Dietary Inflammatory Index and Cardiovascular Risk and Mortality: An Updated Systematic Review and Meta-Analysis

Yu Ni¹Qian Yao²Ting Xu³XiuChuan Li^4*

• ¹Chengdu Medical College, Chengdu, China
• ²Chengdu Third People's Hospital, Chengdu, China
• ³Chengdu University of Traditional Chinese Medicine, Chengdu, China
• ⁴Chinese People's Liberation Army Western Theater General Hospital, Chengdu, China

Background Cardiovascular 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.. Methods A 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. Results Thirty 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). Conclusion Higher 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.