.1177/1352458508093619 18632783 Dixon JB. The effect of obesity on health outcomes. Mol Cell Endocrinol. (2010) 316:104–8. 10.1016/j.mce.2009.07.008 19628019 Bayoumi M Al Harbi A Al Suwaida A Al Ghonaim M Al Wakeel J Mishkiry A. Predictors of quality of life in hemodialysis patients. Saudi J Kidney Dis Transpl. (2013) 24:254. 10.4103/1319-2442.109566 23538347 Booth S Johnson MJ. Improving the quality of life of people with advanced respiratory disease and severe breathlessness. Breathe. (2019) 15:198–215. 10.1183/20734735.0200-2019 31508158 Stephenson J Smith C Kearns B Haywood A Bissell P. The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study. BMC Public Health. (2021) 21:1990. 10.1186/s12889-021-12009-8 34732156 Thapa P Thebe P. Quality of life of postmenopausal women in rural area, Nepal. Post Reprod Health. (2021) 27:151–7. 10.1177/20533691211014741 34098788 Dixon AE Pratley RE Forgione PM Kaminsky DA Whittaker-Leclair LA Griffes LA Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammation. J Allergy Clin Immunol. (2011) 128:508–15.e1–5. 10.1016/j.jaci.2011.06.009 21782230 Monadi M Firouzjahi A Hosseini A Javadian Y Sharbatdaran M Heidari B. Serum C-reactive protein in asthma and its ability in predicting asthma control, a case-control study. Caspian J Intern Med. (2016) 7:37. 26958331 Zhang X Zheng J Zhang L Liu Y Chen GP Wang L Systemic inflammation mediates the detrimental effects of obesity on asthma control. Allergy Asthma Proc. (2018) 39:43–50. 10.2500/aap.2018.39.4096 29279059 Spector T Hart D Nandra D Doyle D Mackillop N Gallimore J Low-level increases in serum C-reactive protein are present in early osteoarthritis of the knee and predict progressive disease. Arthritis Rheum. (1997) 40:723–7. 10.1002/art.1780400419 9125256 Sokolove J Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis. (2013) 5:77–94. 10.1177/1759720X12467868 23641259 Lassmann H Van Horssen J Mahad D. Progressive multiple sclerosis: pathology and pathogenesis. Nat Rev Neurol. (2012) 8:647–56. 10.1038/nrneurol.2012.168 23007702 Inui A Meguid MM. Cachexia and obesity: two sides of one coin? Curr Opin Clin Nutr Metab Care. (2003) 6:395–9. 10.1097/01.mco.0000078989.18774.74 12806212 Kirwan AM Lenighan YM O’reilly ME Mcgillicuddy FC Roche HM. Nutritional modulation of metabolic inflammation. Biochem Soc Trans. (2017) 45:979–85. 10.1042/BST20160465 28710289 Barbour KE Boudreau R Danielson ME Youk AO Wactawski-Wende J Greep NC Inflammatory markers and the risk of hip fracture: the women’s health initiative. J Bone Miner Res. (2012) 27:1167–76. 10.1002/jbmr.1559 22392817 Tella SH Gallagher JC. Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol. (2014) 142:155–70. 10.1016/j.jsbmb.2013.09.008 24176761 Spittle M Hoenich NA Handelman G Adhikarla R Homel P Levin NW. Oxidative stress and inflammation in hemodialysis patients. In: Avram MM editor. Improving Prognosis for Kidney Disorders. Dordrecht: Springer (2002). p. 45–52. 10.1007/978-94-017-1848-6_5 De Filippis F Pellegrini N Vannini L Jeffery IB La Storia A Laghi L High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. (2016) 65:1812–21. 10.1136/gutjnl-2015-309957 26416813 Bach-Faig A Berry EM Lairon D Reguant J Trichopoulou A Dernini S Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. (2011) 14:2274–84. 10.1017/S1368980011002515 22166184 Merra G Noce A Marrone G Cintoni M Tarsitano MG Capacci A Influence of mediterranean diet on human gut microbiota. Kompass Nutr Diet. (2022) 2:19–25. 