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Peer-reviewedCC BY 4.0PLOS One

Associations of dietary inflammatory index with incident cardiovascular outcomes and all-cause mortality in patients with prediabetes and type 2 diabetes mellitus: A prospective study of data from the UK Biobank

  • Ya Shi1
  • Jingjing Zeng2
  • Menglin Fan3
  • Bo Chen4
  • Zhaoxia Zhang5
  • Bo Yang
  • Yang Tian
  • Guigao Guo
  • Nan Wang
  • Ying Xing
  • Shaoyong Xu
5 affiliations
  1. 1Department of Endocrinology, Xi’an Daxing Hospital Affiliated to Yan’an University, Xi’an, Shaanxi, China
  2. 2Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
  3. 3Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
  4. 4Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
  5. 5Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Abstract

Background: While the dietary inflammatory index (DII) is linked to cardiovascular disease (CVD) and mortality in the general population, its role in individuals with prediabetes and type 2 diabetes (T2D) remains understudied. Given the elevated inflammatory burden in this high-risk group, we aimed to examine the association between energy-adjusted DII (E-DII) and incident cardiovascular outcomes and all-cause mortality using a prospective cohort from the UK Biobank. Methods: We conducted a prospective cohort study using UK Biobank data, including 18,193 individuals with prediabetes and 6,469 with T2D, all free of cardiovascular disease and cancer at baseline. The E-DII was derived from 24-hour dietary recall data, incident CVD and all-cause mortality were ascertained through linked hospital and death records. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), with a median duration of 12.2 years (IQR: 11.5–13.0). Results: Among participants with T2D, an energy-adjusted DII > 1 (vs. ≥−1 to ≤1) was associated with a higher risk of cardiovascular events (HR 1.24, 95% CI 1.00–1.53) and all-cause mortality (HR 1.36, 95% CI 1.01–1.84). The association with cardiovascular mortality was not statistically significant (HR 1.50, 95% CI 0.76–2.94). No significant associations were observed among participants with prediabetes. Conclusions: A more pro-inflammatory dietary pattern, as measured by the E-DII, is independently associated with increased risks of incident cardiovascular events and all-cause mortality in individuals with T2D. These findings support the integration of DII into nutritional risk assessment for diabetic populations and highlight the potential of dietary modification to improve long-term outcomes.

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Cite

BibTeXRIS
BibTeX
@article{shi2026associations,
  title = {{Associations of dietary inflammatory index with incident cardiovascular outcomes and all-cause mortality in patients with prediabetes and type 2 diabetes mellitus: A prospective study of data from the UK Biobank}},
  author = {Ya Shi and Jingjing Zeng and Menglin Fan and Bo Chen and Zhaoxia Zhang and Bo Yang and Yang Tian and Guigao Guo and Nan Wang and Ying Xing and Shaoyong Xu},
  journal = {PLOS One},
  year = {2026},
  month = nov,
  doi = {10.1371/journal.pone.0360954},
  url = {https://doi.org/10.1371/journal.pone.0360954},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Associations of dietary inflammatory index with incident cardiovascular outcomes and all-cause mortality in patients with prediabetes and type 2 diabetes mellitus: A prospective study of data from the UK Biobank
AU  - Ya Shi
AU  - Jingjing Zeng
AU  - Menglin Fan
AU  - Bo Chen
AU  - Zhaoxia Zhang
AU  - Bo Yang
AU  - Yang Tian
AU  - Guigao Guo
AU  - Nan Wang
AU  - Ying Xing
AU  - Shaoyong Xu
PY  - 2026
DA  - 2026/11/11
JO  - PLOS One
DO  - 10.1371/journal.pone.0360954
UR  - https://doi.org/10.1371/journal.pone.0360954
AB  - Background: While the dietary inflammatory index (DII) is linked to cardiovascular disease (CVD) and mortality in the general population, its role in individuals with prediabetes and type 2 diabetes (T2D) remains understudied. Given the elevated inflammatory burden in this high-risk group, we aimed to examine the association between energy-adjusted DII (E-DII) and incident cardiovascular outcomes and all-cause mortality using a prospective cohort from the UK Biobank. Methods: We conducted a prospective cohort study using UK Biobank data, including 18,193 individuals with prediabetes and 6,469 with T2D, all free of cardiovascular disease and cancer at baseline. The E-DII was derived from 24-hour dietary recall data, incident CVD and all-cause mortality were ascertained through linked hospital and death records. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), with a median duration of 12.2 years (IQR: 11.5–13.0). Results: Among participants with T2D, an energy-adjusted DII > 1 (vs. ≥−1 to ≤1) was associated with a higher risk of cardiovascular events (HR 1.24, 95% CI 1.00–1.53) and all-cause mortality (HR 1.36, 95% CI 1.01–1.84). The association with cardiovascular mortality was not statistically significant (HR 1.50, 95% CI 0.76–2.94). No significant associations were observed among participants with prediabetes. Conclusions: A more pro-inflammatory dietary pattern, as measured by the E-DII, is independently associated with increased risks of incident cardiovascular events and all-cause mortality in individuals with T2D. These findings support the integration of DII into nutritional risk assessment for diabetic populations and highlight the potential of dietary modification to improve long-term outcomes.
SN  - 1932-6203
ER  -