Association Between the Dietary Inflammatory Index and Obesity in Peruvian Adults Aged 18 to 59 Years: Analytical Cross-Sectional Study
DOI:
https://doi.org/10.14306/renhyd.30.1.2645Keywords:
Diet, Obesity, Body Mass Index, Adults, PeruAbstract
Introduction: The Dietary Inflammatory Index (DII) is a parameter that assesses diet quality through its inflammatory load and helps prevent the burden of non-communicable diseases. In Peru, there are no reports on the inflammatory capacity of the diet.
Objective: To determine the association between the DII and obesity and abdominal obesity in Peruvian adults aged 18 to 59 years, using data from the 2017–2018 Food and Nutritional Surveillance by Life Stage Survey (VIANEV).
Methods: An analytical cross-sectional study was conducted, applying the DII to assess the inflammatory potential of the diet. The DII was calculated from 24-hour dietary recalls, standardizing consumption against global referent values and summing inflammatory scores. Obesity was defined as a body mass index (BMI) ≥30 kg/m² and abdominal obesity as a waist-to-height ratio (WHtR) ≥0.5. Multivariable Poisson regression models were applied, and prevalence ratios (PR) are reported.
Results: The prevalence of obesity and abdominal obesity was 26.8% (95% CI: 22.3–29.2) and 85.4% (95% CI: 82.8–87.8), respectively. After adjusting for sex, age, and geographic domain, adults in the highest DII quartile had twice the prevalence of obesity (PR: 2.01; 95% CI: 1.17–2.36) and 2.71 times the prevalence of abdominal obesity (PR: 2.71; 95% CI: 1.56–3.21) compared to the lowest quartile.
Conclusions: Consumption of a diet with a higher inflammatory score is associated with a greater likelihood of obesity and abdominal obesity. These findings highlight the importance of anti-inflammatory diets in obesity prevention in Peru and suggest the need for interventions based on national dietary guidelines.
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References
1. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015 Jul;33(7):673-89. doi: 10.1007/s40273-014-0243-x.
2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017 Dec 16;390(10113):2627-2642. doi: 10.1016/S0140-6736(17)32129-3.
3. Ríos-Reyna C, Díaz-Ramírez G, Castillo-Ruíz O, Pardo-Buitimea NY, Alemán-Castillo SE. Políticas y estrategias para combatir la obesidad en Latinoamérica. Rev Med Inst Mex Seguro Soc. 2022 Oct 25;60(6):666-674.
4. Pajuelo J, Miranda-Cuadros M, Campos-Sánchez M, et al. Prevalencia de obesidad abdominal en adultos peruanos. Rev Peru Med Exp Salud Publica. 2019;36(4):589-595.
5. Instituto Nacional de Estadística e Informática (INEI). Encuesta Demográfica y de Salud Familiar (ENDES) 2024. Lima: INEI; 2025.
6. World Health Organization (WHO). Noncommunicable Diseases Country Profiles – WHO Global Report. Geneva: WHO; 2018. 312 p.
7. Rivera-Dommarco J, Colchero MA, Fuentes ML, et al. La obesidad en México: estado de la política pública y recomendaciones para su prevención y control. Cuernavaca: Instituto Nacional de Salud Pública; 2012.
8. Wirth MD, Burch JB. Inflammatory potential of the diet: role of circadian rhythms and sleep. In: Hébert JR, Hofseth LJ, editors. Diet, Inflammation, and Health. London: Academic Press; 2022. p. 747-785.
9. Phillips CM, Chen LW, Heude B, Bernard JY, Harvey NC, Duijts L, Mensink-Bout SM, Polanska K, Mancano G, Suderman M, Shivappa N, Hébert JR. Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review. Nutrients. 2019;11(8):1873. doi: 10.3390/nu11081873.
10. Neale, EP; Batterham, MJ; Tapsell, LC. 2016. Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis. Nutrition Research, 36(5): 391–401, doi: 10.1016/j.nutres.2016.02.009.
11. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17(8):1689-98, doi: 10.1017/S1368980013002115.
12. Li J, Lee DH, Hu J, Tabung FK, Bhupathiraju SN, Rimm EB, et al. Dietary inflammatory potential and risk of cardiovascular disease among men and women in the U.S. J Am Coll Cardiol. 2020;76(19):2181-93, doi: 10.1016/j.jacc.2020.09.535.
13. Yi Q, Li Q, Zhao Y, Lin Q, Yang X, Han X, et al. Association between dietary inflammatory index and obesity in adults with and without disabilities: results from NHANES 2011-2018. Front Nutr. 2024;11:1340657, doi: 10.1111/ijcp.14567.
14. Oliveira TMS, Bressan J, Pimenta AM, Martínez-González MÁ, Shivappa N, Hébert JR, Hermsdorff HHM. Dietary inflammatory index and prevalence of overweight and obesity in Brazilian graduates from the Cohort of Universities of Minas Gerais (CUME project). Nutrition. 2020;71:110635, doi: 10.1016/j.nut.2019.110635.
15. Villaverde P, Rivera-Paredez B, Argoty-Pantoja AD, Velázquez Cruz R, Salmerón J. Dietary Inflammatory Index and Blood Pressure Levels in Mexican Adults. Nutrients. 2024;16(18):3052. doi: 10.3390/nu16183052.
16. Carvalho CA, Silva AAM, Assunção MCF, Fonseca PCA, Barbieri MA, Bettiol H, Shivappa N, Hébert JR. The dietary inflammatory index and insulin resistance or metabolic syndrome in young adults. Nutrition. 2019;58:187-193. doi: 10.1016/j.nut.2018.07.014.
