The association between dietary inflammatory index and diabetic foot ulcers in type 2 diabetes: a case-control study

Sultan Mohammed Alanazi¹Ohoud Aied Alabonassir²Saleh Hussain A Almasabi^2*Khalid Alhazmi³Majid Ali Alotni⁴Dahlia Soleman A. Mirdad⁵Salah Alghamdi³

• ¹Northern Border University, Arar, Saudi Arabia
• ²Department of Surgery, College of Medicine, Najran University, Najran, Saudi Arabia
• ³University of Tabuk, Tabuk, Saudi Arabia
• ⁴Qassim University, Buraydah, Saudi Arabia
• ⁵University of Jeddah, Jeddah, Saudi Arabia

Abstract Background: Diabetic foot ulcers (DFUs) are a major complication of type 2 diabetes mellitus (T2DM). This study examined the association between the Energy-adjusted Dietary Inflammatory Index (E-DII) and odds of DFUs. Methods: In a case-control study, 100 patients with DFUs and 150 T2DM controls were recruited. Dietary intake was assessed using a validated FFQ, and E-DII scores were calculated. Logistic regression estimated odds of DFUs across E-DII tertiles. Results: DFU patients had higher E-DII scores than controls (2.1 vs. 1.5, p<0.001). E-DII scores were positively correlated with both ulcer duration (ρ = 0.32, p = 0.002) and PEDIS score (ρ = 0.45, p < 0.001). Multivariable logistic regression showed that higher E-DII scores were significantly associated with increased DFU risk (OR for highest tertile: 1.94 [1.02-3.67]). Conclusion: Our findings suggest that a pro-inflammatory diet, as measured by the E-DII, is associated with an increased odds and severity of DFUs in individuals with T2DM.