10.1159/000523727 Yoo JY Groer M Dutra SVO Sarkar A Mcskimming DI. Gut microbiota and immune system interactions. Microorganisms. (2020) 8:1587. 10.3390/microorganisms8101587 33076307 Frati F Salvatori C Incorvaia C Bellucci A Di Cara G Marcucci F The role of the microbiome in asthma: the gut–lung axis. Int J Mol Sci. (2018) 20:123. 10.3390/ijms20010123 30598019 Kirby TO Ochoa-Repáraz J. The gut microbiome in multiple sclerosis: a potential therapeutic avenue. Med Sci. (2018) 6:69. 10.3390/medsci6030069 30149548 Tseng C-H Wu C-Y. The gut microbiome in obesity. J Formos Med Assoc. (2019) 118:S3–9. 10.1016/j.jfma.2018.07.009 30057153 Järbrink-Sehgal E Andreasson A. The gut microbiota and mental health in adults. Curr Opin Neurobiol. (2020) 62:102–14. 10.1016/j.conb.2020.01.016 32163822 Chisari E Wouthuyzen-Bakker M Friedrich AW Parvizi J. The relation between the gut microbiome and osteoarthritis: a systematic review of literature. PLoS One. (2021) 16:e0261353. 10.1371/journal.pone.0261353 34914764 Herbert J. Cortisol and depression: three questions for psychiatry. Psychol Med. (2013) 43:449–69. 10.1017/S0033291712000955 22564216 Castrén E Berninger B Leingärtner A Lindholm D. Regulation of brain-derived neurotrophic factor mRNA levels in hippocampus by neuronal activity. Prog Brain Res. (1998) 117:57–64. 10.1016/S0079-6123(08)64007-8 Molteni R Barnard R Ying Z Roberts C Gomez-Pinilla F. A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning. Neuroscience. (2002) 112:803–14. 10.1016/S0306-4522(02)00123-9 12088740 Lopez-Garcia E Schulze MB Fung TT Meigs JB Rifai N Manson JE Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. (2004) 80:1029–35. 10.1093/ajcn/80.4.1029 15447916 Esmaillzadeh A Kimiagar M Mehrabi Y Azadbakht L Hu FB Willett WC. Dietary patterns and markers of systemic inflammation among Iranian women. J Nutr. (2007) 137:992–8. 10.1093/jn/137.4.992 17374666 Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. (2002) 13:3–9. 10.1097/00041433-200202000-00002 11790957 Myles IA. Fast food fever: reviewing the impacts of the Western diet on immunity. Nutr J. (2014) 13:1–17. 10.1186/1475-2891-13-61 24939238 Khayyatzadeh SS Bagherniya M Fazeli M Khorasanchi Z Bidokhti MS Ahmadinejad M A Western dietary pattern is associated with elevated level of high sensitive C-reactive protein among adolescent girls. Eur J Clin Investig. (2018) 48:e12897. 10.1111/eci.12897 29377099 Tomasello G Mazzola M Leone A Sinagra E Zummo G Farina F Nutrition, oxidative stress and intestinal dysbiosis: influence of diet on gut microbiota in inflammatory bowel diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. (2016) 160:461–6. 10.5507/bp.2016.052 27812084 Zinöcker MK Lindseth IA. The Western diet–microbiome-host interaction and its role in metabolic disease. Nutrients. (2018) 10:365. 10.3390/nu10030365 29562591 Esmaillzadeh A Kimiagar M Mehrabi Y Azadbakht L Hu FB Willett WC. Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. Am J Clin Nutr. (2007) 85:910–8. 10.1093/ajcn/85.3.910 17344515 Maurer M Riesen W Muser J Hulter HN Krapf R. Neutralization of Western diet inhibits bone resorption independently of K intake and reduces cortisol secretion in humans. Am J Physiol Renal Physiol. (2003) 284:F32–40. 10.1152/ajprenal.00212.2002 12388390 Shaito A Hasan H Habashy KJ Fakih W Abdelhady S Ahmad F Western diet aggravates neuronal insult in post-traumatic brain injury: proposed pathways for interplay. EBioMedicine. (2020) 57:102829. 10.1016/j.ebiom.2020.102829 32574954