17. Zuercher MD, Harvey DJ, Au LE, Shadyab AH, Santiago-Torres M, Liu S, Shivappa N, Hébert JR, Robbins JA, Garcia L. Energy-Adjusted Dietary Inflammatory Index and Diabetes Risk in Postmenopausal Hispanic Women. J Acad Nutr Diet. 2024;124(11):1431-1439. doi: 10.1016/j.jand.2023.08.002.
18. Ministerio de Salud (MINSA). Instituto Nacional de Salud. Centro Nacional de Alimentación y Nutrición. Informe técnico Vigilancia de la situación del sobrepeso, obesidad y sus determinantes en el marco del Observatorio de Nutrición y estudio del sobrepeso y obesidad - Primer semestre 2025. Lima: INS; 2025.
19. Ministerio de Salud (MINSA). Instituto Nacional de Salud (INS). Informe técnico de la Vigilancia Alimentaria y Nutricional por Etapas de Vida: Adultos 2017-2018. Lima: INS; 2022. 191 p.
20. Ministerio de Salud (MINSA). Instituto Nacional de Salud (INS). Tabla Peruana de Composición de Alimentos. Lima: INS; 2019.
21. Ahuja JK, Montville JB, Omolewa-Tomobi G, Heendeniya KY, Martin CL, Steinfeldt LC, et al. USDA Food and Nutrient Database for Dietary Studies, 5.0. Beltsville, MD: Agricultural Research Service, Food Surveys Research Group; 2012
22. Rothwell JA, Perez-Jimenez J, Neveu V, Medina-Remon A, M'Hiri N, García-Lobato P, et al. Phenol-Explorer 3.0: a major update of the Phenol-Explorer database to incorporate data on the effects of food processing on polyphenol content. Database (Oxford). 2013;2013:bat070.
23. Organización Mundial de la Salud (OMS). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894: i-xii,1-253.
24. Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13(3):275-86, doi: 10.1111/j.1467-789X.2011.00952.x.
25. Ramallal R, Toledo E, Martínez-González MA, Hernández-Hernández A, García-Arellano A, Shivappa N, et al. Inflammatory potential of diet, weight gain, and incidence of overweight/obesity: The SUN cohort. Obesity (Silver Spring). 2017;25(6):997-1005, doi: 10.1002/oby.21833.
26. Ruiz-Canela M, Zazpe I, Shivappa N, et al. Dietary inflammatory index and anthropometric measures of obesity in a population sample at high cardiovascular risk from the PREDIMED (PREvención con DIeta MEDiterránea) trial. Br J Nutr. Mar 28 2015;113(6):984-95, doi: 10.1017/S0007114514004401.
27. Shivappa N, Bonaccio M, Hebert JR, et al. Association of proinflammatory diet with lowgrade inflammation: results from the Moli-sani study. Nutrition. 2018;54:182-188, doi: 10.1016/j.nut.2018.04.004.
28. Alkerwi Aa, Shivappa N, Crichton G, Hébert JR. No significant independent relationships with cardiometabolic biomarkers were detected in the Observation of Cardiovascular Risk Factors in Luxembourg study population. Nutrition research (New York, NY). 2014;34(12):1058-1065. doi:10.1016/j.nutres.2014.07.017.
29. Kord Varkaneh H, Fatahi S, Tajik S, Rahmani J, Zarezadeh M, Shab-Bidar S. Dietary inflammatory index in relation to obesity and body mass index: a meta-analysis. Nutr Food Sci. 2018;48(5):702–21, DOI: https://doi.org/10.1108/NFS-09-2017-0203.
30. Wang Y, Armijos RX, Weigel MM. Dietary inflammatory index and cardiometabolic risk in Ecuadorian women. Nutrients. 2024;16(8):1234. doi:10.3390/nu16081234.
31. Nouri-Majd S, Salari-Moghaddam A, Keshteli AH, Esmaillzadeh A, Adibi P. Dietary Inflammatory Potential in relation to General and Abdominal Obesity. Int J Clin Pract. 2022;2022:5685249. doi: 10.1155/2022/5685249.
32. Farhangi MA, Vajdi M. The association between dietary inflammatory index and risk of central obesity in adults: An updated systematic review and meta-analysis. Int J Vitam Nutr Res.2020;90(5-6):535-552. doi:10.1024/0300-9831/a000648.
33. Hariharan R, Odjidja EN, Scott D, Shivappa N, Hébert JR, Hodge A, de Courten B. The dietary inflammatory index, obesity, type 2 diabetes, and cardiovascular risk factors and diseases. Obes Rev. 2022;23(1):e13349. doi: 10.1111/obr.13349.
34. Crovetto M, Valenzuela M, Arruda N. Descripción de la progresión de la obesidad y enfermedades relacionadas en Chile. Rev Med Chil. 2019;147(9):1114-23. doi: http://dx.doi.org/10.4067/s0034-98872019000901114
35. Shamah-Levy T, Romero-Martínez M, Barrientos-Gutiérrez T, Cuevas-Nasu L, Gaona-Pineda EB, Gómez-Humarán IM, et al. Encuesta Nacional de Salud y Nutrición 2020 sobre Sobrepeso y Obesidad: Prevalencia en población adulta. Cuernavaca: Instituto Nacional de Salud Pública; 2021. Disponible en: https://ensanut.insp.mx/encuestas/ensanutcontinua2020/doctos/informes/Adultos_2020.pdf.
36. World Health Organization (WHO). Healthy diet. WHO Fact Sheet No. 394. Geneva: WHO; 2015. Disponible en: http://www.who.int/mediacentre/factsheets/fs394/en/.
37. Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet. 2002 Jan 19;359(9302):248-52. doi: 10.1016/S0140-6736(02)07451-2.
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