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Original article Association of dietary inflammatory index with mortality risk: a prospective analysis of the Korea National Health and Nutrition Examination Survey
Dahyun Park1orcid , Hee Ju Jun2orcid , Garam Jo2orcid , Soyoung Kwak3,4orcid , Min-Jeong Shin2,5orcid
Epidemiol Health 2025;e2025017
DOI: https://doi.org/10.4178/epih.e2025017 [Accepted]
Published online: April 9, 2025
1Multidisciplinary Research Center for Public Health in Complex System, Korea University, Seoul, Korea
2Interdisciplinary Program in Precision Public Health, Graduate School of Korea University, Seoul, Korea
3Perlmutter Cancer Center, NYU Langone Health, New York, United States
4Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA, New York, United States
5School of Biosystems and Biomedical Sciences, College of Health Science, Korea University, Seoul, Korea
Corresponding author:  Min-Jeong Shin,
Email: mjshin@korea.ac.kr
Received: 21 November 2024   • Revised: 4 March 2025   • Accepted: 18 March 2025
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Abstract

OBJECTIVES
The energy-adjusted dietary inflammatory index (E-DII), a tool developed based on comprehensive research and literature reviews, is used to assess the inflammatory potential of specific diets. Although previous research has demonstrated an association between E-DII and mortality, longitudinal studies investigating a causal relationship in Asian populations are lacking. This study aimed to explore the prospective association between E-DII and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality using a population-based Korean cohort.
METHODS
The analysis included data from 40,596 individuals who participated in the Korea National Health and Nutrition Examination Survey between 2007 and 2015. The exclusion criteria encompassed the diagnosis of cancer or CVD at baseline, pregnancy at baseline, and death within the first 2 years after baseline. The E-DII was calculated using data from 24-hour dietary recall interviews. Cox proportional hazard regression models were employed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality risk across E-DII tertiles.
RESULTS
Over an 8.2-year follow-up period, 2,070 deaths were recorded. Compared with the lowest E-DII, a higher index was associated with an increased risk of mortality from all causes (HR, 1.45; 95% CI, 1.25 to 1.69), cancer (HR, 1.41; 95% CI, 1.09 to 1.81), and CVD (HR, 1.53; 95% CI, 1.07 to 2.18). The association between E-DII and all-cause mortality was particularly pronounced among individuals with metabolic conditions.
CONCLUSIONS
Our findings suggest a strong positive association between high E-DII and increased mortality in Korean adults, especially those with metabolic disorders.

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