Association of Dietary Inflammatory Index and Oxidative Balance Score with All-Cause and Cardiovascular Mortality in US Non-Diabetic Adults

Yunan HanLin LiYongxiang WangWen Fan^*

• The First Affiliated Hospital of Yangtze University, Jingzhou, China

Background: Inflammation and oxidative stress (OS) are critical factors in the pathogenesis of chronic diseases (CDs), with dietary factors being a central modifiable determinant. This study aimed to assess the association of the Dietary Inflammation Index (DII) and Dietary Oxidative Balance Score (DOBS) with all-cause and cardiovascular (CV) mortality in non-diabetic adults. Methods: Data on non-diabetic adults were extracted from National Health and Nutrition Examination Survey (NHANES) (2009-2018). Dietary information was collected via 24-hour recalls, and DII and DOBS were calculated. Multivariate weighted Cox proportional hazards models, Kaplan-Meier (KM) survival analysis and restricted cubic spline (RCS) analyses were conducted to assess mortality associations. Subgroup analyses were performed based on gender, age, BMI, smoking, hypertension, and hyperlipidemia. Results: After applying multivariable-weighted Cox proportional hazards regression, participants with the highest DII quartile exhibited elevated risks of all-cause mortality [Q4: HR=1.554 (1.258, 1.934)] and CV mortality [Q4: HR=2.100 (1.307, 3.375)]. In contrast, the highest DOBS quartile was linked to reduced all-cause mortality [Q4: HR =0.724 (0.553, 0.946)], with no significant association observed for CV mortality. RCS analyses confirmed a positive dose-response between DII and both mortality outcomes, as well as an inverse relationship for DOBS. Subgroup analyses revealed that high DOBS (Q4) scores were negatively associated with all-cause and CV mortality in women, individuals aged ≥ 60 years, current smokers, hypertensive individuals, and those without dyslipidemia. High DII (Q4) scores were positively associated with all-cause mortality across sexes, individuals aged ≥ 60 years, smokers, and those with hypertension or dyslipidemia. Additionally, high DII scores were associated with CV mortality among women, both smokers and non-smokers, and individuals without hypertension or dyslipidemia. Conclusion: Higher DOBS levels are associated with lower all-cause mortality, while higher DII levels are linked to increased all-cause and CV mortality. Dietary interventions targeting inflammation may reduce mortality risks, thereby informing public health strategies.