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Peer-reviewedCC BYAmerican Journal of Otolaryngology

Association of the energy-adjusted children's dietary inflammatory index with hearing loss in school-aged children: A cross-sectional study of NHANES 2005–2020

  • Lei Lei1
  • Zhaoping He2
  • Xiaoru Sun3
  • Haiyang Wang3
  • Jian Zou4
4 affiliations
  1. 1Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital of Sichuan University, 37 Guoxue Hang, Wuhou District, Chengdu, Sichuan, 610041, China; Nemours Biomedical Research, Nemours Children's Health, Delaware, 1600 Rockland Rd., Wilmington, DE, 19803, USA
  2. 2Nemours Biomedical Research, Nemours Children's Health, Delaware, 1600 Rockland Rd., Wilmington, DE, 19803, USA; Corresponding authors.
  3. 3Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital of Sichuan University, 37 Guoxue Hang, Wuhou District, Chengdu, Sichuan, 610041, China
  4. 4Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital of Sichuan University, 37 Guoxue Hang, Wuhou District, Chengdu, Sichuan, 610041, China; Corresponding authors.
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Abstract

Objective: Hearing loss (HL) has been linked to a pro-inflammatory diet. This study evaluated the association between HL and the Energy-Adjusted Children's Dietary Inflammatory Index (EC-DII), a comprehensive inflammatory assessment of dietary nutrients in children. Methods: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) for children aged 6 to 14 years who completed both audiometric testing and 24-h dietary assessments between 2005 and 2020. HL was defined as audiometric thresholds ≥16 dB on the pure-tone average of 0.5, 1, 2, and 4 kHz for speech frequency (SFHL) and 3, 4, and 6 kHz for high frequency (HFHL). EC-DII scores (Energy-adjusted per 1000 kcal to account for differences in total energy intake) were calculated for each participant and classified into quartile I-IV. The association was evaluated using multivariable logistic regression models, with statistical significance reported as p -values, odds ratios (ORs), and 95% confidence intervals (CIs). Results: In adjusted regression analysis model, EC-DII scores were significantly associated with an increased risk of HFHL (OR = 1.16, CI = 1.06–1.27, p = 0.001) and SFHL (OR = 1.16, CI = 1.04–1.30, p = 0.009). EC-DII quartile IV, the highest level of dietary inflammation, was associated with an increased risk of HFHL (OR = 1.33; CI 1.09–1.6, p = 0.004) and SFHL (OR = 1.31, CI 1.06–1.63, p = 0.017). Conclusion: The study demonstrated that higher EC-DII scores, as well as the highest dietary inflammatory level quartile IV, were significantly associated with HL. Due to the cross-sectional nature of the study, causal inferences and temporal relationships could not be established. Therefore, the potential contribution of a pro-inflammatory diet, as quantified by the EC-DII, to the development of HL in children requires further investigation through prospective cohort studies and well-designed clinical trials.

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Cite

BibTeXRIS
BibTeX
@article{lei2026association,
  title = {{Association of the energy-adjusted children's dietary inflammatory index with hearing loss in school-aged children: A cross-sectional study of NHANES 2005–2020}},
  author = {Lei Lei and Zhaoping He and Xiaoru Sun and Haiyang Wang and Jian Zou},
  journal = {American Journal of Otolaryngology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.amjoto.2026.104963},
  url = {https://doi.org/10.1016/j.amjoto.2026.104963},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Association of the energy-adjusted children's dietary inflammatory index with hearing loss in school-aged children: A cross-sectional study of NHANES 2005–2020
AU  - Lei Lei
AU  - Zhaoping He
AU  - Xiaoru Sun
AU  - Haiyang Wang
AU  - Jian Zou
PY  - 2026
DA  - 2026/10/30
JO  - American Journal of Otolaryngology
DO  - 10.1016/j.amjoto.2026.104963
UR  - https://doi.org/10.1016/j.amjoto.2026.104963
AB  - Objective: Hearing loss (HL) has been linked to a pro-inflammatory diet. This study evaluated the association between HL and the Energy-Adjusted Children's Dietary Inflammatory Index (EC-DII), a comprehensive inflammatory assessment of dietary nutrients in children. Methods: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) for children aged 6 to 14 years who completed both audiometric testing and 24-h dietary assessments between 2005 and 2020. HL was defined as audiometric thresholds ≥16 dB on the pure-tone average of 0.5, 1, 2, and 4 kHz for speech frequency (SFHL) and 3, 4, and 6 kHz for high frequency (HFHL). EC-DII scores (Energy-adjusted per 1000 kcal to account for differences in total energy intake) were calculated for each participant and classified into quartile I-IV. The association was evaluated using multivariable logistic regression models, with statistical significance reported as p -values, odds ratios (ORs), and 95% confidence intervals (CIs). Results: In adjusted regression analysis model, EC-DII scores were significantly associated with an increased risk of HFHL (OR = 1.16, CI = 1.06–1.27, p = 0.001) and SFHL (OR = 1.16, CI = 1.04–1.30, p = 0.009). EC-DII quartile IV, the highest level of dietary inflammation, was associated with an increased risk of HFHL (OR = 1.33; CI 1.09–1.6, p = 0.004) and SFHL (OR = 1.31, CI 1.06–1.63, p = 0.017). Conclusion: The study demonstrated that higher EC-DII scores, as well as the highest dietary inflammatory level quartile IV, were significantly associated with HL. Due to the cross-sectional nature of the study, causal inferences and temporal relationships could not be established. Therefore, the potential contribution of a pro-inflammatory diet, as quantified by the EC-DII, to the development of HL in children requires further investigation through prospective cohort studies and well-designed clinical trials.
SN  - 1532-818X
SN  - 0196-0709
ER  -